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sugarmag

scarring cystic acne on left cheek

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Hello everyone, this is my first post. I'm a 31 year old female and I've had acne since my teenage years. Usually it is just some blackheads and whiteheads mostly in my oily T zone. I think stress, hormones and makeup have been the main culprits behind my breakouts, but I've never had too much trouble clearing up my skin after a breakout. Every once in a blue moon I've gotten some acne cysts/nodules under the skin that eventually rise to the surface so I can pop them. I've never had any scarring. I've been using Proactive when needed throughout the years. I alternate that with Arbonne FC5 cleanser.

My acne has always been minor/moderate and manageable until last year when I developed a couple acne cysts on my left cheek. I popped them both and they both left scars, but that was just the beginning of this nightmare. One scar is on the outside of my check closer to my ear, so I'm not really bothered by that one. It is more red than pitted, so I know it'll eventually fade away. The other scar I was very bothered by because it is on the front of my cheek about 2 inches below my eye. It was a pitted boxcar type scar. I did some research on what to do to get rid of it and was getting ready to do some dermarolling with copper peptides. I never got to start doing that, tho, because a small pimple formed right above the scar. It formed practically right at the top edge it. I figured I should wait until this new pimple went away before I started treating my scar. And I vowed to NOT pop the new pimple because I was so afraid of causing another scar. So... I didn't touch it. I put the Proactive spot treatment on it and went on with my regular regimen.

Well... That "little" pimple appeared sometime in late January/early February. By the middle of March it had turned into a very large painful cyst under my skin that was not forming a "head" or coming to the surface at all. It didn't look that bad on the surface, just like a regular red blemish. But underneath it was swollen to the size of a silver dollar. My mom gave me some tretinion .05% to put on it to hopefully make it come to the surface, but all it did was cause the pore on the surface to turn very dark red, almost black, and it peeled. This thing was just not going away! I gave it another week and in that time the inflammation under my skin went from a round silver dollar size to a smaller, thinner band of tough inflamed tissue about an inch long. I could see a slight sunken area in my skin where a portion of the inflammation had been and gone away, but I kept telling myself it was just my imagination. I could feel the band of inflammation under my skin, but you couldn't really see it on the surface. The weird thing was it no longer hurt. It was just there and didn't seem to be going anywhere. I decided it was time to see a dermatologist for the first time in my life.

I went to the dermatologist on March 23 and she gave me a kenalog (cortisone) steroid shot in the cyst. She also gave me a prescription for tretinion .025% and recommended I put it on my face at least every other day. I was so excited that I got the steroid shot because I thought this cyst was finally going to go away! Yay! Little did I know the worst part was just beginning...

On March 24 the redness began to subside. I thought this was a good sign. On the night of March 25 I looked in the mirror and to my horror my cyst was now a pitted, atrophied area on my face about an inch long and a quarter of an inch wide in the middle. I thought the cyst had eaten away at my tissue and this was what I was left with. I was shocked! I cried all night and the entire next day. It looked pretty bad... Definitely the worst thing I've ever seen on my face by far. It looked like the cyst was healing and the damage left behind was now revealing itself. Very depressing. And to top it all off, I could still feel this band of hard inflamed tissue under the skin. There was a crater on my face AND the cyst was still there!!

Over the next week I did some research online and found out that cortisone steroid injections like the one I had can cause some fat atrophy at the site of injection and this would eventually go away. This was the best information I could have come across. I was elated to know that what had happened to my face was most likely temporary. It would have been nice if the derm had warned me about this possible side effect, but at least I knew now. But that wasn't the end of the story, unfortunately.

One night about a week and a half after I got the shot, after I washed my face I noticed that a small "head" had formed over the cyst. I looked closely and could see some yellow coloring behind it. I applied slight pressure and pus poured out. I figured what the hell, and continued to apply pressure. More pus came out and lots of blood and clear fluid. I wondered if it was infected, so I made another appointment with the derm.

