Cystic acne treatment: A comprehensive review
Abstract
Acne, a common skin condition, is primarily seen in teenagers and young adults and is characterised by large pus-filled bumps beneath the skin. Cystic acne is a common form and is linked to a high incidence of acne-related skin diseases. Causes include age, sex, and lifestyle changes. Treatment options for severe acne include medications, laser therapy, chemical peels, and microneedling patches. This review focuses on cystic acne treatment options and discusses their advantages and disadvantages. Medications like isotretinoin reduce inflammation but have side effects. Laser therapy targets bacteria without medication but may require multiple sessions for optimal results.
1 BACKGROUND
Cystic acne is a severe form of acne that can cause painful, inflamed cysts deep beneath the skin surface. This condition often leaves scars and significantly impacts a person's self-esteem and overall well-being [1]. Treatment options for cystic acne include topical medications, oral medications, and alternative therapies. Topical medications, such as retinoids and benzoyl peroxide, work by unclogging pores and reducing inflammation [2]. Oral medications, such as antibiotics and oral contraceptives, may be necessary for more severe cases. Alternative therapies, such as laser therapy and chemical peels, can also be effective in treating cystic acne by targeting the underlying causes of the condition [3-5]. It is important for individuals with cystic acne to consult with a dermatologist to determine the most suitable treatment plan based on their specific needs and the severity of the condition. In addition to medication, alternative therapies such as blue light therapy or chemical peels may be considered. It is essential to work closely with a dermatologist to develop an individualised treatment plan for cystic acne [6]. The dermatologist will assess the severity of the acne and recommend the most appropriate course of treatment. They may combine different medications and therapies to effectively manage the condition. Dermatologists may also provide guidance on proper skincare routines and lifestyle changes that can help improve the condition [7]. It is important for patients to follow the recommended treatment plan consistently and communicate any concerns or changes in their symptoms to their dermatologist for adjustments if needed. It is crucial to follow the prescribed treatment plan consistently and be patient, as it may take several weeks or months to see significant improvement [8]. Regular follow-up appointments with the dermatologist will ensure that the treatment is working effectively and can be adjusted if needed. Additionally, the dermatologists may advise making certain lifestyle changes to help improve the condition, such as maintaining a healthy diet, practicing good skincare hygiene, and avoiding triggers such as excessive sun exposure or stress [9]. In some cases, the dermatologist may also suggest certain procedures, such as corticosteroid injections or laser therapy, to target stubborn cysts. It is important to follow up with the dermatologist regularly to monitor progress and discuss any concerns or side effects that may arise from the treatment. Moreover, the dermatologists can provide guidance on proper skincare routines and recommend suitable over-the-counter products to complement the treatment plan [10]. With proper care and patience, cystic acne can be effectively managed, and significant improvement can be achieved. Maintaining a consistent skincare routine, using gentle cleansers, avoiding harsh exfoliants, and applying non-comedogenic moisturisers, as well as adopting a healthy lifestyle by eating a balanced diet, exercising regularly, and managing stress levels, can contribute to the overall improvement of cystic acne [11]. Regarding professional help from a dermatologist, they can prescribe medications such as topical or oral antibiotics, retinoids, or hormonal treatments to target the root causes of acne. It is important to follow their instructions and attend regular check-ups to monitor progress and make necessary adjustments to the treatment plan. With patience and persistence, it is possible to control and minimise the impact of cystic acne on your skin [8]. Dermatologists can offer various treatments to reduce the appearance of acne scars that may result from cystic acne, such as chemical peels, microneedling, or laser therapy. They can monitor the progress of the treatment and make necessary adjustments to ensure optimal results [12]. With their expertise and support, individuals can regain their confidence and enjoy a smoother complexion. Cyclic acne treatment is discussed in this review.
2 MAIN TEXT
2.1 Whiteheads
Whiteheads, also known as “closed comedones” are a common form of acne caused by clogged pores with oil, dead skin cells, and bacteria. These small, white bumps on the skin can be treated with over-the-counter medications like benzoyl peroxide or salicylic acid. However, if whiteheads persist or worsen, it may be necessary to consult a dermatologist for further treatment options [13]. Pus fills the blocked pore, making it appear white due to the presence of pus. Dermatologists can easily extract whiteheads, and they are typically painless. It is important to avoid picking or squeezing whiteheads as this can lead to further inflammation and potential scarring [14].
