DermTV – How to Treat Cystic Acne [ Epi #107]

Hello, I’m Dr. Neal Schultz [pause] and welcome to DermTV. In cystic acne, usually you need internal
treatment. In cystic acne, you get red, swollen, large cysts—usually on
the face, sometimes on the upper back and the upper chest. But it’s not just
the fact that you have these unattractive cysts that’s the problem. They
hurt, and the reason that they hurt is because they’re so large and they’re
so deep. As the cyst gets larger and larger, it stretches the skin over
it, and stretching the skin, stretches the nerves. That’s what makes
the nerves fire. If you stretch pain nerves, you’ll make them fire and that’s
what causes pain. Also, the fact that they’re so deep also pushes on
pain fibers and causes them to fire and create pain. It’s the same depth
that’s causing this problem that’s also responsible for the fact that
topical medications for blackheads and whiteheads and even superficial
pus pimples don’t work, and that’s why you need to have internal treatment.
We discussed how Accutane is really a great miracle cure for really
bad cystic acne, but most people with cystic acne don’t need Accutane. Most
people will improve with oral antibiotics—sometimes for two weeks, sometimes
for three weeks. And sometimes the first antibiotic doesn’t work,
and your dermatologist will give you a second antibiotic. But usually
antibiotics will be helpful. But when they’re used for acne, it’s very
different than having antibiotics for a cold or a sore throat because, in those
cases, when you’re finished with your infection, you stop the antibiotic abruptly,
not with acne. With acne, we gradually reduce the dose of the antibiotic
from three times a day, to twice a day, to once a day and, by gradually
reducing it, we fool the body into thinking it’s still having the medication,
and that’s how, when you finally do stop the antibiotic, you have a
sustained improvement, and you don’t have to keep taking antibiotics If antibiotic treatment doesn’t help men,
they then have the option of going to Accutane. But women have another
choice. If antibiotics don’t help women, they can take birth control pills.
Because birth control pills that are estrogen-dominant tend to help acne, and
there are a least a half-a- dozen on the market which are very, very helpful.
So if women have a need for contraception and acne, estrogen-dominant
birth control pills are a perfect choice. But the important thing to
remember here is that, if you do have cystic acne, see your dermatologist.
There are oral medications that will control this problem and you no longer
need to have these unattractive painful cysts.

Comments 65

  • so interesting! thank you

  • You are so helpful!
    Thank You Dr. Schultz.
    We have the same last name, by the way.

  • i have sisted acne and i was put on roaccutane im doing nuthin but reserch on it as im wondering why i having had any simtmes sorrry for bad spelling

  • @amiterisu He said oral medication, so he means pill. 🙂

  • I've literally tried everything besides Accutane. I've been given face creams and facewash, omega 3 oil, anti biotics and birth control pills… But NONE of them worked. My last option is Accutane but the risks to it make me iffy, since I'm very prone to depression. But I wan't this stuff gone. I feel hopeless… T___T

  • @Nintend0rk64 same here…prone to depression so it's scary to even consider accutane

  • @CellarDoor367 usually they say that it takes a month or two for your skin to get used to new medication for acne. I remember a makeup guru on youtube said that her acne got worse with some prescription treatments for her acne but going through with it for three months, her acne disappeared. and now she has near flawless skin. so try and stick through with it.

  • If I'm trying to get pregnant, should I wait to treat the cystic medicine?

  • I have heard clearasil ultra rapid action treatment cream really helps with these. I used it and it got rid of my small pimples in 2 days.

  • But you don't have antibiotics for colds and the majority of sore throat.

  • A lot of dermatologists don't bother with antibiotics anymore because it temporarily controls P. acnes until the bacteria builds resistance and the cycle continues till you run out of antibiotics to try. Cortisone shots for cysts is good but not a long term treatment. What else is left to treat cystic acne since Accutane has been recalled completely due to FDA warning and countless life altering side-effects?

  • I need you to be my dermatologist.

  • Apply H2O2 externally can really help?

  • YES. i want the antibiotics.

  • Yes antibiotic work very well but only wile you use them. (I prefer doxyciline because it is cheap, without side efects) Stop using and everything goes back.

    Doxycicline is only 1-2$ for week it could be used indefinitely but I am afraid that it may cause some health problems later, even if I feel great while using it.

    Or am I wrong? maybe it is safe to use antibiotic all time? it will also prevent infections. farmers pump cattle with antibiotic all time.

  • What if even Accutane cant help?

  • @SugarFreeTargets yea they help me but didn;t get ride of all… did u end up using Accutane?

  • @SugarFreeTargets

    lol.. wat a stupid post… U know what I eat? My diet is so clean it's not even funny. please don't post ignorant generalised advise like this. As is often a little more complex then just eating well.

