Every guy has sprouted a zit at one time or another. But what about when your acne is more than just a lone pimple or two?
The most severe form of acne is called cystic acne, and it refers to the big, red, pus-filled cysts that develop deeper in your skin than the more superficial breakout. Because they’re inflammatory, the lesions can be tender and painful to the touch, too. Plus, they tend to be larger than the typical zit, often reaching the size of a pencil eraser or larger, according to the American Academy of Dermatology (AAD).
Cystic acne pops up when oil, skin cells, or bacteria plug up your hair follicles, and the immune system rushes in to clean it up, says dermatologist Valerie Goldburt, M.D. The bacteria can also cause infections.
Cystic acne is especially common in men because testosterone spurs its growth, says dermatologist Judith Hellman, M.D.
Aside from their appearance, cystic acne lesions can also leave permanent scars, says Dr. Goldburt. So treating them requires more than treating typical zits.
The over-the-counter benzoyl peroxide and salicylic acid creams often used to treat regular acne don’t usually work for cystic acne, she says. That means a trip to your dermatologist is in order if you have deep breakouts underneath the skin that don’t respond to drugstore treatment.
You might be prescribed antibiotics, but cystic acne sometimes pops back up after antibiotics are stopped.
In that case, if the acne doesn’t clear up after a few months, you might want to consider a more serious treatment like Accutane (Isotretinoin), which is a vitamin A derivative. The oral pill hits four root causes of acne: too much oil production, too much acne-causing bacteria, clogged pores, and inflammation, according to the AAD.
About 85 percent of people will see their skin clear up from a four-to-five month course of Accutane, the AAD says, but it can cause side effects: These include depression, headache, blurred vision, dry eyes, chapped lips, and trouble seeing in the dark (Accutane can also cause severe birth defects in women, too).
If you don’t want to try Accutane, your doctor may prescribe laster treatment or Fractora, a microneedling device that works like lasers, says Dr. Hellman.
To help the process along, Dr. Hellman recommends Neutrogena salicylic acid acne wash and Dr. Murad advises glycolic acid wipes and creams. And resist the urge to pop your pimples—it’ll make scarring more likely.
By Suzannah Weiss