2.2 Blackheads
Blackheads are a common type of acne caused by clogged pores with excess oil and dead skin cells. They are often found on the nose, the forehead, and chin and are generally easier to treat than whiteheads. Regular exfoliation and topical creams with retinoids or salicylic acid can help unclog pores and reduce the appearance of blackheads. Professional extraction by a dermatologist may be necessary for stubborn blackheads [15-17]. The extraction involves using a special tool to manually remove blackheads, which can be more effective in cases where home remedies have failed. It is important to note that squeezing or picking at blackheads can lead to further inflammation and scarring, so it is best to leave the extraction to a trained professional. Dermatologists may also recommend prescription drugs to control blackheads and stop future breakouts [18]. Maintaining a consistent skincare routine, including gentle cleansing and moisturising, is crucial to keeping pores clean and preventing the formation of new blackheads. Consistently following a skincare routine and seeking professional help can help maintain a clearer complexion. However, individual skin types and responses to skincare routines can vary greatly, and some individuals may still experience new blackheads due to factors such as hormonal changes, genetics, or environmental factors [19]. Blackheads, also referred to as “open comedones” are the result of clogged pores that leave clusters of oil and dead skin cells exposed to the air. Oxygen causes a darkening of the hue and overall appearance of clogs.
2.3 Papules
Papules are small red bumps that occur when pores break down due to inflammation. Hormonal imbalances, particular medications, or a genetic predisposition can all be causes. Hormonal imbalances, such as during puberty or menstruation, can lead to increased oil production and clogged pores, making individuals more susceptible to papules [20]. Certain medications, such as corticosteroids or lithium, can alter the balance of hormones or cause skin inflammation. Genetics also plays a role in determining an individual's susceptibility to papules, as some people may naturally have more sensitive or acne-prone skin [21]. Understanding and managing these factors can help individuals prevent and effectively treat papules. In addition to hormonal imbalances, lifestyle choices can increase the likelihood of developing papules [22]. A diet high in processed foods and sugar can lead to hormonal imbalances and inflammation, which can manifest as papules on the skin. Poor skincare habits, such as not properly cleansing or exfoliating the skin, can contribute to the buildup of dirt and oil, further exacerbating the formation of papules. During puberty, teenagers may experience an increase in papules due to hormonal changes [23]. Good skincare habits, such as regularly cleansing the face and using non-comedogenic products, can help minimise oil production and reduce the occurrence of papules. However, some individuals with seemingly healthy skin and good skincare habits still experience persistent papules due to underlying medical conditions or genetic predispositions. Environmental factors, such as pollution or high humidity levels, can also contribute to the development of papules (Figure 1). Hormonal imbalances can also play a role in the formation of papules, as fluctuations in hormone levels can stimulate excess oil production and lead to clogged pores [24]. It is crucial to avoid squeezing or picking acne papules to prevent the spread of bacteria and potential scarring. Seeking professional guidance from a dermatologist will ensure a tailored approach to effectively managing and treating persistent papules [25].
Acne is caused by a variety of natural factors.
2.4 Pustules
Pustules are a type of acne lesion that can be found on the skin, similar to papules. Even though they are the result of excessive oil production and clogged pores, pus makes them distinct [26]. Avoid picking or squeezing pustules because they have a white or yellowish centre and red, inflamed skin around them in order to avoid spreading infection and leaving scars. Consult a dermatologist for proper diagnosis and treatment options. They may recommend topical treatments such as benzoyl peroxide or retinoids to reduce inflammation and clear up pustules [27]. In some cases, oral antibiotics may be prescribed to target the underlying bacteria causing the infection. Maintaining a consistent skincare routine with gentle cleansing and moisturising can prevent future breakouts and promote overall skin health. Pustules can be effectively managed and minimised by following the dermatologist's advice and avoiding harsh products [28]. However, oral antibiotics may not effectively target the bacteria causing breakouts due to antibiotic resistance. This can result in acne persisting despite following the recommended skincare routine. In such cases, alternative treatments may be needed, such as topical medications or stronger antibiotics. Pustules are the classic acne lesions with a white or yellowish crown above red, inflamed nodules [29].
2.5 Nodules
Nodules are deep, painful bumps under the skin that can take weeks or months to heal. They are frequently resistant to topical treatments and can result in severe acne [30]. Dermatologists may recommend injecting corticosteroids directly into the nodules to reduce inflammation and promote healing. Consult a dermatologist to determine the best treatment plan for nodules as they can leave behind scars if not properly treated. Other treatment options include oral medications such as antibiotics or isotretinoin, which can control the underlying causes of nodules and prevent further breakouts [31]. These medications reduce oil production, decrease inflammation, and target bacteria that contribute to acne development. However, it is crucial to discuss the potential side effects and risks with a dermatologist before starting any treatment regimen. Severe nodular acne may be prescribed isotretinoin, a powerful oral medication that shrinks oil glands, reduces inflammation, and eliminates acne-causing bacteria [32]. However, due to its potential for serious side effects such as birth defects and depression, patients should have thorough discussions with their dermatologist to weigh the benefits against the risks before starting treatment. Acne nodules are a severe form of the disease that is notoriously difficult to cure [33]. They appear like papules but originate in the skin's deeper layers, making them slow to cure and nearly impossible to burst. The “heads” of nodules are fleshy or ruddy, tough to the touch, and cause pain.
