What are cystic lesions?

Cystic lesions, also known as acne, are solid blockages that form in clogged hair follicles due to the buildup of excess oil, dead cells, and bacteria. Acne can manifest itself to varying degrees and affect people of any age or skin type. Treatment for cystic lesions generally involves the use of over-the-counter or prescription medications, depending on the severity and prominence of the lesions. People who experience scarring due to severe acne can take corrective measures to improve the appearance of their skin.

There are three known elements that can contribute to the formation of cystic lesions. Oil, dead skin cells, and bacteria can combine to block skin pores, and these blockages can manifest as irritated, inflamed lumps or cysts just below the skin's surface. Excess sebum, or oil, production combined with a buildup of dead skin cells can also cause hair follicles to become clogged, leading to the development of acne. It has been claimed that increased sebum production can be induced by fluctuations in hormone levels, heredity, or the presence of bacteria. There is an ongoing dispute within the research community as to whether or not diet contributes to the development of acne.

People with acne typically experience breakouts on the neck, face, shoulders, and back. Breakouts are usually limited to these areas due to the high concentration of oil glands in these locations. Acne does not always manifest as raised, inflamed bumps on the skin. Cystic lesions can manifest to varying degrees.

Comedones are mild blockages that appear near the surface as whiteheads and blackheads. Papules and pustules are swollen areas that indicate infection or irritation in a hair follicle, may contain pus, and may be tender to the touch. Nodules and cysts are larger blockages within hair follicles, they form deeper in the skin and contain pus. Larger cysts are solid in composition, painful to the touch, and have the potential to scar.

People with severe acne may want to seek professional medical advice to treat persistent breakouts that do not respond to over-the-counter treatments. During an office visit, a doctor may take a complete medical history, ask a series of questions about the frequency and severity of flare-ups, and perform a preliminary exam. The doctor may refer the individual to a dermatologist.

Treatment of cystic lesions focuses on four goals: reducing oil production, preventing and fighting bacterial infection, promoting cell turnover, and alleviating inflammation. Any treatment regimen can take up to eight weeks to start relieving symptoms. Over-the-counter (OTC) treatments are generally mild in chemical composition and promote the shedding of dead skin cells, the drying of oils on the skin, and the eradication of bacteria. Side effects associated with over-the-counter treatments can include skin irritation, skin peeling, and an initial worsening of symptoms.

For those people who can't find relief with over-the-counter treatments, prescription medications may be the next step. Dermatologists often recommend the use of oral or topical acne medications. The use of oral acne medications may reduce the effectiveness of oral contraceptives and should not be used by women who are pregnant or may become pregnant.

People with moderate to severe acne may be prescribed an antibiotic to fight infection and relieve redness and skin irritation. An isotretinoin may be recommended for people with severe cystic acne. The use of antibiotics and isotretinoins can induce side effects that may include increased skin sensitivity, muscle aches, and excessive drying of the mouth, lips, eyes, and nose. Women with moderate to severe acne may be prescribed an oral contraceptive to relieve their acne symptoms, however, an increased risk of heart attack, blood clot, and stroke may accompany oral contraceptive use.

Prescription topical medications work by preventing clogging of hair follicles and promoting cell regeneration. Individuals may also be prescribed topical antibiotics for use in combination with other topical medications. Those who use a prescription topical medication may experience side effects that may include increased skin sensitivity, excessive skin dryness, and a temporary worsening of symptoms.

Laser and light therapies can be performed to target oil and bacteria production to reduce inflammation, improve skin quality, and decrease scarring. Cosmetic procedures may also be performed to correct scars associated with severe acne. Procedures including dermabrasion, microdermabrasion, and collagen injections can be used to reduce the appearance of scars and even skin tone. Severe cases may require surgical scar correction, known as excisional needling, which involves cutting the acne scars which are then closed with a skin graft or sutures.

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