We all know the feeling of waking up the morning of an important event only to find a painful, deep, and hard-to-cover-up acne spot on our faces. As a near-universal experience, the feeling of developing unwanted acne is something that almost everyone can relate to — so why haven’t we been able to find a cure?
Known primarily for being more of a nuisance than a serious medical condition, acne is the most common skin condition in America. Currently, statistics estimate that acne vulgaris (the medical name for acne) affects upwards of 50 million Americans every single year¹.
Acne is often associated with entering puberty and your teenage years. It is important to note that it is also common for adults to experience regular acne breakouts during times of stress, hormonal fluctuations, or as a result of other medical conditions.
In one study, it was found that up to 54% of women and 40% of men older than 25 were living with some degree of regular facial acne — which is still a relatively high percentage when compared to the 76-95% of teenagers between the ages of 16-18 who are experiencing regular facial acne due to puberty² ³.
Depending on various factors, the type of acne that a person may experience can differ from individual to individual. Ranging in type and appearance, from mild blackheads and whiteheads to painful and often deep-feeling acne cysts and nodules, the location, severity, and frequency of a person’s acne breakouts are often unique to the individual⁴.
So, if acne is such a widespread issue, why don’t we have a fool-proof solution designed to prevent acne from showing up in the first place?
While acne is triggered and caused by a wide variety of different factors, traditional acne treatment options do not necessarily prevent a breakout from starting. Historically, traditional acne treatment methods are more focused on practicing good hygiene and regularly cleaning the face to reduce the build-up of pore-clogging oils — all of which are helpful but do not target the underlying cause of the breakout.
Looking to explore other options, new research has shown that our fat cells (yes, the fat cells that we all would be fine having a few less of!) are actually integral to our ability to fight off acne when paired with an effective skincare routine.
So, as it turns out, there may be a more effective way to keep your acne away — and the secret may have been just beneath your skin the whole time!
Before we explore treatment options for chronic cystic acne, we need to understand how and why we are susceptible to this skin condition in the first place. Skin is the largest organ in the human body and is an essential protective barrier that keeps us safe from surrounding elements. As much as we would like to think that our skin is an impervious layer of tissue, it actually contains millions of small indentations called pores, which connect our oil glands and follicles to our outermost layer of skin.
Throughout the day, the glands beneath our skin produce an oily substance called sebum. Sebum is designed to help carry dead skin cells out of the pore to be shed from the body, as follicles can develop blockages, resulting in a build-up of oil under the skin's surface. When this occurs, the plug of oil and dead skin is susceptible to becoming infected by bacteria (often by Propionibacterium acnes, which is a strain of bacteria naturally found under our skin) which in turn results in swelling, the development of pus, and the creation of an acne lesion⁵.
While it makes sense to think of acne as small blockages of oil and debris, it is more difficult to pinpoint what causes these events to occur in the first place. Despite the fact that almost everyone has experienced acne during their lifetime, the specific reasons why an individual may develop an acne breakout can be due to a wide variety of different causes. Examples of some of the most common causes of acne include⁶:
Commonly associated with puberty, an increase in androgen and estrogen hormones in the body triggers an increase in oil and sebum production. This increase can lead to a greater risk of pore blockages and the formation of deep cystic acne spots.
There is some level of genetic involvement in acne breakouts, especially among those who experience more severe cystic acne regularly. Having a close family member with severe acne increases your risk of experiencing painful acne breakouts.
Teenagers, typically those undergoing the changes of puberty, are the age group most commonly associated with acne. This being said, it is possible for young children as well as adults to experience acne breakouts as well.
Acne is a possible side effect of corticosteroids and lithium-based medications, which are most commonly used to treat other medical conditions. Depending on the severity of a person’s acne, they may need to make adjustments to their treatment to reduce the prevalence of their acne breakouts.
While beauty companies often market their products as clean and good for the skin, regularly applying oil-based foundations and cleansers can irritate or clog the pores, resulting in the formation of acne.
Looking to finally crack the code on chronic acne, many researchers have been working to find new treatments and therapies designed to target acne and prevent future breakouts. One exciting new study has found a connection between the connective tissue cells of our skin and the ability to avoid an acne flare-up.
Fibroblasts are the most common type of cells that make up our connective tissue. Responsible for producing collagen proteins, these cells help to make and maintain the structural framework for our skin and other tissues in our body⁷. In most cases, fibroblasts are found deep in our skin tissue, meaning that they were not considered to be involved in the process of developing acne — until now.
In a study conducted in 2022, a new subset of fibroblast cells was found closer to the surface layer of the skin⁸. Identified to be the precursor to our subcutaneous adipose fat cells, these fibroblast cells are particularly vulnerable to being triggered by Cutibacterium acnes, which is one type of bacteria that is responsible for causing inflammation and acne⁸.
