How can a 35-year old male treat facial cysts?
January 27, 2010 1:21 PM   Subscribe

How can a 35-year old male treat facial cysts?

I am a 35 year old male who experienced moderate, and sometimes severe, acne from ages 18-27. It led to real depression. That whole period was a blur of seeing doctors, staying inside, obsessing and feeling low nearly to the point of suicide. I was previously considered handsome and felt like after college I'd turned into an antisocial leper.

Back in those days I would wake up to 2-3 new whiteheads every day that would (sorry) explode and bleed. My diet was fine and health otherwise normal. But my face looked terrible. I tried and tried to find diet and other lifestyle patterns that would exacerbate it, but there were no patterns. I slowly became shy and continue to be so.

During that time, I tried the following, as recommended, to no avail -

-accutane (twice)

None of it had an noticeable effect.

Then like a miracle in 2003, a new doctor recommended Bactrim which cured my skin completely from 2003-2008. None of my various doctors could explain why it worked, but I didn't care. For those 5 years, I was so carefree. I went out. I talked to people. I thought acne was behind me.

But in 2009, my skin began reverting to its old ways. One awful weekend last spring, I had 8 huge cysts, 4 on both sides of my face. I looked like something was seriously wrong with me. Turning over on the pillow would wake me up at night because of the pain. I went on Bactrim again right away, but I'd obviously become immune to it.

To make matters worse, I have observed absolutely zero males my age with a problem this bad. In the last few months it's only gotten worse. I've found myself becoming reclusive all over again, avoiding people at my job. I actually have a good job these days, a new job that requires some confidence and sociability and face to face interaction with clients. I feel like such a freak.

I know many of you will say - we can't help, see a doctor. I have seen 6 doctors in 10 years and none of them have been willing to look at any root problems. They shrug and say, "Have you tried benzoyl peroxide?" etc. No one has asked about hormones or any other deep-down issue that could possibly make a 35 year old male have persistent cystic acne. I have seen a few women my age with mild acne, but no males with multiple, noticeable cysts.

(I did get some relief back in the bad old days once when a doctor used cortisone shot one me. Is that something that would be seriously risky if I tried it myself? I've always assumed it was benign enough, but they obviously don't sell cortisone shots in the pharmacy or anything.)

As you can probably tell, I'm desperate. I'm frustrated, I'm embarrassed and I feel like I'm at my wit's end. I wasted my 20s hiding out from life because of acne and I don't want to go back there. I would drop money on a miracle surgery if I thought it would make this problem go away.

After so many doctors and so many drugs - what else, on a deeper level, could be wrong with me?
posted by anonymous to Clothing, Beauty, & Fashion (24 answers total) 4 users marked this as a favorite
No solutions when it comes to your creams and whatnot, but have you tried sleeping on a towel?
posted by unixrat at 1:30 PM on January 27, 2010

Unfortunately, one of the things that on a "deeper level" that could be affecting this is just genetics.

I too get cystic acne (not to the degree you get it, and not so much on my face), and so did my father. In fact, I get it FROM my father; we're just both prone to cysts in general. (I've also had a couple cysts in my breasts, and one in...another place). As we speak, I've got one at the corner of my mouth that's on its way out, only to be joined by another small one on top of my upper lip.

I know you're leery of seeing the doctor again, but -- clearly, that one doctor who original prescribed you the Bactrim knew you well enough to know that that might work. Have you considered seeing that doctor SPECIFICALLY, because he will at least have been familiar with your prior history? Plus, at one time it did work for you, and now it doesn't; perhaps he can figure that out.

In terms of short-term solutions -- well, I'm female, so I do have the natural "out" of being able to cover any cysts up with makeup. But that made me wonder -- have you considered growing a beard? I know that seems like a weak solution, but...if it is indeed possible that there's a genetic aspect to things, and you may not be able to completely erradicate them (I've given up on my own ever totally going away), that may at least help with camoflauging things.

