The horrible form of acne vulgaris is Cystic acne. It is a chronic inflammation of the pilosebaceous units. The key components are increasing sebum production; colonization of pilosebaceous ducts by Propionibacterium acnes which leads to inflammation and hypercornification and occlusion of pilosebaceous ducts. It is a boil-like infection, which hurts when it is touched.
EPIDEMIOLOGY:
cystic acne is more common in older children and teens going through puberty, lasts 5-10 years and usually resolves by age 20-25
RISK FACTORS:
- Severity of acne is associated with the sebum excretion rate, which increases at puberty. Hormones play a major role. Both androgens and progestogens increase sebum excretion and oestrogens reduce it.
- There may be a positive family history. There is a high concordance in monozygotic twins.
- Several studies suggest that diet can affect your skin in various ways. Certain food raise blood sugar more quickly, which leads to increase in Insulin hormone production. Having excess insulin in the blood can cause your oil glands to produce more oil, which increases the risk of acne formation.
Food items that are likely considered to trigger a spike in Insulin includes-
- White rice
- White bread
- Sugar
- High glycemic carbohydrates
- Dairy products
- Saturated fats
- Trans fats
These kinds of food stimulate the production of hormones that can cause excess oil to be created and secreted by oil glands.
CLINIC FEATURES:
- Cystic acne usually affects the face and the trunk.
- Comedone is the common and vital feature of cystic acne.
- Closed Comedone (white heads) usually have no visible follicular opening and are caused by an accumulation of sebum and keratin in deeper pilosebaceous ducts.
- Open Comedone (black heads) are dilated keratin filled follicles.
- Inflammatory papules, nodules and cysts occurs and may arise from Comedones.
- Scars may also develop if you try to pop cystic acne.
EMOTIONAL EFFECTS:
At all age’s acne can have negative effects on self esteem especially in adolescents. The consequences can be devastating, leading to an embarrassment, school avoidance, lifelong effects on the ability to form friendships, attract partners, acquire and keep employment.
MANAGEMENT:
1) Mild acne is normally managed with topical therapy. Treatment should initially be applied at low concentration for short duration and increased as tolerated. Azelaic acid is another thing that may be useful for mild cystic acne. Patients also respond well to topical antibiotics such as erythromycin or clindamycin.
2) For moderate cystic acne, systemic tetracycline such as Oxytetracycline should be used.
3) Oestrogen containing oral contraceptives or combined Oestrogen/ anti-androgen oral contraceptives may provide additional benefits in women.
4) Isotretinoin has revolutionized the treatment of moderate to severe acne that hasn’t responded adequately to other therapies. A typical course lasts for 4 months. Combination with systemic steroid may be required in the short term for severe acne.
BEST TREATMENT FOR CYSTIC ACNE AND PHYSICAL MEASURES:
1) Intralesional injections and triamcinolone acetonide may be required for inflamed acne nodules or cysts.
2) In cases of scaring, carbon dioxide laser, microdermabrasion, chemical peeling or localized excision can also be considered.
3) The blocked hair follicles are unplugged with Vitamin A derivative and help to prevent new blockages from forming.
4) Topical antiseptics- destroys and prevents the growth of microorganisms on the skin that may cause infection.
5) Use of antibacterial soaps and skin cleanser also reduces the risk of infection.
6) Food is believed to help your skin. You may reduce the risk of developing acne by eating low glycemic food made up of complex carbohydrates. The food which contains zinc, Vitamin A and E, antioxidants are also thought to be helpful for skin. They reduce inflammation.
