From the Guidelines
The most effective treatment for cystic acne is oral isotretinoin, which is strongly recommended for severe, scarring, or treatment-resistant cases, as it reduces oil production, fights bacterial infection, and decreases inflammation, according to the guidelines of care for the management of acne vulgaris 1.
Treatment Options
For mild to moderate cystic acne, the following treatments can be considered:
- Topical retinoids like tretinoin 0.025-0.1% applied nightly, combined with benzoyl peroxide 2.5-5% in the morning to reduce inflammation and kill bacteria
- Oral antibiotics such as doxycycline (100mg twice daily) or minocycline (100mg daily) for 3-6 months to control inflammation
- Hormonal treatments like combined oral contraceptives or spironolactone (50-200mg daily) for women with hormonally driven acne
Important Considerations
- Use a gentle, non-comedogenic cleanser twice daily to mildy clean the affected area
- Avoid picking or squeezing lesions, which can worsen scarring
- Maintain consistent use of prescribed medications, as cystic acne typically requires several weeks to months of treatment before significant improvement occurs
- Isotretinoin requires careful monitoring due to potential side effects, and its use is strongly recommended for severe, scarring, or treatment-resistant cases 1
Additional Recommendations
- Combining topical therapies with multiple mechanisms of action is recommended as a good practice statement 1
- Limiting systemic antibiotic use and combining systemic antibiotics with benzoyl peroxide and other topical therapies are also recommended as good practice statements 1
- Intralesional corticosteroid injections can be used as an adjuvant therapy for larger acne papules or nodules 1
From the FDA Drug Label
The exact mechanism of action of isotretinoin is unknown. Nodular Acne Clinical improvement in nodular acne patients occurs in association with a reduction in sebum secretion The decrease in sebum secretion is temporary and is related to the dose and duration of treatment with isotretinoin, and reflects a reduction in sebaceous gland size and an inhibition of sebaceous gland differentiation.
The treatment for cystic acne is isotretinoin (PO), which inhibits sebaceous gland function and keratinization. The dose is 5 to 1 mg/kg/day. 2
From the Research
Treatment Options for Cystic Acne
The treatment for cystic acne typically involves a combination of therapies to address the multifactorial pathophysiology of the condition. Some of the treatment options include:
- Topical retinoids, such as adapalene, which down-regulates toll-like receptor 2 expression and inhibits activator protein-1 activity 3
- Antimicrobial agents, such as benzoyl peroxide, which acts synergistically with adapalene to regulate innate immunity 3
- Oral antibiotics, such as doxycycline, which can be combined with topical therapies for more severe cases 3, 4, 5
- Combination therapies, such as clindamycin and benzoyl peroxide, which can provide efficacious and well-tolerated treatment 6, 7
Combination Therapies
Combination therapies are often preferred for the treatment of cystic acne, as they can provide a more comprehensive approach to addressing the condition. Some examples of combination therapies include:
- Adapalene and benzoyl peroxide, which can be used together to reduce inflammatory and non-inflammatory lesions, and prevent lesion and microcomedone formation 3
- Clindamycin and benzoyl peroxide, which can be used together to provide a stable formulation in a single tube, with excipients that minimize treatment-related irritation 6
- Adapalene, benzoyl peroxide, and doxycycline, which can be used together to provide a highly effective treatment for severe acne with nodules 4
Maintenance Therapy
Maintenance therapy is often necessary for patients with cystic acne, to prevent relapse and continue to reduce disease symptoms. Some options for maintenance therapy include: