Cystic Acne Treatment: Hormonal Therapies And Antibiotics

Cystic acne treatment is difficult, once delayed. Cystic acne is one the most severe and difficult forms of acne to treat. Causing masses of infection to accumulate underneath the skin tissue, cystic acne cannot be treated simply by opening up pores in the skin—because the pores no longer exist. However the condition is easily treatable during the initial stages. But If the condition evolves to a chronic stage, and progresses for too long, it can result in a permanent acne cyst.

This cyst gets lodged deep into the skin and treatment would most likely involve surgery, round of antibiotics as well as prescription-strength creams, lotions, or gels comprising a healthy dose of vitamin A. These ointments can unclog the skin and make antibiotics more effective. Now after finally explaining what a cyst actually is and why acne cyst is one of the more severe kinds of acne, we can now look in to the details of cystic acne.

 Cystic Acne Treatment

In the case of mild acne, over-the-counter (OTC) medications are proved the most beneficial for the treatment and long-term management but the same medications are rendered useless when it comes to cystic acne treatment. It is advised to consult a dermatologist as soon as you observe the insensitivity of your acne towards OTC medications. Upon consultation with a skin specialist he is most likely to resort to one of the following treatment methods as recommended ones:

Antibiotics For Cystic Acne Treatment

The dermatologists prescribe oral antibiotics as the first line cystic acne treatment. The inclination of dermatologists towards oral antibiotics is because of the fact that such medications help curb the growth of bacterial population (specifically Propionibacterium acnes) and reduce the inflammation to some extent.

According to the study published by Theresa N. Canavan and colleagues described the inefficacy of antibiotic treatments when it comes to cystic acne treatment, since in most of the cases the bacterial population develops resistance towards the prescribed antibiotic treatments.

In some other cases, keeping in mind the impending problem of development of resistance against antibiotics, dermatologists combine the oral antibiotics (oral Isotretinoin) with the topical treatments widely used for the treatment of patients suffering from mild to moderate acne.

Hormonal Therapies For Cystic Acne Treatment

Hormonal therapies are widely used for the treatment of women suffering from acne in general. FDA has so far approved four Combined Oral Contraceptive pills (COCs) as potent hormonal therapies to combat acne in women.

Hormonal acne is treated by cystic acne treatment.

James Leyden, MD, and co-authors carried out a Randomized Control Trial (RCT) to evaluate the effectiveness of Oral Contraceptives in the acne patients at a low dose, published in Journal of American Academy of Dermatology. The study concluded that the hormonal therapy implemented by the administration of oral contraceptives resulted in the decrease of a number of apparent lesions (both inflammatory and overall). The study attributed the effect to the anti-androgenic action of the oral contraceptives as the biochemical markers of androgenicity were greatly decreased post hormonal treatment.

Retinoid For Cystic Acne Treatment

Non-hormonal treatments are also of prime importance in the case of the patients render insensitive to the antibiotics and hormonal therapies. Hormonal therapies are also of less importance in the case of main patients as androgenism leading to acne outbreak is rare in their cases.

Retinoids are widely available in the form of gels, lotions, and creams of varying strengths which are prescribed by the dermatologist after assessing the situation and progression of acne in an individual.

Retinoid treatment in combination with an oral antibiotic can help the skin pores to resist clogging and hence the antibiotics can better target the bacterial population, inhabiting the clogged pores when their favorable growth environment disrupts.

The claim of the efficacy of retinoid has also been backed by the clinical study conducted by Lawrence N. Farrell, M.D and his colleagues, published in Journal of American Academy of Dermatology. The study reported significant improvement in the number of nodules and cysts of the nodulocystic acne lesions as the reported diameters of all the symptoms greatly reduced when measured after sustained therapy of retinoid.

Isotretinoin/Accutane For Cystic Acne Treatment

Isotretinoin has been an effective and the first of its kind prescription medication to be approved by FDA for the treatment of acne. Accutane is used for cystic acne treatment too.

The most common name by which Isotretinoin is known amongst the U.S. population is Accutane however, other market names are being used to sell the drug in other parts of the world.

Isotretinoin improves the condition of acne in the patients suffering from varying types and severity of acne.

The solution has been permanent in many cases as mentioned by Gary L. Peck, M.D. in an RCT trial published in Journal of American Academy of Dermatology. The study conferred with the observation that even after the therapy ceases the healing process continues and the sustained effect is observed in most cases. The main mechanism of action of Isotretinoin is the suppression of sebum production, which is one of the root causes, which promote the build-up of the environment in which acne causing bacteria thrives leading to an acne outbreak.

Can Spironolactone Be Used For Cystic Acne Treatment

FDA has not recommended spironolactone for cystic acne treatment. Despite the fact, dermatologists, in few cases, prescribe it.

Spironolactone, most commonly known as the oral spironolactone, was originally designed to be prescribed to the patients who are suffering from hyper tension and conditions of the heart such as congestive failure. The drug was first made available in the market in 1957 and since then it has been used mainly in many indications of a wide variety of diseases.

The basic content of the spironolactone is the chemical called canrenone. Canrerone has shown its anti-androgenic properties in the women who are positive for Poly Cystic Ovary Syndrome (PCOS) as well as women who suffered from hirsutism. Since then, Spironolactone is the drug of choice for the dermatologists to be prescribed in patients who suffer from acne.

So far, spironolactone is not FDA recommended for the treatment of acne but it is widely suggested by dermatologists all over the globe to help manage acne. Usually, the dose of spironolactone is taken on the advice of the doctor. A general observation is that the production of sebum and the outbreak of acne is reduced to a visible extent right after the initiation of this treatment. This medicine is anti-androgen in nature which means it reduces the androgen (testosterone) based traits like sebum production.  Here the medicine works and reduce the androgenic effect and helps in cystic acne reduction.

The dosage of spironolactone is not free from side effects either. Acne patients may suffer from some adverse effects when they are undergoing therapy with spironolactone that can be as mild as fatigue, headache and breast tenderness to as serious as irregularities in the menstrual cycle and hyperkalemia. It is also necessary to take note of the time, which may be up to 6 months before the therapy starts showing any effect. This delay in the response is concurrent with any other hormonal therapy.

Spironolactone shows antiandrogen properties and it is contraindicated during pregnancy or before conceiving. The anti-androgenic properties of spironolactone if administered during pregnancy may lead to the feminine development of the unborn fetus especially when the sex of the fetus is male.

An extensive research was carried out by a Yemisci and co-workers, in which researchers weighed down the benefits and risks of using spironolactone in the women suffering from acne. The study comprised of a clinical trial as well as reviewed the studies that were carried out earlier with a focus on the characteristic effects of spironolactone. The study, published in Journal of European Academy of Dermatology and Venereology concluded that it is safe and effective to use spironolactone in the patients suffering from acne.

So, keeping the research and results in mind, spironolactone can be safely used as a treatment for cystic acne. Until FDA approves it for cystic acne treatment ambiguity of spironolactone will persist.

Low Glycemic Diet As A Cystic Acne Treatment

The possible association between low glycemic diet as cystic acne treatment diet is not a myth.

  • Evidence has been unearthed that High Glycemic Load diet may as well worsen the acne outbreak.
  • In earlier studies, the association between the consumption of dairy products and the possible outbreak of acne has also been brought to light but the evidence is not strong enough to back the association.
  • Other food contents such as dietary fibers, Vitamin A, zinc, natural antioxidants and health fatty acids (omega-3) are still to be further researched upon in order to find out their role in the either curbing or allowing the acne to proliferate and get worse.

If the reasons behind regular visits to dermatologists all across the globe are drawn out, then it will come as a shock to many that most of these visits are because of acne. adults form the majority (62%) of the total acne patients and this major chunk is comprised of both men and women. On every regular visit to a dermatologist because of acne the one main question which every person suffering from acne asks the dermatologist “Is my diet causing the acne?”

The overall link between foods and the outbreak or intensifying symptoms of acne have been a point of intense debates. The time period before 1960s when there were no studies regarding the outbreak of acne and the underlying food causes, it was assumed by the dermatologists that given the nature of certain foods e.g. fats, food rich with glucose and chocolate may be the reason behind the onset and proliferation of acne. not only these foods were thought to be dangerous for the patients at the risk of developing acne it was also though that if during the outbreak of acne the consumption of this type of diet is sustained then the acne may easily and rapidly get converted into severe acne.

In the December 1969 issue of The JAMA Network, a study was published focusing on the alleged role of chocolate and other derivatives in terms of causing the acne. James E. Fulton Jr., MD, concluded in the study that even when the test group was administered with increased amount of chocolate and derivatives in their food the level of sebum produced remained the same hence proving that the consumption of chocolate and other such foods do not alter the metabolism of the pilosebaceous glands.

Certain other scientists in that particular era targeted other genres of food products mainly dairy products and found similar results that there was no positive association between the increased intake of such foods linked with the adverse progression of acne or its onset. These studies were a proof enough for the dermatologists to believe that the link between acne and food nutrition is just a myth and the same has been communicated to the acne patients by the dermatologists for many years until recently.

All of such studies, carried in the late 60s and early 70s, were not long term studies and they failed to take into account the usual diet which the participants were on before the start of the study. This and several other factors have deemed the studies faulty which disproved the possible link between acne and the diet.

The relation between diet and acne symptoms is recently discussed in detail by Whitney P. Bowe in her review, published in Journal of American Academy of Dermatology. According to the study, the misconception that there is no link between acne and the type of diet is not applicable now. the studies carried out recently have confirmed the possible link between acne outbreak and the consumption of dairy products. While this link is weak, but the link found between high glycemic load diet and acne has been found to be more convincing one. Low glycemic diet is taken as a part of cystic acne treatment so that acne outbreak can be controlled.

Robyn N. Smith and fellow researchers carried out a randomized control trial on people suffering from acne and altered their diet with food of varying glycemic quantities, published in the Journal of American Academy of Dermatology. After a period of 12 weeks there was a conclusive decrease in the number of lesions reported in the experiment group as compared to the control group. The study highlighted the decreasing glycemic content of the food directly associated with the insulin sensitivity of the body. Diet having a low glycemic load was also directly related to the decrease in the weight of the body and the total energy intake of the body.

The study of Robyn N. Smith points towards an obvious connection between acne outbreaks with the increased intake of High Glycemic Load diet. Before restrictions and dietary recommendations to be adopted for the acne patients can be chalked out, it is necessary that a carefully designed randomized control trials be performed to pin point the exact way in which HGL diet contributes towards the outbreak and greater incidence of severe acne while a LGL diet does the exact opposite. Doing so will allow the acne patients to tackle the progression of cystic acne with the antibiotics as well as the diet so that it is challenged on both fronts.

Cystic acne treatment would be more effective if diet is watched out for acne our break.

Oral Contraceptive Pills As Cystic Acne Treatment

OCPs have two way-action. In some cases, it causes acne due to progesterone, and in most cases, it reduces hormonal cystic acne.

As contraceptive pills regulate hormones, suppressing some while elevating others, they are known to cause elevated oil secretion and hence, acne.

OCPs containing progesterone sometimes cause acne. Due to which acne is becoming more and more common among young and sexually active women. In many cases, physicians will recommend to stop taking these contraceptive pills for some time, in order to reduce acne symptoms, but this is a double-edged sword, as it increases chances of women becoming pregnant which can further increase the chances of developing acne, as discussed earlier.

Since every birth control pill contains progesterone, which, as mentioned previously, causes sebum producing pores to open, elevating oil secretions, and making the body prone to retain water, thus increasing chances of developing acne, as chances of bacterial infection increases.

A Potent OTC Treatment For Acne

But, on the other hand, oral contraceptive pills are well-known Over The Counter (OTC) treatment for acne as highlighted in the study carried out by Julie C. Harper published in Dermatologic Clinics. According to the study, Combination Oral Contraceptive pills (COCs) have a key role in reducing acne in the women suffering from hyperandrogenism-triggered acne.

OCPs help in hormonal regulation in women suffering from different hormonal diseases. In such a woman who has severe hormonal trouble, OCPs help in reducing hormonal cystic acne by hormone regulation.

If you are interested in getting to know more about the role of oral contraceptive pills in alleviating or worsening acne, then an elaborate discussion on the potential of contraceptive pills is published in an E-book on how to beat acne.

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