2.6 Cysts
Cystic acne is a severe form of acne characterised by large pus-filled bumps beneath the skin, which can be painful and leave deep scars if not treated properly. Patients should consult with a dermatologist to explore the best treatment options, which often require a combination of medications and procedures [34]. Common treatment options include oral antibiotics, topical creams and gels containing retinoids or benzoyl peroxide, and hormonal therapy for women. In severe cases, dermatologists may recommend drainage and extraction of cysts, corticosteroid injections to reduce inflammation, or isotretinoin, a powerful oral medication with potential side effects [35]. Patients must follow their dermatologist's guidance and adhere to the prescribed treatment plan to achieve the best possible outcome and prevent further scarring. Both conditions can be unpleasant and sensitive. It is important for individuals with acne or rosacea to maintain a gentle skincare routine and avoid harsh products that can further irritate the skin [36]. Additionally, adopting healthy lifestyle habits such as managing stress levels, eating a balanced diet, and protecting the skin from excessive sun exposure can also contribute to managing these conditions effectively [37].
3 ACNE TREATMENT
A consistent skincare routine is crucial for managing acne, involving cleansing, moisturising, and exfoliating to keep the skin clear and prevent further breakouts. Avoiding harsh scrubbing or over-exfoliation can irritate the skin and worsen acne [24]. An oil-free moisturiser can maintain hydration without clogging pores after using a gentle cleanser with salicylic acid to combat excess oil and prevent breakouts on oily skin. Chemical exfoliants with glycolic acid can also be used once a week to remove dead skin cells and prevent clogged pores [29]. Additionally, it is important to protect the skin from sun damage by using a broad-spectrum sunscreen with at least SPF 30. Sunscreen helps prevent the darkening of acne scars and reduces the risk of skin cancer [19]. It is also advisable to avoid touching or picking acne as this can introduce bacteria and lead to further inflammation. However, not all individuals with oily skin will benefit from using salicylic acid. Some may experience increased dryness and irritation, leading to further inflammation and breakouts. In such cases, exploring alternative skincare ingredients or consulting a dermatologist for personalised advice may be necessary [27]. It is essential to recognise that salicylic acid may not be suitable for everyone with oily skin as it can cause dryness and irritation, potentially worsening their condition. It is important to consider individual skin sensitivities and reactions before incorporating salicylic acid into a skincare routine [34]. Additionally, maintaining a consistent skincare regimen that includes gentle cleansing and moisturising can help balance oily skin without relying solely on salicylic acid.
3.1 Topical medications for acne
Salicylic acid-containing skincare products should be used cautiously and under the guidance of a dermatologist, especially for individuals with sensitive or easily irritated skin. Alternative ingredients like benzoyl peroxide or tea tree oil can effectively target acne without causing excessive dryness or irritation [23]. Prioritising skin health and balance is crucial when selecting skincare products. A holistic approach to skincare involves considering factors such as individual skin type, concerns, and preferences to find suitable products that address acne while maintaining overall skin health [28]. Consulting with a dermatologist can provide valuable insights and personalised recommendations based on an individual's specific needs. The oily skin with acne may benefit from using a facial cleanser containing salicylic acid to unclog pores and prevent breakouts [15]. A lightweight, oil-free moisturiser can also be used to hydrate the skin without adding excess oil. Consulting with a dermatologist is essential for determining the best combination of products and treatments to address specific concerns and achieve long-term results [13]. However, not all individuals with oily skin and acne will benefit from using salicylic acid cleansers. Some individuals may have a sensitivity or allergy to salicylic acid, which can lead to irritation and breakouts. In such cases, using products with benzoyl peroxide or sulphur may be more effective. Consulting with a dermatologist is crucial as they can provide personalised recommendations based on an individual's specific skin type and concerns [16].
3.2 Retinoid and retinoid-like drugs
Retinoids are commonly used to treat oily skin and acne, working to unclog pores, reduce inflammation, and promote skin cell turnover. However, they can also cause dryness and irritation, especially in sensitive individuals [18]. To minimise side effects, it is crucial to use retinoids as directed and start with a lower concentration. Dermatologists can guide individuals in selecting the right retinoid or retinoid-like drug and developing a skincare routine that suits their needs [8]. In addition to retinoids, benzoyl peroxide is another option for treating acne. It kills bacteria that contribute to acne, but it can cause dryness and irritation. Salicylic acid is another commonly used treatment that can be used in combination with other treatments for more effective results [3]. For mild-to-moderate acne, a benzoyl peroxide cleanser in the morning and a salicylic acid toner in the evening can help kill bacteria, exfoliate the skin, and prevent clogged pores, resulting in clearer, healthier skin [1]. However, not everyone will experience the same results with this combination of treatments. Some individuals may have sensitive skin and cannot tolerate the harshness of benzoyl peroxide or salicylic acid, leading to excessive dryness, irritation, and breakouts [17]. It is essential to consult a dermatologist before starting any new acne treatment regimen to ensure that it is suitable for their specific skin type and condition. Alternative treatments are available for individuals with sensitive skin, and a dermatologist can provide personalised recommendations to avoid potential side effects and ensure effective acne treatment [33].
