How can I treat painful cystic acne that keeps worsening?

Question

Hello doctor,

I am going through the worst and most painful cystic acne. They are very deep and clogged with blood, but they are not hard and are very soft. Whenever I sleep at night, blood comes out through the acne, and they are not even healing. It is just getting worse day by day.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I know how distressing long cystic acne can feel, especially when it causes pain, swelling, and bleeding. You are not alone, and this is treatable with the right approach.

At this stage, calming the inflammation, preventing new breakouts, and protecting your skin barrier are essential. I am giving you a step-by-step treatment plan to manage it effectively.

For treatment, in the morning and at night, use a gentle cleanser.
Apply Clindamycin 1% gel in the morning, using a thin layer only on active acne lesions, followed by a noncomedogenic moisturizer suitable for sensitive skin.
After this, apply a broad-spectrum sunscreen every morning, even if you are indoors, as sun exposure can worsen redness and make acne marks darker.
Use any oil-free, acne-safe sunblock suitable for sensitive skin.

At night, cleanse your face gently and apply Adapalene and Benzoyl Peroxide gel in a pea-sized amount for the entire face at bedtime, starting two to three nights per week and gradually increasing as your skin adjusts. Always follow it with a moisturizer to reduce dryness and irritation. Mild redness or dryness in the first few weeks is expected and usually settles with continued use. This will help with acne, comedones, and scars.

For cysts, take tablet Doxycycline 100 milligrams per day orally, one hour after breakfast with water, for at least one month (avoid if pregnant or lactating).

Please avoid scrubs and harsh face washes, and avoid picking or squeezing acne, as these significantly worsen redness and scarring. Consistency is key, and visible improvement usually takes eight to twelve weeks.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.