While milder forms of acne may be successfully treated by using good hygiene and over-the-counter topical treatments, cystic acne, which develops under the skin, is typically unresponsive to these methods. Cystic acne can cause severe scarring and disfiguration and requires a dermatologist's intervention.
The Best Treatment: Isotretinoin
Isotretinoin is a strong oral medication derived from vitamin A that is taken once or twice daily for between 16 and 20 weeks. This treatment works best for severe cystic acne because it eliminates all of the causes of acne: excess sebum production, clogged pores, bacteria and inflammation.
Patients may note an increase in acne during the first few weeks they take isotretinoin. During the course of treatment, dermatologists carefully monitor patients for possible adverse side effects. Most patients note complete resolution of cystic acne after only one round of isotretinoin, although some may require an additional round of therapy.
Isotretinoin causes birth defects in developing fetuses, and for that reason, its use is carefully monitored in women of child-bearing age. Before starting treatment, women must submit to pregnancy testing and agree to use two forms of birth control. Pregnancy testing is conducted throughout the course of treatment as well. Additionally, women are required to sign up with the U.S. Food & Drug Administration's iPLEDGE® monitoring program.
Not all patients will be good candidates for oral isotretinoin. It can cause increased sugar levels in diabetic patients, and in some cases, it can cause serious conditions such as liver problems, pancreatitis, hearing problems, or depression or suicidal thoughts. The decision to use isotretinoin should be made only after thorough consultation with a dermatologist.
While isotretinoin is the best treatment to resolve cystic acne, those who are not good candidates may have to rely on other treatment methods. Large cysts and those that become inflamed may be surgically drained in a physician's office. Cysts can also be injected with a dilute corticosteroid, which causes them to dissolve in three to five days.
A dermatologist may also prescribe a broad-spectrum antibiotic to fight the bacteria that causes the acne, such as doxycline, erythromycin, minocycline and tetracycline. Women may be prescribed birth control pills, which help curtail excess oil production. Patients can use this therapy for a long time, but it may be inappropriate for women who smoke, are older than 35, are prone to blood clots or have migraines. In some cases, use of a synthetic steroid called spironolactone is used in conjunction with birth control pills to achieve optimal results.