  • @SugarFreeTargets the only thing that should be doubted, is ur logic that diet is responsible for everything.. Bro, I'm dieting for a natural bodybiulding comp. The only what to get as lean as as required to look good, is to eat 100% clean. Anyway…

  • @SugarFreeTargets

    WTF fuck are you talking about… I never claimed to be more successful then anyone. Thou u just emphasised ur a worthless piece of shit, when u told me to "swallow some bleach" SMH

  • I have two questions:
    1. I've been on birth control for almost 4 years now and the specific on I am on claims to be helpful for acne yet I still get really painful cystic acne breakouts. Why doesn't it work for me?
    2. My derm prescribed me some oral antibiotics to help with the cysts and she said it would not affect the affectiveness of my birth control. But I am still affraid to take them because I've been told over and over again that antibiotics cancel out birth control. What should I do?

  • I get one bump on my face that hurts and has no hole to pop occasionally… i don't have problems with my skin how do i get rid of it??

  • All i want to say is Thank you Doc 😉

  • i've been on accutane 4 times and it still came back

  • Dr. Schultz,
    I started Alesse birth control pills 3 weeks ago. I noticed that by the end of my 3rd week, my skin was more clear than I had seen… since I was maybe 9! (I am 22 now). The problem is, I started the 7 day placebo pills 2 days ago, and now have 3 big breakouts. Is there a direct link between the new breakouts & the commencement of the placebo pills? I use benzoyl topically.
    How can I clear my skin up if I will still break out badly during that placebo period without the estrogen?

  • but dosent the birth control make u break out when u stop using it

  • Anti Biotics didn't help me. And my parents decided to wait until my body was full of this severe cystic acne and now I have really bad inflamation, scars, and I still get cyst even though I'm off my second round of accutane. My life is great man, 17 yrs old, stress headaches, horrible scars, not just physically but mentally. Dude to be honest because of my acne and my social skills now, I don't ever want to have a family. A wife, a girlfriend, screw it all.

  • @BIGDADDYDUKE2 but tell us how you REALLY feel.

    Try some red star nutritional yeast and avoid ALL sugar, corn syrup etc.
    Takes a good 2 cups a day but it will clear you up considerably and help control your acne.
    If you're one of the lucky ones, it will actually eliminate it.

  • @JonDeth I feel super insanely bad dude. Its not something I can speak about without crying. I know most people will think hey its just acne. But its not just acne when your life revolves around it. I couldn't play sports because of it, there goes my dreams of wanting to be a football player. I couldn't box(like boxing) anymore. I couldn't wrestle. It made it hard to laugh or speak at all because some cyst formed around my mouth and when you speak it stretches the skin and it would hurt….

  • @JonDeth my cyst. When your my age and your in highschool some people like to be alittle friendly so when they walk by they'd like pat your shoulder or slightly smack your chest, but I had cyst there so it hurt. It was embrassing when someone would pat you and you're wearing a white shirt and you start bleeding and it leaves a blood stain. I couldn't wear a book bag anymore. I grew my hair out long to cover my face because I got made fun of for my face. I started to get this acne at age 11….

  • @JonDeth And at 12 the jokes came in. I feel like even though I'm 17 I feel that I'm at a 12 year olds mentality. Do you know what that feels like? I can't get passed age 12 dude because everyone around me at that point in my life made it terrible for me. I hate the way I look, I hate that my parents don't seem to care and all ONE of my parents can say is sorry, the other just wants me to know it can be worse. Well its not worse but that doesn't help my problem in any way…..

  • @JonDeth Its not fair at least to me that the only reason why I didn't get help at 12 was because my parents didn't think it was to much of a problem. Well they're not in my shoes they don't have the low confidence, they don't hate what they see in the mirror, they don't get depressed, they don't break down every few months. No dude its just me. Its not fair. Everyday dude, I get up to my disrespect. For what dude? I hate my life. I hate who I am, I hate that no one really cares….

  • @JonDeth I'm sorry I'm dumping all this on you. I just really needed to let it out. My parents don't want me to have a phycologist, but I don't want one either. I already feel like no one really cares, so why the hell would I pay for someone to care? Screw that dude. I've never met anyone with acne as bad as me, nor have I seen it with all these kids that post accutane diaries. I've never seen it this bad with anyone. Its so not fair man. Now all I can do is just think about how my life….

  • @JonDeth would be if I didn't have acne. How school would be, how out going I WOULD be. But I can only think about it because thats not reality. Reality is me spending the rest of my life hating myself for something I had no control over. Spending the rest of my life thinking how maybe I might have went to the nfl or did something great like that. And when I'm sharing my story with someone and they ask me "well what stopped you from doing that" I get to tell them "acne".

  • Thanks. I used topical mediacations a lot on my cystic acne and it worsened! I need to a dermotologist soon.

  • @KissMyHerpes1 Thanks man. Do you mind if I ask you a question? For me my acne is a very touchy topic. I hate shopping for acne products and I hate when people ask me pointless questions about it. So I understand if you don't want to talk about it. But how did you skin end up man? I want to face the truth. If the truth is that there is no escape from a scared up face then I want to know so I don't get my hopes up. In 6 months I go in for chemical peels if my parents can afford it….

