How well does Retin-A work for cystic acne?

Tags:man age 25-34 pores acne cystic acne

I've always had large, red and pretty painful breakouts, from my adolescence to this day. My dermatologist says it's definitely a case of cystic acne due to my pores getting clogged all the time for some reason. It's probably genetic because my dad had it too when he was young. Anyway... I've read a lot about Retin-A but I'm not sure it's going to work for me. Nothing ever works for my deep breakouts. I kind of lost all my faith in these treatments. Should I give Retin-A a try? What do you think? Did it work for very bad acne cases, like mine, in the past?


M, 29, Virginia

Retin-A can be used to treat severe acne, including cystic acne. However, on its own Retin-A is unlikely to fully eradicate large cystic acne.

Prescription-strength Retin-A has been available for decades, and now a type of Retin-A called tretinoin is available without a prescription. Tretinoin Retin-A cream is an effective way to open clogged pores, small bumps and small cysts. It is a bit more effective on fair-skinned individuals than on dark-skinned individuals.

However, neither topical tretinoin or Retin-A will eliminate 100 percent of your blemishes, but approximately half of your blackheads, whiteheads and pimples. Combining tretinoin topical with benzoyl peroxide and other skincare treatments may be a more effective way to achieve clear skin.

If you do decide to try Retin-A or tretinoin topical it is important that you faithfully apply sunscreen whenever you go outdoors, as these treatments make the skin more sensitive to sun exposure.

Retin-A can be an effective acne treatment, so it won’t hurt for you to try it out, but since you have cystic acne you’ll probably need a more comprehensive strategy.

If you’re truly desiring a singular approach, although it may be ineffective, you may want to try an over-the-counter tretinoin topical (a form of Retin-A) first. An example of this is the recently released Differin OTC (which is adapalene 0.1%).

Unlike other treatments, tretinoin topical does not require monitoring blood tests, since only small quantities of the medication are absorbed internally by the skin. However, in the United States, the only over the counter retinoid that is approved without the need for an office visit by a medical professional, is Differin 0.1%.

However, tretinoin topicals will not eliminate all of your blemishes, whether they are adult acne, hormonal acne or cystic acne. Tretinoin, a type of retinoid topical, is a comedolytic agent. This means it actually helps to unclogged pores that have been blocked by excess oil and dry skin. An additional benefit of tretinoin is in its ability to be an anti-ager by slowing and preventing photo-aging, and improve dark marks and sun spots (typically in lower doses than those needed for acne treatment). Versions of tretinoin topical that make use of microsphere technology are absorbed slower, are better for the skin cells, and have fewer side effects.

Should this be ineffective, additionally treatments can be employed; namely, Retin-A combined with other treatments.

In some cases a combination of tretinoin topical and clindamycin (a topical antibiotic) with or without additional benzoyl peroxide may be most effective. The tretinoin unclogs the blocked pores and the clindamycin destroys the acne bacteria. Combining these two treatments can be more effective than just one, but doing so also has the effect of increasing the potential side effects. Both treatments make the skin more sensitive to the sun. As a result, if you decide to use both treatments at once it’s even more important that you apply sunscreen on a daily basis.

For pigmentary disorders, like melasma, or irregular pigmentation, like post-inflammatory hyperpigmentation (aka dark marks) and actinic lentigines, retinoids also help improve their appearance. The acne uses are just the tip of the iceberg for retinoids!

Ultimately, the most effective way to tackle cystic acne, inflammatory acne, and blemishes is to follow a structured skin care routine. I recommend that you speak with your board-certified dermatologist to learn which products are best suited to your specific needs.

In order to determine the right approach to tackle your cystic acne, you will need to schedule an appointment with a board-certified dermatologist. Your dermatologist will conduct a detailed examination to determine your skin type (oily skin, sensitive skin, dry skin, etc.), the cause of your cystic pimples, and the best long term solution.

If you have severe cystic acne it is likely that you will need a combination of topical and oral retinoids to combat it. It’s also likely that you’ll need an oral or topical antibiotic to prevent infection. Once the acne has subsided, a chemical peel with salicylic acid may be an option. Consult with your dermatologist to learn more.