3.3 Antibiotics
Antibiotics are commonly prescribed for individuals who cannot tolerate benzoyl peroxide or salicylic acid, which reduce bacteria on the skin that contribute to acne [9]. However, long-term use can lead to antibiotic resistance and side effects; therefore, it is important to use them under the guidance of a dermatologist. Other alternatives for sensitive skin include gentle cleansers, non-comedogenic moisturisers, and natural remedies like tea tree oil or green tea extract [10]. Dermatologists can help determine the best approach for each individual's unique needs. Prescription medications for treating acne include retinoids, derived from vitamin A, which unclog pores and promote skin cell turnover, helping prevent new breakouts. Retinoids can be applied topically or orally depending on the severity of the acne [25]. Hormonal therapy is often recommended for women with hormonal acne, which involves using birth control pills or anti-androgen medications to regulate hormone levels and reduce acne flare-ups. A retinoid cream can be applied daily to remove excess oil and dead skin cells, preventing further clogging and reducing the occurrence of new acne breakouts [27]. Combining antibiotics with benzoyl peroxide can prevent antibiotic resistance, such as erythromycin and benzoyl peroxide (benzamycin) and clindamycin and benzoyl peroxide (benzocaine, Duac). Using only a topical antibiotic is not recommended [18].
3.4 Azelaic acid and salicylic acid
Azelaic acid and salicylic acid are two common ingredients in acne treatments that help kill bacteria and reduce inflammation [12]. Azelaic acid is found in over-the-counter products like cleansers, toners, and spot treatments, while salicylic acid unclogs pores and exfoliates the skin. Consult a dermatologist to determine the most suitable treatment option based on the severity of the acne and your individual skin type [17]. Benzoyl peroxide, derived from vitamin A, is also a popular ingredient in acne creams and gels. Retinoids, derived from vitamin A, help unclog pores and promote cell turnover. These ingredients can be found in prescription-strength creams or gels as well as some over-the-counter products [19]. The choice of treatment depends on the individual's specific needs and the severity of their acne. For mild acne, over-the-counter products with benzoyl peroxide or retinoids may be suitable, while severe acne may require stronger retinoids or combination treatments with antibiotics or hormonal therapy [22]. Alternative treatments such as laser therapy or chemical peels may be necessary for severe acne patients. However, some individuals may experience adverse reactions or side effects from certain treatments, highlighting the importance of personalised treatment plans and regular monitoring by healthcare professionals [33]. Azelaic acid, a natural yeast-produced chemical, is as effective as some conventional acne treatments when used twice daily. Pregnant and nursing mothers can use azelaic acid formulations (Azelex, Finacea). Salicylic acid treatments can be washed off or left on, but only a few studies have shown effectiveness [31].
3.5 Dapsone
Dapsone is a medication commonly used to treat acne by reducing inflammation and killing acne-causing bacteria. However, it can cause adverse reactions such as dryness, redness, and itching. Healthcare professionals should closely monitor patients and adjust treatment plans accordingly [29]. Pregnant and nursing mothers should consult their healthcare provider before using Dapsone as its safety during pregnancy and breastfeeding has not been fully established. Dapsone is also effective in managing skin conditions such as dermatitis herpetiformis and leprosy and is typically prescribed in higher doses and for longer durations [16]. Patients should be educated on proper usage and the importance of adhering to the prescribed dosage and schedule (Table 1). For dermatitis herpetiformis, higher doses and longer durations may be prescribed to control symptoms and prevent flare-ups [15]. Healthcare professionals should closely monitor patients' skin conditions and potential side effects to adjust dosages accordingly. Patients should also be educated on proper application and the importance of following the prescribed Dapsone (Aczone) 5% gel twice daily for inflammatory acne, especially in acne-prone females [13].