  • @KissMyHerpes1 is your face clear completely or what? Thanks for answering if you don't I understand.

  • @KissMyHerpes1 Its hard for me to be confindent and think that my face will be clear.

  • In my case, doc gave me 1 month supply of Erythromicin(don't remember the dosage), 5% benzoyl peroxide cream, and some gel(I think Salicylic acid) I was hezitant about taking the antibiotics because they upset my stomach, but I saw no results with just the topical medications. I ended up finishing the bottle because of desperation. I recently began breaking out again, luckily I'm taking antibiotics for unrelated reason, and I bought more Ben. Perox. New cysts stopped forming before it got worse.

  • I have a boil problem that usually breaks out in places I can not say on here. What should I do?

  • @HeyYouPMme Most definitely, Thank you!

  • I have a lot of large pores that have sebum in them that never seems to go away. It's on my nose and mostly in the folds and in my chin with some near my inner eyebrow. The skin on my nose area is very thin. Is it safe to do extractions? If they stay in it gets worse & seems to spread. I have a dermatologist here in Canada but he doesn't explain anything. He also scarred my cheek with a glycolic peel years ago as my skin was more sensitive than he thought. I don't know where to start again

  • how do i know if my birth control im allready on is estrogen dominant?

  • @candycanelolz same here 🙁

  • @livejoann it just has to do with your level of hormones, your skin's ph and oil levels, etc. A big acne myth is that people with great hygiene have clear skin, but that is sadly not the case :/ The only "realistic" option for cystic acne is oral medication, bottom line.

  • hi i had a cyst near the lap of my ass i went to doctor he told me to get surgery ,i dont know what to do i have this from last 2 years plz guide me

  • THANK YOU. I went to a dermatologist yesterday who would not stop trying to sell accutane to me. My acne is not painful and though it is "cystic acne" it isn't THAT bad. Sure I have 4 or so big zits on my face, but I'm not going to go in every month for blood tests and pregnancy tests on some medication. I'm probably going to find a different dermatologist now. Even though this is the fourth one I've seen.

  • @potatochipXL I heard that topical accutane is called TAZORAC. I saw it on a YT video.

  • I have these unfortunately… The ones on the left side of my face have gone away but my right side of my face has a huge spot of them on my cheek… even in simplest touch sometimes will make then leak or explode while apply my doctors treatments or cleansing which makes it hard for me to "don't pick pimples…" im seing a dermatologist next month hopefully they can help me with my acne.

  • @Snarlik I'd advise you go on accutane before its too late. I had 6 cystic pimples. I had gotten a cortisone injections to each and now im on my 4th month of accutane. Its been getting better ever since. Although i had some skin stretched so now i have nics in my face. 🙁 go on it before its too late.

  • I did notice that my cyst acne has died down since I started taking birth control.

  • I got on ortho tri cyclen lo to treat my acne which occasionally popped up. I have been on ortho tri cyclen for about a month & a half now and few weeks ago i started getting cystic acne on my face. Should i stop taking the pills? Please help!

  • I'm sixteen years old I have Cystic Acne on my face It's so painful that it wakes me up during the night and keeps me up for several hours at a time. I've had to deal with it for many years, I hate getting up in the mornings to go to school because I get teased I have tried every over the counter ointment gel cream and cleansing system you can name many people have told me to see a dermatologist but insurance does not cover it and we're pinching penny's now. I can't take much more.

  • but if i wait it takes like a month to go away!!!

  • for me i get acne scars 🙁 i hate it!!

  • Alyssa,I know how frustrating this can be. As a teenager I had cystic acne. Which is what made me become an Esthetician. I really do wish that acne could be covered by insurance. First of all stay strong,ignore these jerks with the teasing. Obviously, they don't get much attention at home or anywhere else for that matter that they have to tease someone to get some kind of attention. Stand tall and be confident these jerks feast on weakness.
    Know that ever women is beautiful!!

  • I have dry skin and the only acne I really get is cystic acne and blackhead. I almost wish that I just got regular acne because cystic acne hurts so much 🙁

  • I usually get them around ny tine of the month. .ugh

  • no no,,, no Ab…its bad 

  • Bullshit

  • Hello there, have you considered Fopobiacne Secrets yet? Simply just do a google search. On there you will discover that a great guidelines about how exactly you can break free from your acne. Why not give it a chance? maybe it's going to work for you too.

  • Is Fopobiacne Secrets effective to clear your acne naturally? We have read many good stuff about Fopobiacne Secrets (just google search it).

  • Hi there, have you considered Fopobiacne Secrets yet? Simply just do a google search engine search. On there you will find an awesome tips about how you can break free from your acne. Why don't you give it a shot? perhaps it's going to work for you too.

  • If you have too little progesterone, you may need progesterone only pill.

  • It's still astonish me just how many people do not know about Fopobiacne Secrets (do a google search) despite the fact that lots of people get rid of their acne problem with it. Thanks to my mate who told me about it. I have get rid of my acne problem.

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