How to Really Treat Cystic Acne, According to Dermatologists
My period is no joke. The day-long pre-game migrane and painkiller-proof cramps that I put up with every month aren't a good time, but they are nowhere near as annoying as the hormonal cystic acne I get around my mouth and jawline in the days leading up to my menstrual cycle.
These zits are huge red bumps that itch, hurt, and take so long to clear up, that when skin's finally clear, I'm just about due to start my cycle all over again.
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For anyone who has the pleasure of experiencing cystic breakouts like myself, it's a known fact that picking these pimples is the worst thing you can possibly do. Since these blemishes are deep under the skin, trying to pop them will just make them more inflammed, red, and can even cause them to spread, which means, yep, you'll get more zits.
It turns out, though, that trying to pop a cystic pimple isn't the only mistake that many of us are making when we're trying to self-treat cystic acne. If it seems like none of the spot treatments you've been using are working, it's because they're not.
"Over-the-counter medications do not work well at all," says Dr. Jeanine Downie, a Montclair, New Jersey-based dermatologist and founder of Image Dermatology. "If cystic acne is not treated properly, it can scar the skin permanently."
The same goes for other skincare products targeted for acne-prone skin.
"Scrubbing and doing abrasive treatments with the hope they will get rid of the acne is only going to increase inflammation and make the acne more irritated," says Dr. Shari Sperling, a New Jersey-based board-cerified dermatologist. This includes harsh scrubs and astringinent-based toners.
Dr. Ava Shamban, a Los Angeles-based dermatologist agees. "While some creams and washes pads and peels are sometimes enough for surface acne [whiteheads, blackheads, and pustules], you’ll most likely need the big guns to treat cystic acne," she says.
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These "big guns" can only be prescribed by a dermatologist.
"That said, by far the best cystic acne treatment is isotretinoin (i.e. Accutane). Isotretinoin is an oral form of vitamin that is a multi-tasker, targeting all aspects of cystic acne," Dr. Shamban explains. "It will kill [acne-causing] bacteria, unclog pores and surpresses the production of excess sebum while fighting off inflammation. And it is the best and only medication that can actually help to shrink the oil producing glands permanently, so it has the side effect of making skin and lips incredibly dry and sometimes flaky."
Another oral prescription that your dermatologist may consider is spironolactione, a blood pressure medication that's becoming an increasingly popular treatment for hormonal acne becasue it blocks androgens (male hormones) from over-stimulating the oil glands.
Alternatively, an in-office cortisone shot is a quick way to calm an inflammed cystic zit. It'll difuse the bump and the redness surrounding it.
As for what you can do at home, you've got a few options. Those pimple patches you've seen all over Instagram? They now come in microneedling form.
"There's now a new kind of pimple patches with 'microneedles' in them, which may also be a quicker fix," says Dr. Shamban. "Usually a bandage-like patch with a series of hundreds of microneedles, these teeny tiny pricks in the skin are able to drive and deliver acne-fighting active ingredients [before they dissolve] deep in to the skin. This supports the dissolution of the acne more efficiently than any topical medicine, and when done with moisture binding ingredients, skin does not dehydrated during the process."
As far as topicals go, a hydrocortisone cream can reduce the appearance of angry red cystic pimples, but won't have any effect on the source of these blemishes.
Whatever cystic acne treatment you do go with, all of the dermatologists I spoke to agree that you shouldn't skip your daily moisturizer.
"When we treat acne, it is important to respect the skin barrier," says Dr. Joshua Zeichner, a New York City-based dermatologist. "While many acne treatments can dry out a pimple, if they dry out the skin too much, it can lead to skin barrier disruption with irritation and inflammation. It is OK to apply a moisturizer to your face along with your acne treatment to help keep the skin well hydrated and in as good shape as possible."
Could acne patches cure your pimples? We try them out (and talk to a dermatologist)
By Sarah Lindenfeld Hall, Go Ask Mom editor
In a house with a teen and a 40-something-year-old mother, acne is, frankly, a fact of life.