| Type of preparation | Function |
|---|---|
| Gel | Patients with oily skin are treated with gels, as they are more comfortable and have a drying effect. However, it can cause burns and prevent some cosmetics from adhering to the skin. |
| Solution | Its main solution is used in combination with topical antibiotics dissolved in alcohol. Patients with oily skin can also use the solution in place of the gel. |
| Lotion | All types of skin can utilize lotions. On the skin with hair, the lotion spreads evenly. Propylene glycol, which typically is present in lotions and has a drying and burning effect |
| Cream | Creams are meant for people with dry or sensitive skin, so the formula should not irritate or dry out the skin. Patients who use it will experience very oily skin when applying the cream if they have oily skin. |
3.6 Combined oral contraceptives
Acne breakouts in women can be regulated through medication, skincare, and lifestyle modifications. Patients should understand the potential side effects and risks associated with oral contraceptives and consult with their healthcare provider regularly to ensure that the treatment is effective and safe for their individual needs [35]. To optimise acne management, patients should maintain a healthy skincare routine and lifestyle habits, including using gentle cleansers and moisturisers, avoiding harsh exfoliants, and protecting the skin from excessive sun exposure [28]. Regular exercise, stress management, and a balanced diet can also help prevent acne breakouts. Patients should also be educated about the importance of not picking or popping pimples as this can lead to further inflammation and scarring. A comprehensive approach that combines medication, skincare, and lifestyle modifications is crucial for effectively managing acne in women [11]. This includes using gentle exfoliants, avoiding irritants, wearing sunscreen, engaging in regular exercise, and maintaining a balanced diet rich in fruits and vegetables [19]. Educating patients about the negative effects of picking or popping pimples can encourage proper skincare practises and prevent scarring or infection. However, these measures may not work for everyone, and for some individuals, acne breakouts may persist or worsen due to hormonal imbalances, genetics, or underlying medical conditions [13]. In such cases, additional interventions, such as prescription medications or dermatological treatments, may be necessary to effectively manage acne.
3.7 Anti-androgen agents
Medications like spironolactone and oral contraceptives can help treat acne because they stop the production of androgens and sebum, which stops acne from forming [4]. Dermatological treatments such as chemical peels, laser therapy, and photodynamic therapy can also help reduce acne by targeting bacteria, oil production, and inflammation. Consulting with a dermatologist can help determine the most appropriate treatment plan for individuals with persistent or severe acne [7]. Dermatologists evaluate the severity of the acne and consider the individual's medical history before recommending a treatment plan. In some cases, oral antibiotics or hormonal therapy may be prescribed to regulate hormone levels and control acne outbreaks [9]. The dermatologist also provides guidance on proper skincare routines and recommends products to prevent further irritation and breakouts. Regular follow-up appointments are scheduled to monitor progress and make necessary adjustments [16]. For a teenage girl with severe acne, a combination of oral antibiotics and topical creams may be prescribed to target the bacteria causing the acne and reduce inflammation. Hormonal therapy may be recommended to balance hormone levels and prevent future breakouts [14]. A skincare routine involving gentle cleansers, non-comedogenic moisturisers, and sunscreen is advised. Regular follow-up appointments allow the dermatologist to monitor progress and make necessary adjustments. If oral antibiotics are ineffective, women and adolescent girls should try spironolactone (Aldactone), which works by preventing androgen hormones from affecting the sebaceous glands. Period cramps and chest pain are possible side effects [9].
3.8 Isotretinoin
Isotretinoin is a powerful medication that reduces oil production in the skin and shrinks the sebaceous glands. It is used as a last resort due to potential side effects such as dryness, mood changes, and congenital anomalies in pregnant women [29]. Regular blood tests and close monitoring by a healthcare professional are necessary when taking isotretinoin. Complementary treatments, such as creams, gels, and lotions, can also be effective for managing acne [21]. These products contain ingredients like benzoyl peroxide, salicylic acid, and retinoids, which work to unclog pores, reduce inflammation and promote cell turnover. However, these treatments can cause skin irritation, dryness, and redness, especially when first starting [22]. It is recommended to start with a lower concentration and gradually increase as tolerated to minimise these side effects. Isotretinoin is a vitamin A derivative sold under brand names such as Amnesteem and Claravis and may be prescribed for moderate-to-severe acne when other treatments have failed. However, it is important to monitor the skin reaction and consult a skin care professional if adverse effects occur. Isotretinoin is a vitamin derivative sold under brand names such as Amnesteem and Claravis and is prescribed for moderate-to-severe acne when other treatments have failed. It's crucial to take part in an FDA-approved risk management programme and undergo routine medical screenings to look out for side effects [17].
3.9 Therapies for acne
Acne treatments can include topical treatments like benzoyl peroxide and retinoids as well as oral antibiotics like tetracycline. These treatments reduce inflammation, kill bacteria, and unclog pores [8]. For women with acne related to hormonal imbalances, hormonal therapy may be recommended. Consult a dermatologist to determine the most suitable treatment plan based on the severity and underlying causes of acne. Severe cases of acne, such as cystic acne, can be treated with oral antibiotics such as tetracycline to control bacterial infections and reduce inflammation [14]. Topical retinoids such as tretinoin can help unclog pores and promote the shedding of dead skin cells. However, in some rare cases, these treatments may not be effective in managing cystic acne [18]. For instance, severe cystic acne may be resistant to both oral antibiotics and topical retinoids, causing the acne to persist and worsen over time. Topical retinoids may not be able to effectively address factors such as hormonal imbalances, genetic predispositions, or underlying medical conditions [10].
