My Cystic Acne Left Me With Scars — Here’s Why, According to A Dermatologist

November 16, 2021
Samantha Holender
By: Samantha Holender | by L'Oréal
My Cystic Acne Left Me With Scars — Here’s Why, According to A Dermatologist

My skin has run the gamut on the acne front. Whiteheads on my forehead, blackheads on my nose, cysts on my cheeks — you name it, I’ve had it. Yet even though my pimple-prone skin got better with age (and a heck of a lot of skincare!), the cystic acne from my teenage years has left a handful of permanent scars on my complexion. The discoloration from my whiteheads and blackheads faded over time, but the painful, large, and deep-rooted cystic pimples left their mark. To find out why cystic acne scarred my skin more than other types of pimples, I turned to board-certified dermatologist and consultant Dr. Morgan Rabach from L.M. Medical.

Why Does Cystic Acne Scar More Than Whiteheads and Blackheads? 

Cystic acne is more prone to leave a scar on the skin largely because of where it forms. While whiteheads and blackheads, or comedonal acne, form on the surface level of the skin, cystic acne can affect the deeper levels of the dermis. “Blackheads and whiteheads are very superficial and associated with the top layer of the skin, the epidermis,” says Dr. Rabach. “A cyst, on the other hand, forms deeper in the dermis when dead keratin cells load up in the sebaceous gland and fill it up until the walls just close, like a grape under the skin.” She explains that due to its location, a cyst has no direct connection to the outer surface of the skin, can’t readily be popped, and cannot readily find a release for the buildup of pus and inflammation. In other words, “a cyst is situated in the dermis, below the skin cells and in the layer of collagen.”

A cyst’s origin is directly related to its tendency to scar. “Below the epidermis, you have a layer of collagen and elastin where your blood vessels and nerves are,” says Dr. Rabach. “And when you have a big ball of debris, keratin, dead skin cells, pus, and inflammatory cells (aka your cyst), it actually moves the collagen away and makes it less dense in the area.” This loss in collagen can create dents on the skin’s surface, shadowing, and permanent scarring, as opposed to post-inflammatory hyperpigmentation associated with more surface-level acne. 

As noted, the deep-rooted nature and heavy inflammation correlated with cystic pimples can cause a loss of pigmentation, or melanocytes, in the collagen layer. “The body issues a stress signal in order to get rid of the infection, and as a result of moving the pimple out of the way, melanin drops out of the cell and leaves a scar behind,” says Dr. Rabach. What’s more, if you have cystic acne and get frequent attacks to the same area, your scarring will likely be worse. “If you get multiple heads to the same area, the collagen doesn’t have time to go back to normal. It’s like a scraped knee that you scrape again — you’re dealing with damaged tissue that hasn’t healed before damaging it again.” 

Tips to Address Cystic Acne

While there are a handful of products or in-office procedures, such as micro-needling, that can reduce the appearance of scarring, Dr. Rabach emphasizes the importance of taking preventative measures and working with your dermatologist. “Spot treatments and pimple patches don’t really work because they’re not able to penetrate to the depth the cyst pimple is at,” she says. Instead, she suggests having a conversation with your board-certified dermatologist to discuss antibiotic treatments and cortisone shots that can help manage cystic acne. Your dermatologist may recommend that you incorporate a retinol (one we like is the La Roche-Posay Effaclar Adapalene Gel), into your routine. In Dr. Rabach’s opinion, “It’s the most successful ingredient in terms of reducing the appearance of pore size and helping with excess oil production because it helps clear out dead skin cells and resurface the skin.” 

Photo Credit: Chaunte Vaughn

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