Why do I Still Have Acne?

In my mid-20s I thought I escaped the dreaded reality that plagues so many. I was able to get through my adolescent years counting the number of pimples I had on one hand. Then it happened. I started getting hard, painful, cystic lesions that seemed to pop up out of thin air. 

The truth is experiencing acne is almost universal. According to the American Academy of Dermatology “approximately 85 percent of people between ages 12-24 experience at least minor acne.” Unfortunately, this is not just a problem for your teenage years. Acne can occur at any stage of life and may continue into your 30s, 40s, or later. 

If you are experiencing acne you are not alone!

Acne types range from a simple blackhead or whitehead to a large painful cystic lesion. Cysts and nodules are the most severe type of acne lesions and are typically referred to together as nodulo-cystic acne. These bumps are large, deep, painful, and can be blood or pus-filled. If left untreated these types of lesions can linger for weeks and cause scarring. Wonderful, right? So let’s talk about the nitty-gritty and get down to what causes the problem and your options to treat it. 

DEFINITIONS: 

Nodule: Elevated, solid, lesion greater than 1 centimetre located in the deeper layers of the skin. 

Cyst: Nodules that contain fluid or semi-fluid material.

If you are seeing a cyclical pattern to the appearance of your cystic lesions and they are concentrated on the chin, cheeks, and jawline, aka the “U-zone”, then changing monthly hormones could be playing a role in your acne. 

This type of acne is deep to the surface of the skin and is more likely to cause scarring. I don’t recommend spending a lot of time treating it with over-the-counter options, which only work close to the surface of the skin and are helpful for less severe types of acne. 

Don’t try to treat this type of acne at home, especially if you are seeing signs of scarring. Resist the temptation to pop nodules and cysts because you could cause more scarring! Keep your skin clean, but don’t overdo it! Many acne-fighting products can cause irritation to the skin leading to more inflammation. This only exacerbates the inflammation that is already present. 

Your situation is unique and needs an individualized plan of action. During a consultation, we can discuss a long-term plan that can include medical-grade skincare and/ or oral medications (medications you take by mouth) if necessary. Some patients may need procedures like chemical peels to help with the active acne lesions and the pigmentation it may leave behind. 

Injection of a low-dose corticosteroid can decrease the localized inflammation and rid that pesky lesion within hours to days versus weeks that it can typically take to resolve the problem on its own. In my practice, this is lovingly called an “acne shot”. 

It is important to remember that nodulo-cystic acne is not going to go away overnight. It takes time, guidance, and the right combination of treatments to clear your skin and tame this unwanted problem.