There are so many things circulating on social media about cystic acne treatment, but how do we separate reality from random trends with no basis? Dr. Dustin and Cassandra are here to sift out the non-sensical.
Manuka honey will get rid of inflammation.
Dr. Dustin says, “Honey does have healing properties, but cystic acne is a deep inflammatory condition inside the body, and we’re not going to get a lot of effect from honey on the skin. It’s not going to penetrate deep down within the skin. It’s not going to modulate the intense inflammation because cystic acne occurs at deep levels of the skin.”
Eating clean will cure your acne.
“It’s easy to fall into the fallacy that you have to change your diet and drink more water in order to cure your acne. However, there’s not a lot of evidence to support that,” Dr. Dustin says. “Skim milk and high glycemic food like junk food may exacerbate acne in some people, but that doesn’t necessarily mean it’s causing it. There’s not even data which suggest that whole milk causes acne. On the other hand, whey protein can exacerbate acne so choosing vegan protein powders can help. There are going to be a lot of studies over the next decade about the gut microbiome and the skin microbiome. So, we’re going to learn a lot about the way our gut interacts with the outside of our bodies.”
“When it comes to diet and skin, everyone has a different story,” he continues. “Some people’s acne clears up when they stop eating things like pizza, but MDs give recommendations based on evidence. We go by population data, not by anecdotal reports. I have to make recommendations on the evidence that’s currently available.” Cassandra adds on that “she cut dairy out of her diet.” She says, “This definitely helped, but there are other factors that made an impact like understanding stress and learning about my skin.”
African black soap is always a good cleanser for acne.
Dr. Dustin suggests that “this is not a bad choice for acne and oily prone skin.”
“It has sulfur in it which can be a really good and underrated ingredient for managing acne. However, some people will get dried out a little too much. So, if your skin gets dried out from it, you may need to a gentle cleanser that’s more hydrating. Also, they do make some African black soap with shea butter.”
Cassandra adds that she’s actually have used African black soap. “The one thing about soaps, especially more traditional soaps, is that they’re a little bit more alkaline (higher, less acidic) on the Ph scale. Your skin is slightly more acidic because that’s what helps it create an acid mantle and a barrier that protects your skin’s microbiome from the outside world. So, it’s best not to overstrip and dilute that too much. If you’re using other products like a toner that can even out your Ph, that’s good.
Neutrogena Oil-Free Moisturizers are wonderful for acne.
Dr. Dustin describes these as “an okay choice.” “Neutrogena offers a lot of fragrance-free options, but they’re not my go-to for a daily moisturizer,” he says.
Cassandra mentions how she used Neutrogena oil-free moisturizers in her youth. “I used this one in my youth because I thought that oils were invariably bad for acne. However, oil can be beneficial if it’s in the right formula. Don’t be afraid of oil if you have super dry skin and acne. Hydrating your skin is very important. As long as it’s not stripping to your skin, you can look to a moisturizer that has salicylic acid, a gentle form of exfoliation, or even sulfur to mitigate acne when hydrating your skin. You can even use adapalene gel along with a moisturizer.
Thayer’s unscented witch hazel Is a cure-all
Dr. Dustin has found that this is not a horrible product, but he qualifies it as “an unnecessary step.” “There are definitely other astringent toners that are way worse for you. If you’re using it with other products, it’s not the worse, but it’s not going to cure acne. “
Hydrogel bandages treat acne.
Dr. Dustin recalls how there was a viral trend where a guy put patches all over his face overnight. “This is not a treatment or for the entirety of your face. I find them particularly good for healing wounds, cuts, and scrapes. If you have a big cyst, they help create a healing environment, but they’re not a treatment by any means. Hydrocolloid bandages and pimple patches are reactive treatments. They can be helpful especially if they have drug delivery in them. Microdarts do this. If you want to ease the appearance of a lesion because you have an event that you need to go to or something, they’re okay. But, if you need to use them frequently, you need a better skincare routine or you need medication from a dermatologist.”
In Cassandra’s experience, she’s “appreciated hydrocolloid bandages.” “While they’re not a treatment, I love how inexpenive they are. I especially like the salicylic acid ones. As for the hydrogel bandages, don’t rip them or press them in like some people do on TikTok. By pressing a bandage in, you could be irritating or inflaming the acne. By tearing, you could potentially rupture some cell walls or some pilosebaceous units. That’s also why you shouldn’t pick at your skin. Make sure that you focus on surrounding one blemish as opposed to putting them all over your face.”
Just get on accutane
Dr. Dustin expresses how “seeing a dermatologist isn’t easy.” He conveys how “many family doctors are not comfortable prescribing Accutane or maybe they don’t have the staff to support the process of all that’s necessary for prescribing Accutane. Moreover, even with telehealth, which makes things more accessible, there are problems. You can only do telemedicine with a patient that lives in a state you’re licensed in. Otherwise, it’s illegal. It’s a very long and expensive process to get a license in another state, and unfortunately, they expire. Furthermore, every state has CME (continuing medical education) requirements, and it’s hard to keep up with them.”
“As for Accutane appearing on TikTok to be the only solution, Accutane isn’t always the first line of treatment for everyone,” he continues. I don’t jump right into Accutane as the first treatment. We go through topical medications. We go through other oral medications like antibiotics or sometimes something called spironolactone. And even when we do prescribe Accutane, sometimes we have to prescribe Prednisone which is a steroid. We do this because there’s a risk of scarring when you take Accutane. Acne can initially get worse from Accutane, and the only way you can modulate that is through steroids.
Cassandra also specifies how “if you have a uterus, you need to be on two forms of birth control to take Accutane as well. You need to make sure that you don’t have issues with the synovial fluid in your spinal cord, and you need to make sure that you don’t have preexisting conditions. For the right patient, Accutane can be helpful, but we have to tread with caution when looking to TikTok for cystic acne solutions.”
Dr. Dustin Portela