Once exposed to the bacteria, the study showed that the fibroblast cells were stimulated to transform into subcutaneous fat cells in a process called reactive adipogenesis⁸. During this transition, the cells also release a peptide called cathelicidin, which is known to have antimicrobial properties in response to acne bacteria infection⁹.
In this way, researchers believe that creating fat cells is a protective measure that the body takes in order to fight against acne infections.
In addition to this breakthrough finding, this study also found that retinoids (a class of compounds that derive from vitamin A) may be able to further support the fat cell’s ability to fight off acne.
Already a popular ingredient in skincare products, retinoids are known for their ability to prevent dead skin cell build-up by promoting increased skin turnover¹⁰.
But, in addition to this benefit, researchers found a connection between retinoid therapy and increased cathelicidin production⁹.
This finding is a ground-breaking advance in the future development of preventative acne treatments. From topical to oral treatment options, continued research on the impact, safety, and efficacy of retinoid therapies are imperative to finding a more sustainable way to combat the many long-term social, mental, and physical impacts that chronic acne can cause.
As we continue to make strides to find new and innovative acne-fighting therapies, there are current treatments to help reduce the impact of your acne flare-ups at any age.
While we currently do not have a fool-proof solution to getting rid of acne once and for all, dermatologists have been working for decades to develop helpful advice strategies to combat some of the long-term complications of chronic cystic acne.
Regardless of age or gender, dermatologists highly recommend access to acne treatment as early as possible to give the best possible outcome.
If a child or teenager can work with skin specialists as soon as they begin to develop symptoms of acne, they are more likely to experience a wide host of benefits, including:
Like any other medical condition, early diagnosis of acne is the best way to get immediate access to effective treatment. Instead of waiting to receive treatment when your symptoms become profound, getting early support in managing chronic cystic acne is one of the best ways to prevent severe flare-ups before they even begin.
For those with deep cystic acne, constant picking and cleaning of the skin can actually result in lifelong acne scars, which can interfere with confidence and self-image. While acne scarring is quite common (with an estimated 43% of all people who receive dermatological care for acne having them), early treatment can help to prevent severe acne breakouts and will reduce your risk of experiencing profound scarring¹¹.
As more and more people are experiencing acne for a longer duration, getting early access to specialist care can help reduce the length of time you are living with chronic acne. Whether you are prepubescent or in your 40s or 50s and are struggling with cystic acne, seeing a dermatologist can be a helpful step in getting the care you need.
While acne is a near-universal experience, many people still hesitate to seek medical care for their symptoms. But, despite the majority of acne symptoms being cosmetic in nature, studies have shown that chronic cystic acne can significantly impact a young person’s psychosocial health.
Depending on the severity of a person’s acne, research has shown that poorly controlled acne can lead to increased feelings of anger, fear, anxiety, and depression while also increasing a person’s experience of bullying¹².
In extreme forms, these negative feelings about oneself can lead to more significant issues later in life, including social isolation, lack of self-confidence, feelings of insecurity, and possible suicidal thoughts¹³.
In most cases, the impact of acne on relationships, social life, and self-worth is more prominent in adolescents, but research does also indicate that adults with acne can also experience adverse health outcomes if they do not receive the correct treatment they need for their acne¹².
So, aside from waiting to experience the potential benefits of acne treatments in the future, what else can a person do if they are currently struggling with chronic acne?
While not every acne treatment will be well adjusted to your specific needs, there are a few rules of thumb that are worth following when preventing acne breakouts.
Whenever possible, following these few steps when taking care of your facial skin can help to keep your acne at bay and will hopefully prevent a full-blown flare-up¹⁴:
Wash your face twice a day, especially after participating in physical activity
Clean your face gently to reduce the risk of injury, and avoid scrubbing whenever possible
Use alcohol-free cleansers and avoid any products that irritate your skin
Use lukewarm water to prevent additional drying of your face
Shampoo your hair regularly to reduce the amount of oil on your scalp
Avoid picking at acne and allow your skin to heal naturally
Clean your pillow and other linens often
Always wear sunscreen and avoid excessive exposure to UV rays
If you are noticing that your acne is causing a significant change in how you view yourself or is impacting your desire to see friends or family, we recommend that you consult with a dermatologist for extra care.
While this may seem dramatic for a condition that does not cause any real “harm” to the body, getting access to the proper care and treatment that you need to feel more confident in your own skin is essential for maintaining a healthy sense of self.
While researchers are still working to crack the code on eliminating acne, taking these steps and working with a specialist is currently our best defense against this incredibly common skin condition.
Hopefully, in the not-so-distant future, advances in acne treatments (based on our existing anatomy and retinoid therapy) will be able to help teens and adults live without the physical and psychosocial impacts that chronic acne can cause.
Skin conditions by the numbers | American Academy of Dermatology Association
What is acne? | Acne.org
Acne | Mayo Clinic
Fibroblast | NIH: National Human Genome Research Institute
How do you prevent pimples? (2022)