But even as I type that I'm cringing at how lame it sounds, and I do sympathize.
posted by EmpressCallipygos at 1:30 PM on January 27, 2010

I'm female, mid-30's, and I have cystic acne only when caffeine is part of my diet. You may have tried this already, but I thought it was worth a suggestion - my skin is like a normal person's as long as I stay away from caffeine completely. I can't believe how many years it took me to figure that out.
posted by something something at 1:32 PM on January 27, 2010 [1 favorite]

Have you seen an endocrinologist?? They are all about the root problem, if you do indeed have a hormonal component to your skin problems.
posted by Kololo at 1:46 PM on January 27, 2010 [1 favorite]

I know you mentioned you looked at diet, what is your diet? Have you tried something drastic like spending 30 days as a raw food vegan and seeing how that effects your skin?

I suggest you keep an exhaustive food log and try adding and removing foods, and tracking how that effects your acne. Tend toward healthier foods(salads, fruits, nuts and seeds) and see if that has any effect.
posted by satori_movement at 1:49 PM on January 27, 2010 [1 favorite]

Nthing Satori Movement on diet - not just a 'healthy diet' but all vegan, raw stuff, no caffeine, no sugar, no meat. Have you tried this? Be sure to eat lots of sprouts of various kinds and drink lots of wheat grass juice (make your own).
posted by zia at 1:58 PM on January 27, 2010 [1 favorite]

After so many doctors and so many drugs - what else, on a deeper level, could be wrong with me?

One possibility: some sort of hormonal imbalance. For this, you might consult an endocrinologist. I developed adult-onset cystic acne in my early 30s. When I was diagnosed with insulin resistance in early 2003, I cut all grains and sugar from my diet - and a happy side effect of this was my acne went almost completely away. Now, a bit of benzaclin keeps it at bay.
posted by chez shoes at 2:11 PM on January 27, 2010

I'm surprised that no one has mentioned this but, how stressed are you? Acne can be attributed to stress. Were those years (18-27) particularly stressful for you? College can be more stressful than high school for a lot of people. Did your job/life change or become stressful in 2009?

My break outs are often more severe when I'm stressed. I know it's not a simple solution, but it's something to think about.
posted by Lizsterr at 2:32 PM on January 27, 2010

Are you on any medications for ADD or ADHD? Several of them provoke breakouts.

Lots and lots of water to clear toxins from your skin; breaking a serious sweat every day should help eliminate stuff, too. I found that the cysts once formed reacted well to a topical solution of Clotrimazone and Betamethasone (Dipropionate Cream USP). Note: this doesn't prevent them, it just seems to make them go away overnight. But I have noticed that using it in the areas that break out. Topical tetracycline worked for me when I got it from the dermatologist.

I get cystic acne on my back and jawline all the time (hormonal, according to my doctor; the reduction of estrogen production and increase in testosterone). Apparently more testosterone causes cystic acne in women. This isn't true for men, but stress is a huge factor; are you feeling more stress at work? at home? Working out to exhaustion can relieve stress as well as forcing you to sweat out any toxins through your skin, so try that as well.

Acne treatments that didn't work before might work now. I would also recommend you see an endocrinologist and see if you have subclinical hypothyroidism or any adrenal factors that might be contributing to the breakouts.
posted by Unicorn on the cob at 2:40 PM on January 27, 2010

Massive amounts of omega-3 fish oil and sleeping on fresh towels.
posted by norabarnacl3 at 2:53 PM on January 27, 2010

OK, I have several potentially-or-not ideas for you:

** nuts - When I last experienced frequent cystic acne, I was going through an intense nut-eating phase (vegan, needed protein). An acquaintance (who is male, btw) said he had had the same problem, and a doctor told him to stop eating so many nuts, and it cleared up the problem. It seemed to help me too. Something about the tannin in the nuts. Probably worth a try.

** cortisone - My dermatologist once told me that he could inject cortisone at the site of an incipient cyst. Maybe if you develop a relationship with a dermatologist -- the right dermatologist -- you could go see him whenever a new cyst starts to develop and he could treat it that way.

