Clinical pearl: A novel technique of intralesional therapy of cystic acne

PROBLEM

Cystic acne is characterized by an inflammatory cyst filled with keratinized material, pus, and blood. Its contents should be drained to promote rapid healing. To reduce the inflammation and post-healing acne scarring, an intralesional injection of triamcinolone acetonide is required after drainage. However, on draining, there is an opening in the cyst wall. Because of this opening, there is drug leakage during intralesional injection, resulting in drug loss and treatment failure [Video 1]. We introduced a new intralesional therapy technique for treating these cystic acne lesions.

SOLUTION

Under aseptic conditions and antibiotic coverage along with anti-acne treatment, the cyst aperture/opening is sealed using cyanoacrylate glue (Fevikwik^®, Pidilite, India), with or without the use of thin cotton twigs [Figure 1]. If the cysts are clinically infected, then normal saline or distilled water is injected to wash out the cyst before sealing the opening. After sealing the opening, an intralesional injection (of 0.1–0.2 mL or more depending on the size of the cyst cavity) of triamcinolone acetonide (4 mg/mL) is given using a 24–26 G needle [Figure 2a-d].

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Figure 1:

The opening of the cyst is sealed with cyanoacrylate glue.

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Figure 2:

(a-d) Intralesional therapy is given for two opened cystic acne lesions after sealing the opening with cyanoacrylate glue.

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Because of the possibility of medication leakage due to increased intra-cystic pressure and mobility of the buccal area, the injection site is sealed with glue. As a result, after sealing the cyst and injection openings, intralesional injection is easy and successful, with no drug loss or bleeding at the site. At the site, there are no side effects of the glue or complications of therapy seen in our three patients. However, to judge the side effects and complications, this modality of therapy should be carried out in a large case–control study. This method can also be used to treat epidermoid cysts and hidradenitis suppurativa that have an opening on their roof.