3.10 Light therapy
Light therapy is a treatment option for managing cystic acne by targeting the bacteria responsible for the condition and reducing inflammation. It can be done with the help of a dermatologist and may involve different types of light, such as blue or red light. However, light therapy may not be suitable for everyone, so it is best to consult with a healthcare professional to determine whether it is appropriate for your specific case [1]. Another treatment option is isotretinoin, also known as Accutane, which is prescribed for severe cases of cystic acne that have not responded to other treatments. It reduces the size of oil glands in the skin and decreases the production of sebum, which can clog pores and lead to acne [9]. Although highly effective, it comes with potential side effects; therefore, it is important to discuss the risks and benefits with a healthcare provider before starting treatment [7]. A 25-year-old individual with severe cystic acne for several years was prescribed isotretinoin as a last resort after consulting with her dermatologist. They went through a thorough discussion about potential side effects, including dry skin, chapped lips, mood changes, and the possibility of severe depression or suicidal thoughts [4]. During treatment, the individual experienced none of the expected side effects, and their acne cleared up within a few months, improving their self-confidence and overall well-being. Many light-based treatments have been tried with varying degrees of success. In most cases, repeated visits to the doctor's office are required. Further research is needed to select the best procedure, light source, and dose for cystic acne management [15].
3.11 Chemical peel
Chemical peels are a common treatment for cystic acne, involving applying a chemical solution to the skin to exfoliate and peel off, reducing inflammation and unclogging pores. However, these treatments can be harsh and may cause redness and irritation. Healthcare professionals must assess the patient's skin type and sensitivity before recommending this treatment option [6]. Further research is needed to determine the long-term effects and optimal frequency of chemical peel treatments for cystic acne management. Educating patients about the potential side effects and risks associated with chemical peels is crucial [24]. The process may cause temporary discomfort and require proper aftercare, such as avoiding sun exposure, using gentle skincare products, and adhering to a prescribed skincare routine. Healthcare professionals can provide comprehensive information and personalised care to help patients make informed decisions about their acne management and achieve the best possible outcomes [8]. Initially, patients may experience redness, swelling, and dryness, but these symptoms are temporary and will subside over time. They may also suggest using a non-comedogenic sunscreen and avoiding direct sunlight to prevent further irritation. Additionally, incorporating soothing ingredients such as aloe vera or hyaluronic acid into the patient's skincare routine can promote healing and maintain skin hydration. In some cases, individuals may not experience any improvement with these treatments and may require stronger medications such as isotretinoin or oral antibiotics [16]. Chemical solutions such as salicylic acid, glycolic acid, and retinoic acid are repeatedly applied to treat mild acne, but improvement is usually temporary and requires repeated treatments.
3.12 Drainage and extraction
Acne treatment options include drainage and extraction, which involve a dermatologist using a sterile instrument to remove the acne lesion, reducing pressure and inflammation. However, it is crucial to consult a dermatologist to determine the most effective treatment plan for your specific case of acne [10]. A comprehensive skincare routine is essential for maintaining clear skin and preventing future breakouts, including gentle cleansing, exfoliation, and topical acne treatments such as benzoyl peroxide or salicylic acid. For mild-to-moderate acne, using a gentle cleanser twice daily and an exfoliating scrub once or twice a week can help remove excess oil and debris from the skin. Applying topical treatments directly to individual lesions can reduce inflammation and kill acne-causing bacteria [32]. Not all individuals with acne will see improvement from topical treatments alone. Some may have severe or persistent acne that requires more intensive treatment, such as oral medications or professional procedures such as laser therapy or chemical peels. In these cases, relying solely on topical treatments may not provide the desired results, and a more comprehensive approach may be necessary. A doctor can use a special instrument to gently remove whiteheads, blackheads, or cysts that haven't disappeared with topical treatments; however, this method may temporarily improve the condition of the skin but may leave scars [12].
3.13 Steroid injection
For severe acne cases, injecting a corticosteroid directly into the acne lesion can reduce inflammation and speed up the healing process. However, only a qualified healthcare professional should use this method because it is not appropriate for all types of acne [3]. Repeated use of steroid injections can lead to side effects such as skin thinning or discoloration. Consult a dermatologist to determine the most appropriate treatment plan for individual cases. Other treatment options include topical medications such as retinoids and benzoyl peroxide, which help unclog pores and reduce oil production [22]. Oral medications such as antibiotics or isotretinoin may be prescribed to reduce inflammation and kill bacteria. Given that these medications have potential side effects and should be under the supervision of a healthcare professional, it is crucial to adhere to the recommended dosage and duration. In addition to medication, lifestyle changes can play a crucial role in managing acne. Maintaining a regular skincare routine with gentle cleansing and non-comedogenic products can help keep the skin clean and prevent clogged pores [25]. Avoiding excessive touching or picking acne lesions can prevent further inflammation and scarring. While medication and lifestyle changes can be effective in managing acne, not all cases require medication, and some individuals may find success solely through lifestyle changes. Steroid drugs can be injected directly into nodular and cystic lesions, resulting in rapid recovery and reduced discomfort [26]. However, skin thinning and discoloration in the treated region are possible side effects.
