Cystic acne is difficult to treat, regardless of a patient's age. There are treatments that are both fast and aggressive, but they might not yield long-term results. If you want to take action against severe forms of acne that cause cysts and nodules, a doctor's help is necessary.
Who Gets Adult Acne?
Fluctuating hormones that cause excess oil production are a large factor in acne, so women are more prone to adult acne than men. Adult acne, or "persistent acne," can last until an adult is in the 30s, 40's, 50s, and even longer. Adults can also develop late-onset acne. Both types of adult acne often cause deep nodules around the lower face--along with jawline, around the mouth and on the chin--but acne can also occur anywhere on the body, such as the chest or back.
Treatment of Individual Cysts
Adult acne cysts can be treated individually in a doctor's office by surgical drainage or by injecting the cyst with a dilute corticosteroid, which dissolves it within three to five days. These fast treatments might be a helpful when a cyst is likely to rupture and cause scarring, but they won't prevent future cysts from forming.
The Most Effective Treatment
The most aggressive treatment for cystic acne is an oral medication called isotretinoin, which is taken once or twice a day for 16 to 20 weeks. This drug is a retinoid that is derived from vitamin A, which is also used in topical retiniod creams. This form of treatment is highly effective in treating cystic acne, as it targets all causes of acne: bacteria, excess oil production, clogged pores and inflammation. Most patients only require one round of isotretinoin to resolve cystic acne, although some may require an additional treatment. Isotretinoin has predictable side-effects. Adult patients may note that acne gets worse in the first few weeks of treatment before it resolves. Dry eyes and skin are also common, so use of lotions and creams and lubricating eye drops may be necessary to relieve temporary discomfort.
Isotretinoin use harms developing fetuses, so women of child-bearing age must use two forms of birth control and undergo routine pregnancy testing during treatment, as well as sign up for the U.S. Food & Drug Administration's iPledge monitoring program. Women who are pregnant or who plan to get pregnant aren't good candidates for isotretinoin. This medication can also cause blood sugar levels to rise in diabetic patients and can result in severe side effects, such as liver problems, hearing loss, and depression or suicidal thoughts. Patients who choose isotretinoin must be carefully monitored by a physician during the course of treatment.
Any Other Treatments?
For some adult patients, use of broad-spectrum antibiotics can curb cystic acne. However, there is the danger that the bacteria in the acne will become resistant to a specific antibiotic, and this necessitates switching to a different antibiotic. Women may get relatively fast results simply by using birth control pills in conjunction with a synthetic steroid called spironolactone.