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What can be worse than ugly red pimples that make your face look like a medical textbook case study? Answer: ugly, LARGE acne cysts that hurt almost with every step you take. It is the sad fate of many an acne sufferer to progress from a mild or moderate form of acne to cystic acne, which is in a different league altogether. Ask Shari Thomas, a 33-year-old homemaker and mother of two who suffered so intensely from the physical and mental scars left by cystic acne that she went into clinical depression necessitating long-term treatment.

The 'baddest' of them all

The principal trouble with cystic acne, says dermatologist Dr Andrew Waite, is that it takes ages to clear up because it responds so slowly to treatment. "Cystic acne lesions can lead to long-term scarring," he says. "The infections that cause acne cysts usually lodge deep beneath the skin and therefore do not discharge infection waste, as a result of which cystic acne does not heal easily."

Perhaps we should go back a little here. As we all know, any kind of acne is bound to produce a certain degree of inflammation. This is the reason why most treatments of acne aim to reduce inflammation. So far so good, but what happens when what is an ordinary pimple bursts open to spread the infection to its surrounding areas?

Unfortunately, that happens more often than you would think, primarily because most people cannot resist picking at or bothering their pimples in some way. And once the pimples burst, it is only a matter of time before the surrounding tissue gets affected and starts forming acne cysts. Quite apart from the fact that these cysts can leave long-lasting scars, they are also excruciatingly painful. As Shari says of her ordeal, "Every waking moment was agony and it seemed the only way I could sleep was to take sedatives."

Confronting the cysts

Obviously, given their extreme nature, acne cysts need firm handling - only in the figurative sense, that is. The first step is to see a dermatologist, who will discuss all the available treatment options with you before prescribing one. According to Dr Waite, if the acne cysts are really severe, a dermatologist will prescribe isotretinoin.

Thereby hangs a tale. Isotretinoin is a retinoid, which means that it derives from Vitamin A and occurs naturally within your body in small quantities. Oral isotretinoin is marketed under various trade names, most commonly Accutane. Other trade names include Amnesteem, Claravis, Decutan, Sotret, and Roaccutane. Isotretinoin is also marketed in topical form, under the trade names Isotrex or Isotrexin.

A single course of oral isotretinoin will last between four and five months. In most cases, it will clear up cystic acne forever, because it reduces the size of the sebaceous glands (instrumental in the onset of acne because they trigger an acne attack by producing excess oil or sebum) to the extent that they virtually stop producing sebum and thus cease to provide a breeding ground for acne-causing bacteria.

What not to do

However, as is the case with all antibiotics, isotretinoin cannot be administered to certain groups of people. For instance, isotretinoin has been linked to foetal abnormalities, and is strictly forbidden for pregnant women or those trying to conceive. Likewise, those suffering from depression or other forms of mental stress should not take isotretinoin because it could lead to further mental irregularities.

Other than antibiotics, acne cysts rarely respond positively to milder forms of treatment. So treat pimples with extreme caution. Shari, who administered a warm compress to her pimples to make them burst open so that they ceased to populate her face, says she has never stopped regretting her foolish act. "If you have pimples, apply benzoyl peroxide and keep your face clean. The moment you interfere with them, you throw yourself open to acne cysts," she says. Wise words.

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