Cystic acne is characterized by thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles.

Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If cystic acne doesn't respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion.

Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical prescription products for cystic acne derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicle. A number of topical antibiotics also are available for cystic acne. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.

For cystic acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products to eliminate cystic acne.

For deep cystic acne, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of cystic acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of cystic acne treatment or within several weeks of concluding cystic acne treatment.

Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve cystic acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.

Doctors may be able to use cosmetic surgery to diminish scars left by cystic acne. Procedures include peeling away damaged skin with chemicals or by freezing it, dermabrasion, intense light therapy and laser resurfacing. Peeling procedures eliminate superficial cystic acne scars. Dermabrasion, which is usually reserved for more severe cystic acne scarring, involves removing the top layers of skin with a rapidly rotating wire brush. Laser resurfacing involves using short pulses of intense light to remove the outer layer of your skin. If your skin tends to form scar tissue, these procedures can make your complexion worse.

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