There may negative effects of long-term cortisone treatment, so this might not be a cure-all. I think people develop allergies or resistance to it (I forget, but I was using it topically for a while years ago and remember hearing this).

** strategic approach - If you have an ongoing relationship with a dermatologist, though, one who will take the problem seriously, he or she may help you develop a systematic diagnostic approach, probably involving keeping a log and/or elimination diets. This is doubtless the way to go.

** don't give up on drugs - There are a lot of different new drugs out there - one that's been used to treat (I think) epilepsy, one that affects androgen levels, etc. Don't give up.

** choosing a dermatologist - My current dermatologist is a) relatively young and fresh out of a prestigious medical and research university, and b) sort of focused on acne as a personal cause, I think. You might do well to research the doctors at a local group dermatology practice and ask if any of them focus on treating acne in particular, or even adult acne.

** special dermatology cosmetics - As a stopgap, a dermatologist might be able to give you the special makeup they seem to prescribe; especially since you're fairly young, it might cover your skin fairly unnoticeably (or not - be careful with this).
posted by amtho at 3:12 PM on January 27, 2010

I know there's a big back lash against anti-bacterial soap but it was great for keeping my skin from breaking out when I was a teen. I don't use it as a face soap now but I do dab a very watered down bit on any spot that's trying to break out and it really helps. It needs to be very watered down or it dries out my skin but it doesn't take much to work for me.
This might not work on severe acne but it cheap and low risk so you might give it a try to see if it helps.
posted by stray thoughts at 3:21 PM on January 27, 2010

What about laser or light treatment?
posted by evilelvis at 3:27 PM on January 27, 2010 [1 favorite]

Have you tried Clindamycin? I think it's available in a liquid form too but I use the gel form topically. I'm supposed to use it daily but I think that's overkill. I also noticed that staying well hydrated throughout the day and getting enough rest (not just sleep) goes a long way to keeping my skin healthier. I try not to have much facial hair because I feel like it just attracts dirt and needs maintenance to keep clean the skin underneath clean but that may just be me.
posted by eatcake at 3:37 PM on January 27, 2010

I'm 43 and still get cystic acne when I eat certain things: ice cream, whole milk (skim is fine), and sugar (primarily candy). So I don't eat any ice cream (well maybe a bite from my kid or wife's bowl once in awhile) or whole milk; I can have a little candy, but too much over several days and I will certainly break out. Yogurt is OK, cheese is OK.

Also I love ZNP Bar (amazon has it) for washing the face.

Sorry to hear about your problem. I am clear most of the time these days (cept around halloween or xmas : candy), but when I do get one or two it really makes me miserable. I can't even imagine how you feel having 8 at a time.
posted by jockc at 5:14 PM on January 27, 2010

The Boyfriend has had similar (though nowhere near as severe) issues. One thing that's worked for him is a one-two punch of topical clindamycin and oral doxycycline (warning: can make you projectile hurl if not taken on top of some food). Another is the Zeno device - a little electronic zit-zapper. Your issue actually sounds similar to sebaceous cysts, as well, and heat (as applied via the Zeno or other) helps some people with that particular malady.
posted by julthumbscrew at 5:32 PM on January 27, 2010

i had horrible cystic acne in college as well, and it caused me to withdraw socially as well. with lots of treatment it went away, but over the last few years i've started getting a few cysts again (i'm female and 29, this started around 26 i guess). i think it's genetics and hormones for sure, as well as environmental things like stress, food, etc.

develop a relationship with a dermatologist who you like. you can get the steroid shots as needed if that is something they feel you need (i know some derms don't do them anymore). maybe there are new drugs out that you don't know about that you can try. maybe there's a different formulation of X that you can try. but develop a relationship with the derm and stay with that doc to work out a solution together.

you'll probably never get the cysts to go away completely or forever, but you can definitely decrease their impact on your life.
posted by misanthropicsarah at 5:46 PM on January 27, 2010

First off, know that this is not your fault and you have nothing to be embarrassed about. I'll second EvilElvis on the light therapy. Photo-dynamic therapy uses light to kill the bacteria that is causing your cysts and shrink the oil glands and has been proven to be effective in treating cystic acne. I'm not sure if you ever noticed that sun exposure helped a bit with the severity, but it's the same principal.