In fact, if you're an adult who is experiencing acne, you are far from alone. Studies - and dermatologists - report a rising number of adults, particularly women, who are dealing with the skin scourge. One dermatologist said the problem had grown to "epidemic proportions," in a New York Times article on the topic.
And that means that households like mine are rushing to find various remedies to resolve the spots that are popping up across our faces. My bathroom includes all manner of creams, gels and face masks. But the most recent addition is acne stickers.
Say what, you might ask?
These acne patches have grown in popularity over the last few years, but come from something that's been used for decades to treat wounds - hydrocolloid dressing. Here's the skinny.
What do these acne patches look like?
A growing number of brands are coming out with their very own acne patches, but basically these small, cloudy stickers made of hydrocolloid dressing are shaped like a circle and coming in various sizes to fit the particular pimple that's dotting your face.
I checked in with Dr. Dean S. Morrell, a pediatric dermatologist at UNC Health Care, to understand how these work.
"Hydrocolloid bandages are well established wound care," he said in an interview. "If people have leg ulcers or bed sores, hydrocolloid is a good protective sheet that's flexible and you can put over it to help encourage healing."
How does it help acne?
"It helps protect it, and it lets the acne lesion evolve like it wants to," Morrell says. "As the lesions come to the surface, they put off fluid and hydrocolloid looks like it helps to absorb some of that."
But, he points out, it doesn't help with blackheads. And it doesn't really seem to help with cystic acne, a severe form of acne. In my experience, these are best for those annoying whiteheads that emerge on your face. And it's best if they are at least partially broken open. (I know ... gross!)
How do you use the acne patches?
Place the sticker over the whitehead and let it sit overnight. In the morning, take the patch off. You typically will see some white goo on the patch that's been sucked out of the pimple. The spot will still be reddish, but it's usually not as bumpy as it was the night before - and a lot easier to hide under some makeup.
Will acne patches cure my acne?
Oh, I was so very, very hopeful. But, no. It can't replace whatever other efforts you're making to keep the acne from appearing in the first place.
"It doesn't prevent your acne," Morrell says. "I wouldn't put a whole sheet on your face to try to prevent acne from happening."
So what are the acne stickers good for?
Well, in my experience, they make whiteheads go away more quickly.
Morrell, as a pediatric dermatologist, has another take. If it has any benefit, it keeps kids' fingers off of the acne lesions, he says.
Just be careful that you don't combine it with too many acne treatments, such as a retinoid cream, salicylic acid or benzoyl peroxide.
"Whenever you occlude something, you always have a chance that you're going to intensive the effect of the medication under there," he says. "So if somebody is already getting irritation from a retinoid medication, you don't want to put a sheet there to push it in more."
Art gets 'caldera-like' acne, too. This tool could help clear it up.
Georgia O’Keeffe is famous for her flowers—erotic red canna lilies, hypnotic Jimson weed, blooming calla lilies. But a more sacred subject may have been the Pedernal mesa, an iconic peak in the flat New Mexico landscape.
“It’s my private mountain. It belongs to me,” O’Keeffe said of the Pedernal, which she painted from her studio on the red earthed Ghost Ranch. “God told me if I painted it enough, I could have it.”
Unfortunately, God (or, in this case, metal soaps) also taketh away.
O’Keeffe’s “Pedernal, 1941”—a sweeping vista of pinks, greens, and yellows creeping up the canvas to the mountain’s darkened summit—is experiencing a peculiar kind of decay. The artist noticed it herself, remarking on granulations, discoloration, and small spots where the paint disappeared altogether in letters to conservator Caroline Keck in 1947. Known as surface protrusions, or “art acne”, this pimpling afflicts oil paintings from every time and place. But the reasons for O’Keeffe’s deformations, which only grew worse over the decades, remained a mystery.
In a feat of artistic sleuthing researchers at Northwestern University finally identified the origin of these “caldera-like” deformations in O’Keeffe’s paintings. Their results will be published in the forthcoming academic text Metal Soaps in Art. In the process, the researchers also devised a new handheld tool for curators to investigate pimples in their own collections. The technology was demonstrated at the 2019 American Association for the Advancement of Science (AAAS) conference in Washington, D.C. on Saturday.
