DEAR DR. GOTT: My daughter is 18 years old. She has swelling in her left cheek that is now moving into her eye. Her dermatologist says it’s cystic acne. We tried tetracycline and erythromycin, to no avail. What can we do? Your help would be appreciated.
DEAR READER: Let’s start with some basic facts about acne. First, despite popular belief, acne can occur to anyone at any age but is most common in teenagers. Because of this, it is thought that hormones may play a role. For some women, the week prior to menstruation, pregnancy or starting/stopping birth control may also cause outbreaks.
When pores that contain hair follicles become plugged by an overproduction of oil, a buildup of bacteria and/or irregular shedding of dead skin cells, acne can occur. It primarily affects the face, shoulders, back, neck and chest because these areas have the greatest number of functional oil glands.
There are five types of lesion associated with acne.
– Papules are small, raised bumps that may be red and tender, and typically signal inflammation or infection of the opening of the hair follicle.
– Nodules are large, solid lumps beneath the surface of the skin and may be painful, indicating infection deep within the hair follicles.
– Pustules are red, tender, pus-filled lesions.
– Comedones occur when the hair follicle becomes plugged by oil and dead skin. When the pore is open, the plug becomes dark and is referred to as a blackhead. When the pore is closed, the lesion is referred to as a whitehead because it remains flesh-colored.
– Cysts are pus-filled lumps beneath the skin that are often painful. They are boil-like and are the most likely form to cause scarring. Because of this, cystic acne is the most severe form of acne and the hardest to treat.
In most cases, a physician doesn’t need to treat acne. If the lesions resist over-the-counter remedies, cover a large area, or are adversely affecting your social interactions or self-esteem, referral to a dermatologist may be beneficial.
There are several over-the-counter remedies. Most are topical lotions or ointments. These may contain salicylic or lactic acid, sulfur, resorcinol or benzoyl peroxide as the active ingredient. Their primary purpose is to dry oil and aid the removal of dry skin. Some prescription topicals work similarly to OTC products but are more potent, while others include topical retinoids and antibiotics. Antibiotics (oral and topical) are used to treat infection that may be present and are most commonly used by those with moderate to severe forms. Topical ointments are often used simultaneously. Oral contraceptives can be considered, especially if menstrual-cycle irregularities are also present. Chemical peels and microdermabrasion may be helpful. Laser and light therapies may be recommended for people who can’t tolerate acne medications.
When cystic forms do not respond well to other options, isotretinoin may be considered. It is highly effective but carries some potentially serious side effects, so users must be closely monitored. Women of reproductive age must participate in an FDA-approved monitoring program in order to receive the drug because of the high risk of birth defects should the woman become pregnant. These effects can last for several weeks after stopping treatment.
Home remedies and prevention include using a mild cleanser and warm water to wash the affected areas no more than twice a day. Scrubbing or using strong cleansers may worsen the condition. Avoid touching the areas, using oily or greasy cosmetics or sunscreens, and picking or squeezing the lesions. Remove all makeup before bed, keep applicators clean, and don’t use outdated products. If the back, chest and/or shoulders are affected, avoid wearing tightfitting clothing.
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