I hope you find the help you need, but in the meantime don't let this steal your life from you again. You have so much more to offer the world than your complexion.
posted by cecic at 5:51 PM on January 27, 2010

When I stopped eating milk protein (casein), my cystic acne went away. Completely. I know several other people who have also experienced relief by eliminating milk protien from their diets. I suggest you stop eating milk, cream, cheese, yogurt, etc. for two weeks and see what happens. Be aware that you must check labels of packaged foods very carefully. Even some products that call themselves "non-dairy" have casein or whey in them. Cool Whip is one example, and some "soy cheeses" have milk protein in them.

I didn't develop the cysts immediately after ingesting the dairy; the breakouts would come two or three days later.

Take heart. You have gotten lots of other good suggestions, too. I suspect that the answer for you lies among them.
posted by Dolley at 6:44 PM on January 27, 2010

Sulfacetamide. Works like nothing else does for me. It's a topical antibiotic that I use at night after washing my face. I'm female, mid 30s; have had cystic acne for the last 10 yrs. Was freaked out by the oral antibiotics (& didn't see much improvement), no luck w/clindamycin & hated the Zeno. Was @ my wits end. My derm prescribed this a few years ago, & while every very rare once in a while I still get a cyst, it has completely changed my skin (& my mental state).

It's painless to use - not sticky or heavy, won't bleach the crap out of everything you own, and it's a generic, so it's cheap as hell. Dunno if this will work for you, but it can't hurt to try it...
posted by East Siberian patchbelly wrangler at 8:26 PM on January 27, 2010

In the mean time, maybe you could purchase some makeup to cover up. I don't know how comfortable you are doing that, but honestly a lot of people with "perfect" skin really just know how to apply makeup/cover-up/powder in the right places. If you're up for it, going to the makeup counter and like clinique and asking for a consultation. OR, getting a female friend to ask her for make up. I mean, even people on television who are male have makeup put on them.
posted by proficiency101 at 8:57 PM on January 27, 2010

I have cystic acne and it's been "in remission" (so to speak) for about a year now. The combination that finally worked is oral doxycycline (100 mg per day) and cortisone shots whenever I get a new cyst. You have to make an arrangement with your dermatologist so that whenever you get a cyst, you can just call and ask the receptionist to find 10 minutes in your doctor's schedule to see you that day or the next day. Not every dermatologist will do this, but I was very clear about what I wanted and my dermatologist gave me the green light to do this.
posted by val5a at 10:31 PM on January 27, 2010

I would really urge you to not go on Accutane again (I don't even know if they'll let you take it three times). I was on it twice for my acne, which was severe and embarassing, and while I also suffer from depression, the only times I was having serious, constant suicidal thoughts were the two times I was also taking Accutane. The drug works great, but it's not lasting and if you already have tendencies toward depression, whether chemically or from this affliction, there's absolutely no need to put yourself at risk again.
posted by questionsandanchors at 11:50 AM on January 28, 2010

I'm 39, male and have acne off and on, though not as bad as yours. I never had acne as a teen, and only started getting it when I was around 30. I get it in waves, where I'll clear up completely for a month then it comes back.

I also tried a bunch of different stuff. The last round has been Dapsone gel (commercial name Aczone) combined with doxycycline. I'm not 100%, but I'd say I'm 95%, which is pretty great. So far I've been on the antibiotic for about 12 weeks, and I will likely stop taking it for a while after my next doc appointment. The goal is to have some on hand and possibly start taking it again if it starts flaring up in a couple months.

Good luck.
posted by jeff-o-matic at 2:45 PM on February 4, 2010

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