3.14 Patches as a topical acne treatment
Acne patches have gained popularity in recent years due to their effectiveness in reducing inflammation and killing bacteria (Figure 2). These sticky patches, which contain ingredients like benzoyl peroxide or salicylic acid, can be put on individual acne spots and left overnight. This lets the active ingredients get deep into the skin and work on those specific areas [32]. They are a convenient and discreet option for those who prefer a non-medication approach to treating acne. Paches offer a unique advantage in preventing further irritation or infection. The adhesive nature of these patches creates a barrier that keeps active ingredients in place and shields acne from external factors. This is particularly beneficial for individuals with sensitive skin or those prone to picking at their acne. The discreet nature of these patches allows individuals to go about their daily activities without drawing attention to their acne treatment [29]. For those with sensitive skin, using patches can create a protective barrier on their face, allowing them to confidently go about their day without worrying about further irritation or drawing unwanted attention to their blemishes. However, if the patches cause irritation or allergic reactions on sensitive skin, using them may worsen the condition and draw more attention to the blemishes [23]. Pimple stickers, also known as acne patches, are another type of patch that absorbs moisture and oil from acne. A small, round sticker filled with hydrocolloid, a gel with wound-healing properties, reacts with the oil and dirt of acne, forming a gel that protects the skin from infection and prevents swelling. This protective shield greatly reduces the chance of scarring. An acne bandage acts like a bandage on the blemish, preventing new bacteria from entering and making the situation worse [25]. Overall, acne patches offer a convenient and discreet option for those seeking a non-medication approach to acne treatment.
Acne patch design in action.
4 MECHANISM OF THE PIMPLE PATCH
A pimple patch is a device that creates a barrier between the pimple and the external environment, absorbing excess oil and sebum from the pimple, preventing further clogging, and promoting faster healing. Some patches are infused with ingredients such as salicylic acid or tea tree oil, which reduce inflammation and kill bacteria on the pimple [28]. This protective layer helps reduce redness and swelling, ultimately speeding up the healing process. Pimple patches are designed to prevent further infection, allow the skin to breathe, and regenerate more efficiently. The adhesive nature of these patches ensures that active ingredients stay in direct contact with the pimple, maximizing their effectiveness [24]. Users often notice a significant improvement in the appearance of their pimples overnight or within a few days of consistent use. However, acne patches may not be as effective for individuals with cystic acne as these deep-seated pimples require stronger and more targeted treatments such as oral medications or professional interventions such as cortisone injections. Acne patches are effective against blackheads and pustules, but they are less effective against cystic acne due to their limited penetration [8]. They are great for treating active bumps but won't prevent the problem from coming back, and they can have difficulty with blocked pores. Pimple patches are ineffective for treating acne outbreaks with deep and cystic lesions, and people with severe acne should see a doctor for proper treatment. Additionally, acne patches may not be suitable for those with sensitive skin due to the potential for skin irritation from the adhesive, which may affect the skin around lesions if an allergic reaction occurs [6].
4.1 Hydrocolloid pimple patches
Adhesive patches are gel-like materials that absorb excess oil and pus from pimples, promoting faster healing and creating a protective barrier. They prevent bacteria and dirt from entering the wound, reducing the risk of infection. Medicinal acne patches, on the other hand, contain ingredients such as salicylic acid or benzoyl peroxide that help unclog pores and reduce inflammation [7]. Microneedle patches have tiny needles that penetrate the skin, stimulating collagen production and improving the appearance of acne scars over time. For mild acne cases, adhesive patches can be effective in preventing bacteria and dirt from exacerbating the condition. However, for stubborn or inflamed acne, medicinal acne patches may be the right choice [12]. These patches are infused with ingredients like salicylic acid or benzoyl peroxide, which help unclog pores and reduce inflammation. By targeting the underlying causes of acne, these patches can alleviate symptoms and promote faster healing. However, not all acne patches work effectively for everyone. In some cases, individuals may experience allergic reactions or skin irritation from the adhesive or ingredients in the patch, making their acne worse [5]. It is crucial to carefully consider one's skin type and potential allergies before using any acne patch. Non-medicated acne patches are over-the-counter remedies for minor cosmetic problems, with gelling agents applied to moisturise problem areas and draw excess sebum and pus out of the pimple [9]. Hydrocolloid pimple patches, on the other hand, help the body's natural healing process by draining the infection. New users may notice pus when the patch is removed, but it doesn't irritate or inflame the skin.