The derm said it didn't look infected, but prescribed me doxycycline oral antibiotic and clindamycin topical antibiotic anyway since pus had come out. She didn't want to give me another steroid shot (good thing because I wouldn't have let her anyway) and she said it should be gone in about a week. She said if it is still not gone by the end of April that she is going to refer me to a plastic surgeon to have it cut out. She said it may not be just an acne cyst, but possibly an epidermoid cyst.

I've been on the antibiotic now for 11 days. I can still feel a very, very tiny lump of firm tissue under the skin and I think this is the remnants of that band of inflamed tissue. It is a little dark (red/purple) in that area, but that is easily covered with makeup. I don't wear makeup unless I absolutely have to because I don't want anything to impede the healing process.

The really upsetting part of all this is that where the band of firm inflamed tissue was, I now have a sunken area. It is sunken and pitted. It is an inch long and a quarter of an inch wide. It is not as bad as it was a couple days after I got the shot, but it is still pretty bad and stands out on my otherwise clear face. Sometimes I look in the mirror and this scar resembles what a healed knife wound would look like. My friends say it makes me look "tough" but that's not really what I want to hear. My boyfriend tells me to relax and give it time to heal more, but everyday it looks the same.. Sometimes I think it looks worse as each day passes.

I think what I have is deep collagen loss caused by the damage from the prolonged inflammation. I wish I had just popped this thing back in February instead of letting it sit on my face for so long. I could have dealt with another boxcar scar better than this. The degree of tissue damage I am left with is more than I ever expected. I thought I was doing the right thing by leaving it alone and not popping it... What a mistake. And all the cortisone shot did was atrophy the tissue further.. It didn't even make the cyst go away. I believe the doxy is what healed the cyst.

I guess I'll give it another 6 months and see how my skin restructures itself. I'm hoping it'll fill in this huge scar. It wouldn't be so bad if it weren't smack dab on the front of my cheek. Ugh. I guess if it doesn't fill in I'll need to see someone about getting some collagen injected or some other filler. This sucks.

Anyone else had a similar experience?

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I'm so sorry to hear this happened to you. ;_; I have cystic acne but nothing quite like this, so I can't fully relate. The only thing I can really relate to is the use of doxycycline -- my cysts also leaked pus and fluid just like you described, and since then the use of doxy has essentially cleared me. The only things left behind are these tiny, hard lumps right under the skin that feel almost like whiteheads. Now I've got extensive PIH and rolling/boxcar scarring, but again, nothing like what you've experience.

Anyway, best of luck in working to fix this! I'm sure there's something out there that can help. Don't lose hope and give everything time -- lots of time! Also, try not to focus so much on just this one part of you. You are so much more than just this! Good luck, and please update everyone on how this goes!

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Thank you for your reply. My post was so long I wasn't sure if anyone was going to take the time to read thru the whole thing, lol.

That's great that doxycycline has worked for you! I really like it, too. I'm glad I'm not getting any side effects from it. I wonder if when I go off of it one day my cyst will return. Have you had any experience with getting off of the doxy? If so, how did your skin respond?

I'm sorry, I'm new to these boards and am not up on all the verbiage yet... What does PIH stand for?

Those tiny white bumps you describe under your skin that are left over from the cysts... I've read about those before somewhere. I think I read that they are a form of scarring, but I'm not totally sure. Kind of a strange type of scar I think. The skin really does some weird things sometimes. They'll probably go away on their own I would guess.

As far as this thing on my face, when I looked in the mirror last night it looked worse again. I'm just hoping it'll get better with time. Maybe the cortisone shot atrophy is still playing a part here, I don't know. I'm trying not to think about it, but every time I look in the mirror it really gets me down. It's nice to have some support from other people with acne scars who can relate to what I'm going thru at least to some extent.

Edited by sugarmag

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I feel your pain. I have the exact same problem as you, except it's on my right cheek. My right cheek, primarily on my cheek bone started getting pimples in november. I believe they are cysts, or at least a type of nodualar acne. They pop up on my cheek and are about the size of a pencil eraser to a dime, at least the redness and inflamation makes them look that big. They never form a head, and are painful.