It began with a plea to Marc Walton, a material scientist and co-director of the Center for Scientific Studies in the Arts. A collaboration between Northwestern University and the Art Institute of Chicago, the center’s mission is to help small-scale museums with big-time artifacts preserve their collections. “This is how our lab often works,” Walton says. “We’ll get some strange request from a cultural heritage institution—it’s often an object that has a problem—and we’ll respond to it.” In this case, Dale Kronkright of the Georgia O’Keeffe Museum in Santa Fe reached out about protrusions on many of the artist’s canvases between 1920 and 1950, including the 1941 rendering of Pedernal.
At first, it seemed like a straightforward chemistry project. Simply analyze the materials in the paint, the condition of the canvas, and the environment in which the works are stored for clues, and report back on what might be making these pigments pop. But, Walton said, it quickly became an opportunity for a new kind of technological experiment, with Pedernal as the first subject.
“We had a lot of tools in our toolkit to answer that question [of protrusion formation], but they were bulky, they were difficult to transport and set up, so we rethought the problem and decided we could do better,” he says. Working with Ollie Cossairt, an expert in computational imaging at Northwestern’s Comp Photo Lab, they built a 3-D imaging technique that requires only a smartphone or tablet to analyze diverse surfaces.
It works like this: Curators can open a predetermined pattern on their LCD display, beam it at the painting, and take a picture with the front-facing camera. They then upload that information to the cloud, where it’s fed through an image-processing algorithm, which returns highly-detailed, localized images of the artwork’s surface. “By analyzing the way those patterns are distorted, you can actually determine the shape that’s reflecting,” Cossairt says. Right now, curators must identify individual protrusions manually, but Cossairt says the next phase of research will seek to automate that process as well.
When they turned their clever new gadget on O’Keeffe’s painting of Pedernal, the researchers found the protrusions clustered on light-colored paints and were almost entirely absent from darker areas. It didn’t have anything to do with the base pigment itself—the light green and dark green were both derived from cadmium, in this case a benign element. Rather, the problem arose when O’Keeffe added lead white to lighten each shade, triggering the inflammation.
As Kassia St. Clair writes in her book, The Secret Lives of Color, lead white has been manufactured since at least 2300 B.C.E. and its production has changed very little since Pliny the Elder shared his methods in the first century C.E. Lead was first extracted from rocks, then placed into one side of a two-holed clay pot. In the other vestibule went vinegar. And the receptacles were surrounded by poop. “Fumes from the vinegar reacted with the lead to form lead acetate; as the dung fermented it let off CO2, which, in turn, reacted with the acetate, turning it into carbonate,” St. Clair writes. “After a month some poor soul was sent into the stench to fetch the pieces of lead, by now covered in a puff-pastry-like layer of white lead carbonate, which was ready to be powdered, formed into patties, and sold.” The process was dangerous, as was the pigment itself if ingested. But artists liked lead white’s durability and price point, so it remained on artist’s palettes well into the 20th century.
Art acne first received wide recognition at the turn of the millennium, after conservator Petria Noble identified pimpling on Rembrandt’s “Anatomy Lesson of Dr. Nicolaes Tulp” in 1996. An investigation concluded that the 16th century Dutch master's oil painting was plagued by lead soap. Since then, chemist Joen Hermans told *Chemical & Engineering News”, anxious conservators around the world have been “literally watching paint dry.”
With the new tools described in Walton and Cossairt’s research, this vigil will be even more precise. According to Walton, the demo at AAAS will prove “it’s possible on a mobile device… to get these millimeter-level measurement.” But, he adds, “we’re 5 or 6 years away from something as good as a standard interferometer,” the expensive, intensive, and oversized tool currently in use.
For now, the team is testing their technology on some other iconic works. In addition to paintings in the Georgia O’Keeffe Museum’s collection, Walton and Cossairt have a forthcoming study on the same mobile imaging device and its success with stained glass artwork, like the Art Nouveau windows Louis Comfort Tiffany manufactured with Kokomo Opalescent Glass. If all goes well, Cossairt says, one day every curator, auctioneer, and art enthusiast will have a Star Trek-style tool for instantaneous artwork evaluation at their fingertips.
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