4.2 Medicated pimple patches
Medicated patches are a targeted and effective solution for acne, containing ingredients like salicylic acid or benzoyl peroxide. They reduce inflammation and kill bacteria, making them suitable for stubborn or severe acne. However, caution is essential when using these patches as they can be drying or irritating to certain skin types [15]. Consult a dermatologist or healthcare professional before incorporating them into your skincare routine, and follow the manufacturer's instructions to ensure proper usage and avoid potential side effects. Medicated patches are convenient and discreet, delivering active ingredients directly to the affected area, making them particularly beneficial for nodular acne breakouts. Cystic and nodular lesions are hard, painful pimples that appear deep under the skin surface [28]. They should be treated directly with a non-hydrocolloid patch, and it is best not to irritate the cyst, especially in dry areas. People with darker skin tone are at an increased risk of hyperpigmentation or dark marks. Repeating medicated pimple patches can irritate the skin, even though they are small and unlikely to harm it. A gentle treatment approach is the best course of action for patients with severe acne [4]. This may include using topical medications prescribed by a dermatologist, such as retinoids or antibiotics, to help reduce inflammation and prevent further breakouts. Additionally, maintaining a consistent skincare routine that includes gentle cleansing and moisturising can help keep the skin balanced and minimise irritation. It is important to consult a healthcare professional for personalised advice and treatment options for severe acne [11].
4.3 Microneedling patch
Microneedling patch is an innovative treatment option for severe acne patients. It contains tiny needles that penetrate the skin surface, stimulating collagen production and promoting skin renewal. This process can reduce the appearance of acne scars and improve overall skin texture [8]. However, it is crucial to consult with a dermatologist before trying this treatment to ensure it is suitable for your specific condition. The microneedling patch also helps unclog pores and reduce inflammation, which are common factors in acne development. By creating tiny channels in the skin, the patch allows for better absorption of topical acne medications, making them more effective in treating breakouts [10]. This treatment option is particularly beneficial for individuals who have not seen satisfactory results with traditional acne treatments or who are looking for a non-invasive alternative. However, it is important to note that the microneedling patch may cause temporary redness and mild discomfort during and after the procedure. It is essential to follow the post-treatment instructions provided by a healthcare professional to minimise any potential side effects [15]. A 25-year-old woman who had struggled with severe acne for years decided to try the microneedling patch, and after several sessions, she noticed a significant improvement in her skin texture and a reduction in breakouts. However, not all individuals may experience the same positive results with microneedling patches [29]. For instance, a 45-year-old man with sensitive skin tried the same treatment but developed a severe allergic reaction after just one session, resulting in even worse skin conditions. A microneedle patch is a skin care patch with a series of tiny thin spikes that deliver active ingredients deep into the skin. The increased delivery of skincare ingredients makes the arrangement significantly more effective [13]. The microneedles in these patches are so small that there is no pain, and there is only a mild prickling sensation after applying the patch. Microneedle patches are safe for most skin types but should not be used for active breakouts or cystic acne. If your acne has caused deep-seated hyperpigmentation, speak with an aesthetic doctor about laser or energy-based device treatment.
5 CONCLUSION
Hormonal imbalances, such as fluctuations in oestrogen and testosterone levels, can play a significant role in cystic acne development. Addressing these imbalances through hormonal therapy or birth control pills can be an effective long-term solution. Lifestyle factors, such as diet, stress levels, and sleep patterns, also contribute to the severity of cystic acne. Cystic acne treatment requires a multifaceted approach that addresses both the underlying causes and the visible symptoms. Topical treatments provide temporary relief, but hormonal imbalances and lifestyle factors contribute to the development of the condition. Seeking professional guidance and incorporating a balanced skincare regimen can improve treatment effectiveness. A comprehensive approach combining medical interventions, lifestyle changes, and proper skincare can lead to significant improvements in managing and preventing cystic acne.
AUTHOR CONTRIBUTIONS
Akiladevi Durairaj: Conceptualization (lead); data curation (lead); formal analysis (lead); writing—original draft (lead); writing—review and editing (lead). Karthikeyan Elumalai: Formal analysis (supporting); method-ology (lead), writing—review and editing (supporting); Anandakumar Shanmugam: Project administration (lead); resources (lead); supervision (lead); validation (lead).
ACKNOWLEDGEMENTS
The author Dr. Anandakumar Shanmugam would like to thank the Indian Council of Medical Research (ICMR) for his ICMR Research Associate (RA) Scheme (Project ID: 2021: 9012; No: BMI/11(16)/2022).
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS STATEMENT
Not applicable. No patient or animal was involved in the present review.
CONSENT TO PARTICIPATE
Not applicable.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable as no new data were generated.
