Cystic acne is generally treated by a dermatologist and not a general physician. The treatment of cystic acne may require a lot of patience and compliance to therapy. The results are not always immediate and one should not lose faith in the therapy.
The treatment of cystic acne involves:
Antibiotics: Some times the individual will be started on a long term course of a tetracycline to control the infection. This is long term therapy for 3-4 months. If the acne is still showing no signs of improvement, the next step is to start Isotretinoin.
Isotretinoin: This medication needs to be taken twice a day for at least 3-4 months. Isotretinoin acts by decreasing the size of the oil glands and significantly decreases the sebum production. The drug also stops the enlargement of the cystic glands and prevents the development of comedones. The results of Isotretinoin are not immediate and one should remain patient. The majority of individuals will show a reduction in the symptoms of acne and improvement of the facial features.
Topical Isotretinoin is not useful in the treatment of cystic acne. It may be applied but rarely proves to be effective.
Some individuals will require a slightly longer treatment phase ranging from 4-6 months.
For some individuals maintenance therapy with low dose tretinoin is required to maintain the clear face.
Isotretinoin does clear the cystic acne, but unfortunately it does not always prevent the development of scars.
Disadvantages of Isotretinoin
- the drug is expensive
- can cause excessive drying of the skin
- can cause itching
- can cause sun sensitivity and skin burns
May cause elevation of triglycerides and blood cholesterol.
Elevation in liver enzymes
Because the drug does cause elevation in these parameters, it is essential that routine blood work is done to monitor the degree of elevation of these biochemical products. In some cases, the Isotretinoin must be stopped.
Teratogenic: Isotretinoin is known to cause birth deformities when taken during pregnancy. The FDA mandates a registry of all women who take this drug. It is crucial that all women of child bearing age be given full advice on this drug before a prescription is given. There have been numerous litigations with the drug manufacturers and physicians who prescribe this drug. When the drug is stopped, it is recommended that the women do not get pregnant for another 3 years
Once the cystic acne is cleared, continuous follow up with a dermatologist is recommended and there are many methods which may help clear up the residual acne scars