I got a rather large one in february which got infected and left behind a nice indendent brown mark. I also had a red mark on my cheek about the size of a pinky nail in that area that WAS fading since december.

Well this month I got two large bumps on my cheek right beside the brown spot, and right on the redmark that was fading.

I'll post a picture of the area in a bit, I have tumeric on the spot at the moment and need to wash it off.

Now my cheek bone has 3 ugly spots, the new pimples left behind a red hyperpigmentation mark with purple in the middle.

I'v been working so hard at fading that area and now all that time and patience is wasted and my cheekbone looks terrible.

(cheeks stained yellow from the tumeric) lol

post-143133-1303068453_thumb.jpg post-143133-1303068425_thumb.jpg

post-143133-1303068425_thumb.jpg

post-143133-1303068453_thumb.jpg

Edited by Ivy.

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I haven't gone off the doxy yet, so I couldn't tell you. However, I have heard mixed reviews: some say their cysts come back after a few months, others seem to be clear forever after. All I really know is that my dermatologist told me I would still need to keep up SOME sort of skin care regimen, probably just a topic thing like benzoyl peroxide wash and gel.

PIH = post-inflammatory hyperpigmentation. Those are the red/brown spots left over from cysts and bad pimples. Some people mistakenly call it scarring, but it generally fades anywhere between a few months to two years. Certain treatments like using a salicylic acid wash or glycolic acid peel supposedly help with reducing the coloration (however, these or other treatments should not be used until acne is completely gone). Meanwhile, tanning seems to make it more visible.

I really hope those white bumps aren't scars! Another member from the site postulated that it could be the "stuff" in a cyst, leftover and just waiting under the skin. He apparently removes them. I haven't done this yet, primarily because picking at my skin caused it to get infected (hence the reason why I saw a derm in the first place), and also because leaving it alone has helped it to get better! Today, one of these sort of fell out of my left cheek -- I gently scratched at my face and noticed one had painlessly come off of/out of my skin, leaving a small indented groove behind. I'm hoping the rest will gently do this as well, rather than morphing back into inflamed cysts. Thankfully the doxy should prevent that!

Anyway, please don't let this cyst get you down! I really think that if you have an active infection going, the doxycycline will be the best thing for it. If your cyst starts to surface, I recommend resisting the urge to pick at it. If it opens or starts leaking, I recommend GENTLY cleansing the area with a benzoyl peroxide face wash (or regular soap and water if you don't have it) and then either applying benzoyl peroxide gel or Neosporin. This has tremendously helped me in the past! However everyone's skin is different and I'm sure others on the site have different (and equally successful) methods of dealing with cysts, so feel free to look around for other solutions. In the meantime, hold tight! Like I said, you are SO MUCH MORE than this cyst! Also, while you're staring at ONLY this cyst in the mirror, I'm willing to bet that everyone else who looks at you sees ALL of you, not just this blemish. Take solace in that and smile. ^_^

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I feel your pain. I have the exact same problem as you, except it's on my right cheek. My right cheek, primarily on my cheek bone started getting pimples in november. I believe they are cysts, or at least a type of nodualar acne. They pop up on my cheek and are about the size of a pencil eraser to a dime, at least the redness and inflamation makes them look that big. They never form a head, and are painful.

I got a rather large one in february which got infected and left behind a nice indendent brown mark. I also had a red mark on my cheek about the size of a pinky nail in that area that WAS fading since december.

Well this month I got two large bumps on my cheek right beside the brown spot, and right on the redmark that was fading.

I'll post a picture of the area in a bit, I have tumeric on the spot at the moment and need to wash it off.

Now my cheek bone has 3 ugly spots, the new pimples left behind a red hyperpigmentation mark with purple in the middle.

I'v been working so hard at fading that area and now all that time and patience is wasted and my cheekbone looks terrible.

