Acner.org: Acne treatment

Acner.org: Acne treatment

How to Get Rid of Cystic Pimples

How to Get Rid of Cystic Pimples How to Get Rid of Cystic Pimples

Overview

Cystic acne is a more severe type of acne that is characterized by large cysts deep under the skin that can become infected, swollen, red and painful. Unlike whiteheads or blackheads, the infection does not rise to the surface, making them much harder to get rid of. In many cases, cystic pimples can leave scars. Your dermatologist can prescribe medication to treat this form of acne, but there are some things you can do at home to relieve swelling, reduce redness and help make the pimple heal faster.

Cystic acne treatments

Benzoyl peroxide

Benzoyl peroxide is a first-line treatment for mild and moderate acne vulgaris due to its effectiveness and mild side-effects (primarily an irritantdermatitis). It works against the "P. acnes" bacterium, and normally causes just dryness of the skin, slight redness, and occasional peeling when side-effects occur. This topical does increase sensitivity to the sun as indicated on the package, so sunscreen should be used during the treatment to prevent sunburn. Benzoyl peroxide has been found to be nearly as effective as antibiotics with all concentrations 2.5%, 5.0%, and 10% equally effective. Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial resistance.

Antibiotics

Antibiotics are reserved for more severe cases.With increasing resistance of P. acnes worldwide, they are becoming less effective.Commonly used antibiotics, either applied topically or taken orally, include erythromycin, clindamycin, and tetracyclines such asminocycline.

Hormones

In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen cyproterone in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestindrospirenone is now available with fewer side-effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low-dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

Topical retinoids

A group of medications for normalizing the follicle cell life-cycle are topical retinoids such as tretinoin (Retin-A), adapalene (Differin), andtazarotene (Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and, in general, have much milder side-effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death life-cycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar, but milder, effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use for over 30 years, but are available only on prescription, so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare-up of acne and facial flushing.

Oral retinoids

A daily oral intake of vitamin A derivative isotretinoin (marketed as Roaccutane, Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4–6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. 

The treatment requires close medical supervision by a dermatologist because the drug has many known side-effects (many of which can be severe). About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4–6 months may be indicated to obtain desired results. It is often recommended that one let a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. On occasion, a third or even a fourth course is used, but the benefits are often less substantial. The most common side-effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare-up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, it is recommended that patients have blood samples taken and examined before and during treatment. In some cases, treatment is terminated or reduced due to elevated liver enzymes in the blood, which might be related to liver damage. 

Others claim that the reports of permanent damage to the liver are unsubstantiated, and routine testing is considered unnecessary by some dermatologists. Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression, but, as of September 2005, there is no agreement in the medical literature as to the risk. The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Because of this, the drug is supposed to be given to females as a last resort after milder treatments have proven insufficient. Restrictive rules (see iPledge program) for use were put into force in the USA beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.

Anti-inflammatories

Nicotinamide, (vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin used for comparison. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin, and may also, according to a cosmetic company, be useful for reducing skin hyperpigmentation (acne scars), increasing skin moisture and reducing fine wrinkles.

Ibuprofen in combination with tetracycline are used for some moderate acne cases for their anti-inflammatory effects.

Mandelic acid has been noted to be an effective topical treatment for mild to moderate acne. It is considered to be a gentler alternative to popular alpha hydroxy acids, such as glycolic acid and lactic acid.

Procedures

Dermabrasion

Dermabrasion is a cosmetic medical procedure in which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or "twilight anaesthesia", in which the patient is still partly conscious. Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars.

In the past, dermabrasion was done using a small, sterilized, electric sander. In the past decade, it has become more common to use laser dermabrasion using CO2, Er:YAG laser or a combination of both for the treatment of acne scars. Indications for CO2 laser treatment include previous non erythematous and non-proliferative hypertrophic scars, atrophic acne scars and burn scars. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Phototherapy

Blue and red light

Light exposure has long been used as a short-term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405–420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64% and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light. Particularly when applied over several days, these free radicals ultimately kill the bacteria. Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been cleared for marketing by the U.S. FDA.

It seems that the treatment works even better if used with a mixture of the violet light and red visible light (660 nanometer), resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients; and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments, few if any negative side-effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer-lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.

Photodynamic therapy

In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405–425 nanometer) can decrease the number of inflammatory acne lesion by 60–70% in four weeks of therapy, in particular, when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and not published in a peer-reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.

Laser treatment

Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:

  • to burn away the follicle sac from which the hair grows
  • to burn away the sebaceous gland, which produces the oil
  • to induce formation of oxygen in the bacteria, killing them

Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.

The FDA has approved the use of a cosmetic laser for the treatment of acne. However, efficacy studies have used very small sample sizes for periods of six months or less, and have shown contradictory results. Also, laser treatment being relatively new, protocols remain subject to experimentation and revision, and treatment can be quite expensive. Also, some Smoothbeam laser devices had to be recalled due to coolant failure, which resulted in painful burn injuries to patients.

Step 1

Wet a small towel with hot water and let it cool just enough so it will not scald you.

Step 2

Apply the hot towel to the cystic pimple and let it sit for about 10 minutes.

Step 3

Use a facial steamer, if you have one, to further relax and open the area where you have the cystic pimple. After 10 minutes, turn the facial steamer off and pat the area dry.

Step 4

Apply drawing salve to the pimple and leave on overnight (unless the package instructs differently).

Step 5

Wash the area in the morning and pat dry. You may repeat the process again if you need to.

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