Ah! Those growing pains. For some of us, they sometimes carry on long into adulthood… Acne can happen to people in their 20s and 30s, and even beyond that. It's one of the top reasons why people to visit a dermatologist.
There are 3 stages of acne, with cystic acne being the most severe form.  People who suffer from cystic acne have a lot of red, tender, and painful bumps.
Some of these bumps are hard, while others are soft and filled with pus. If one of them bursts, the infection can spread, causing more breakouts. It's one of the hardest types of acne to successfully treat. 
Dr Ho Rui Ming, an aesthetic doctor answered a couple of tough reader questions regarding cystic acne. Here's what he had to say.
How does cystic acne usually occur?
For the most part, cystic acne happens when an infection that causes acne goes deep into the skin, which in turn creates a large, inflamed, tender pimple that's full of pus.
These deep lesions can create scars that are most likely going to remain if not treated.
Be careful of the types of creams you use
A reader who was prescribed Foban Cream (which contains 2.0% fusidic acid) wanted to know if it would help clear up his cystic acne or make things worse.
Dr Ho does not personally recommend topical Betamethasone and Fusidic Acid as they are not recommended 1st-line treatment options for acne at all.
There are other topical antibiotic creams to consider which are more effective against bacteria in acne. These include Clindamycin and Erythromycin.
Cystic acne may require injectable steroids
Cystic acne is considered a severe skin condition, and it may sometimes need to be extracted or drained in order to clear up the affected area.
In order to help with the healing, injectable steroids (rather than topical creams) would be an effective way to arrest the inflammation and swelling.
Corticosteroid injections in Singapore cost about $50 – $200
Steroid injections can help reduce the inflammatory reaction caused by cystic acne (which leads to potentially reducing the amount of damage and scarring caused by severely affected areas of cystic acne).
These injections (known as Corticosteroid injections) take about 4 – 8 hours to start shrinking the cystic acne. Concurrently, the pain will improve and you'll notice acne becoming flattened and less red within 24 hours.
The cost of the injection is determined by a few factors, which you should discuss with your dermatologist.
Consult your doctor before opting for a corticosteroid injection
You'll need your doctor’s advice on whether your specific cystic acne condition can be treated with an injection or not. There is a small risk of skin depression or skin atrophy post injection, however, these side effects usually get resolved with time.
However, to be safe, it's best that you consult your doctor.
Acne can return after the injection
This is because a corticosteroid injection only treats a pimple but does not prevent acne from recurring at the same spot (or in other spots).
It can be seen as a way to prevent your conditioning from worsening but ultimately, treatment must be continued to resolve the acne completely.
The risk of future scarring from prolonged inflammation makes it important to arrest and treat cystic acne quickly. In this instance, steroid injections are considered a first-line treatment option.
Dark acne spots are caused by Post-Inflammation Hyperpigmentation (PIH)
A reader wanted to know what the best solution for pimples as well as dark acne spots.
According to Dr Ho, this range of acne issues include active acne papules, clogged pores and Post-Inflammation Hyperpigmentation (PIH). Together, these lead to dark spots that are prominent on the face.
Treatments for this type of acne include; Topical antibiotic creams or Oral medications (antibiotics, isotretinoin). Lasers are also good at lightening dark spots caused by PIH. In any case, it's imperative to get it under control to prevent more PIH from occurring.
Don't lose hope!
Yes, even severe skin conditions like cystic acne can be effectively managed with the right methods and the right advice from experienced doctors.
If you haven’t yet found a solution that works well for you, press on! Use Dr Ho’s advice as a reference to see how you can go about getting your acne under control.