(cheeks stained yellow from the tumeric) lol

post-143133-1303068453_thumb.jpg post-143133-1303068425_thumb.jpg

WOW, seems like what we're going thru is really similar. I wonder why we're getting these cysts on only one side of our faces and they keep popping up in the same area... I usually talk on my cell phone on my left side, maybe that's the cause. But I keep the phone really clean and I don't press it up against my face. Could it be the radiation?! I wonder... Or maybe I sleep on my left side more.. But I change my pillow case like every other day. I just don't get it.

I know what you mean about wasting time on this crap... I've wasted a good bit of money, too. I bought two dermarollers and copper peptides that I haven't even been able to use because this stupid cyst/scar won't heal. That stuff isn't cheap. I wish this thing would heal already!

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I haven't gone off the doxy yet, so I couldn't tell you. However, I have heard mixed reviews: some say their cysts come back after a few months, others seem to be clear forever after. All I really know is that my dermatologist told me I would still need to keep up SOME sort of skin care regimen, probably just a topic thing like benzoyl peroxide wash and gel.

PIH = post-inflammatory hyperpigmentation. Those are the red/brown spots left over from cysts and bad pimples. Some people mistakenly call it scarring, but it generally fades anywhere between a few months to two years. Certain treatments like using a salicylic acid wash or glycolic acid peel supposedly help with reducing the coloration (however, these or other treatments should not be used until acne is completely gone). Meanwhile, tanning seems to make it more visible.

I really hope those white bumps aren't scars! Another member from the site postulated that it could be the "stuff" in a cyst, leftover and just waiting under the skin. He apparently removes them. I haven't done this yet, primarily because picking at my skin caused it to get infected (hence the reason why I saw a derm in the first place), and also because leaving it alone has helped it to get better! Today, one of these sort of fell out of my left cheek -- I gently scratched at my face and noticed one had painlessly come off of/out of my skin, leaving a small indented groove behind. I'm hoping the rest will gently do this as well, rather than morphing back into inflamed cysts. Thankfully the doxy should prevent that!

Anyway, please don't let this cyst get you down! I really think that if you have an active infection going, the doxycycline will be the best thing for it. If your cyst starts to surface, I recommend resisting the urge to pick at it. If it opens or starts leaking, I recommend GENTLY cleansing the area with a benzoyl peroxide face wash (or regular soap and water if you don't have it) and then either applying benzoyl peroxide gel or Neosporin. This has tremendously helped me in the past! However everyone's skin is different and I'm sure others on the site have different (and equally successful) methods of dealing with cysts, so feel free to look around for other solutions. In the meantime, hold tight! Like I said, you are SO MUCH MORE than this cyst! Also, while you're staring at ONLY this cyst in the mirror, I'm willing to bet that everyone else who looks at you sees ALL of you, not just this blemish. Take solace in that and smile. ^_^

Oh yeah, those reddish marks... PIH. I have some of those right now. I'm not too worried about them, tho, because whenever I've had those they've always eventually faded. I'm finding that tretinoin is helping them to fade faster (I think).

It sounds like those little white bumps are the remnants of the cysts. Like they're little hard oil beads or something (at least that's how I'm imagining them). I'm sure they will go away, I doubt you have anything to worry about there. Especially since you're on the doxy which has been effective for you. Thank goodness for doxy!

As for my cyst... I think it is gone now. I mean, I don't feel any inflammation under my skin anymore, not even a little bit. I'm glad it's gone and I hope it doesn't come back! I'm going to stick with the doxy to make sure of that. The problem now is just this awful scar leftover... It's red/purple and still sunken in and pitted. And it's so big... An inch long and a quarter of an inch wide. It's pretty shallow tho and I'm thankful for that. But where the "head" of the cyst was there is this really strange skin... It's red/brownish and looks like a scab, but it's not a scab. It's just really thin skin. I imagine that'll be the last part to completely heal.

Thanks for all your advice, I appreciate it!

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it feels so good to know that i am not alone. it seems like you've described my left cheek and the same area where i get the cyst. its reoccuring and im always anxious about it, as i never know when its going to come back and when it does its pretty bad. its funny how its always reoccuring. any how i can feel a lump under the skin so i think mine will be coming up soon too :( i hate these things!

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