Cystic acne refers to deep, painful, pus-filled acne lesions that can cause scarring. The causes of cystic acne are linked to the overgrowth of certain microorganisms (Propionibacterium acnes) or from too much oil (sebum) on the skin. Other factors can promote clogging of pores as well, such as an accumulation of dead skin cells in hair follicle shafts.
Cystic acne causes may be genetic. If your parents had cystic acne, you are likely to get it too. Other causes of cystic acne may include stress and the use of medication or drugs which increase the levels of testosterone hormones and androgens in the body. This stimulates an increase in the production of sebum in the skin, promoting the multiplication of the Propionibacterium acnes bacteria on the skin.
Propionibacterium acnes or P.acnes for short, is a relatively slow-growing bacteria that is linked to acne. This bacteria lives on sebum, which are the fatty acids in the sebaceous glands at the base of hair follicles. People who have acne have more P.acnes than do people without this skin condition.
This bacteria can generate enzymes that degrade the skin, as well as proteins that elicit an immune response from the body. In other words, the presence of these bacteria on the skin attracts white blood cells to the follicle.
White blood cells consequently produce an enzyme that damages the wall of the follicle, allowing the follicle’s contents to enter the dermis. The result of this inflammation is the red bump that typically surrounds a pimple.
P.acnes also causes the formation of free fatty acids (a type of fat including triglycerides and phospholipids, typically found in the body at low concentrations) that irritate the skin, thereby increasing the inflammatory process in the follicle and further stimulating the formation of acne.
There is something about an acne infection with active P. acnes that makes the body react differently than it does to other types of infection from other organisms. For some reason, the body breaks down P. acnes more slowly than it breaks down other invaders. To make matters worse, the immune response magnifies the inflammatory process even more.
In severe acne, the inflammation is very intense and extends deep into the skin, with multiple nodules and cysts. An acne cyst is a sac filled with liquid or semi-liquid material, consisting of white blood cells, dead cells and bacteria (pus).
Cysts have a diameter of 5 mm or more and are usually present, together with nodules, in a severe form of acne known as nodulocystic acne.
Cystic acne lesions are usually scattered in common acne areas.
Nodular acne consists of scattered nodules mostly concentrated on the face, chest, and/or back. The acne lesions may merge to form larger confluent lesions and pus-filled tracts.
Both nodules and cysts can be very deep and painful and last for months. Bleeding and the discharge of pus is common. Crater-like scarring is often the end result.
Cysts tend to be recurrent in the same spot, and you may notice that they increase and decrease in size over time. Avoid picking or squeezing, as this makes the area redder and more prone to having a brown mark or depressed scar left behind. It definitely does not stop the pimple or cyst from coming back in the same place the next time.
Regardless of what the cause of cystic acne is, over-the-counter acne treatment is generally ineffective in such cases. As there is great risk of scarring in both nodulocystic and cystic acne, be sure to seek early medical advice and treatment.