Cystic lesions, also known as acne, are solid blockages that form in clogged hair follicles due to the accumulation of excess oil, dead skin cells, and bacteria. Acne may manifest in varying degrees and affect individuals of any age or skin type. Treatment for cystic lesions usually involves the use of either over-the-counter or prescription medications, depending on the severity and prominence of the lesions. Individuals who experience scarring due to severe acne may pursue corrective measures to improve their skin's appearance.
There are three known elements that may contribute to the formation of cystic lesions. Oil, dead skin cells, and bacteria may combine to block pores in the skin, and these blockages may manifest as irritated, inflamed lumps, or cysts, just under the skin's surface. The excess production of sebum, or oil, combined with an accumulation of dead skin cells can also cause hair follicles to become clogged, leading to the development acne. It has been asserted that increased sebum production may be induced by fluctuations in hormone levels, heredity, or the presence of bacteria. There is ongoing dispute within the research community as to whether or not diet contributes to the development of acne.
Individuals with acne usually experience breakouts on their neck, face, shoulders, and back. Breakouts are usually confined to these areas due to the high concentration of oil glands in these locations. Acne doesn't always manifest as inflamed, raised bumps on the skin. Cystic lesions may manifest in varying degrees.
Comedones are mild blockages that appear close to the surface as whiteheads and blackheads. Papules and pustules are inflamed areas that signal the presence of infection or irritation in a hair follicle, may contain pus, and may be tender to the touch. Nodules and cysts are larger blockages within hair follicles, form deeper in the skin, and contain pus. Larger cysts are solid in composition, painful to the touch, and have the potential to scar.
Individuals with severe acne may seek professional medical advice for treating persistent breakouts that do not respond to over-the-counter treatments. During an office visit, a physician may take a complete medical history, ask a series of questions about the frequency and severity of breakouts, and perform a preliminary examination. The individual may then be referred by his or her physician to a dermatologist.
Treatment for cystic lesions is centered on four objectives: reducing oil production, preventing and fighting bacterial infection, advancing cell turnover, and alleviating inflammation. Any treatment regimen may take up to eight weeks to begin alleviating symptoms. Over-the-counter (OTC) treatments are generally mild in chemical composition and promote the shedding of dead skin cells, the drying of oils within the skin, and the eradication of bacteria. Side effects associated with OTC treatments may include skin irritation, flaking of the skin, and an initial worsening of symptoms.
For those individuals unable to find relief with over-the-counter treatments, prescription medications may be the next step. Dermatologists often recommend the use of either an oral or topical acne medication. The use of oral acne medications may reduce the effectiveness of oral contraceptives and should not be used by women who are pregnant or may become pregnant.
Individuals with moderate to severe acne may be prescribed an antibiotic to fight infection and alleviate skin redness and irritation. An isotretinoin may be recommended for individuals with severe cystic acne. Use of antibiotics and isotretinoins may induce side effects that may include increased skin sensitivity, muscle aches, and an excessive drying of the mouth, lips, eyes, and nose. Women with moderate to severe acne may be prescribed an oral contraceptive to alleviate their acne symptoms, however, an increased risk for heart attack, blood clot, and stroke may accompany oral contraceptive use.
Prescription topical medications work by preventing the clogging of hair follicles and advancing cell regeneration. Individuals may also be prescribed topical antibiotic medication to be used in combination with other topical medications. Those who use a prescription topical medication may experience side effects that may include increased skin sensitivity, excessive drying of the skin, and a temporary worsening of symptoms.
Laser and light therapies may be pursued to target oil production and bacteria to reduce inflammation, improve skin quality, and diminish scarring. Cosmetic procedures may also be performed to correct the scarring associated with severe acne. Procedures including dermabrasion, microdermabrasion, and collagen injections may be utilized to reduce the appearance of scarring and even skin tone. Severe cases may necessitate surgical scar correction, known as punch excision, which involves the cutting away of acne scars which are then closed with either a skin graft or sutures.