What To Know about Nodular Acne

Nodular acne, or nodulocystic acne, is a type of inflammatory acne that causes acne nodules—painful bumps to form under your skin. These bumps can appear as flesh-colored, pink, red, or purple spots on the surface of your skin.

Most teenagers in the United States experience acne at some point, with 20% developing more severe acne, like cystic or nodular acne. Most people inherit mild to severe acne at a young age from their family, but it can also develop in adulthood.

Nodular acne is classified as a severe, inflammatory form of acne. Because of the severity of nodular acne, it is not a form of acne that can be treated with at-home remedies. A dermatologist (a doctor specializing in skin, hair, and nail conditions) can treat nodular acne before any scarring occurs.

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Symptoms

Pimples from nodular acne are larger and more painful than mild acne. Nodular acne can occur anywhere on your body but often appears as hardened lumps on the face, back, neck, or chest. You may feel pain when touching inflamed nodules. Having nodular acne can also cause discoloration on the surface of your skin. Nodular acne lumps often look red, pink, or purple. Over time, acne patches can also lead to acne scars.

Causes

Having too much of the bacteria Cutibacterium acnes (C. acnes), excess oil (sebum), and dead skin cells clogging your pores can cause a bacterial infection. The inflammation from the infection causes nodular acne, which produces hard, painful lumps under your skin.

Eating dairy products or foods with a lot of added sugar may worsen your acne. However, diet is not a known cause of nodular acne.

Risk Factors

Nodular acne is more common in people assigned male at birth. Taking certain medications or having health conditions that affect your hormones can also increase your risk for nodular acne. For example, taking steroids or anticonvulsants (medications used to prevent seizures) can increase your risk for nodular acne.

People assigned male at birth are also more likely to have nodular acne. People with polycystic ovarian syndrome (PCOS) tend to experience fluctuating hormones that can cause nodular acne. PCOS is a hormonal condition that occurs when the ovaries make more androgens (the male sex hormone) than they need to.

Diagnosis

Your dermatologist may ask about your health history to rule out other potential causes, such as lupus or PCOS. Nodular acne cannot be treated with over-the-counter (OTC) medication.

Your healthcare provider will examine your symptoms before introducing a treatment plan. They may feel around your nodules to check the firmness and sensitivity of the lumps under your skin. They will also ask about any pain or discomfort you may be feeling.

Although not common, some healthcare providers may suggest a blood test if they suspect your acne is caused by a hormonal imbalance or changes in your endocrine system (the system in your body that produces hormones).

Treatments for Nodular Acne

Unlike other types of acne, nodular acne cannot be treated with over-the-counter medications or skincare products. It does not respond to common skincare ingredients like salicylic acid and benzoyl peroxide. If left untreated, nodular acne can cause deep scarring and pigment changes.

Typically, your dermatologist will recommend prescription-strength topical acne medications, oral antibiotics, or other medications to treat your nodular acne.

Other common treatments for nodular acne include:

• Oral medications like isotretinoin (formerly Accutane) or spironolactone
• Corticosteroids to reduce inflammation
• Cortisone injections to reduce the size of nodules

Isotretinoin is the most common treatment for nodular acne. If you are assigned female at birth, your healthcare provider may strongly advise taking birth control while on isotretinoin. This is because taking the medication while pregnant increases the risk of birth defects. It is also important to stay hydrated while taking isotretinoin.

Prevention

You may not be able to avoid developing nodular acne, but you can take steps to prevent it from worsening.

It may take several months for your acne to improve after starting treatment, but here are some steps you can take to manage your nodular acne and maintain healthy skin:

• Be gentle with your skin: Use a mild cleanser in the morning and evening, and be careful not to rub your skin excessively.
• Avoid touching your face except to cleanse it: Picking at your skin, touching your acne, and popping pimples can worsen breakouts and cause scarring.
• Wash your hair consistently: Try to keep oil from your hair from touching your face. Oil from your hair can transfer to the skin on your face and cause breakouts by clogging your pores.
• Protect your skin from the sun: Use sunscreen daily before going outside. Certain acne medications can make your skin more prone to sunburns or skin damage.
• Shave carefully: Avoid shaving over areas with acne breakouts as much as possible to prevent cuts and scarring. When not shaving, exfoliate your skin thoroughly, and always use clean shaving tools.
• Limit cosmetic use: Even products labeled noncomedogenic (meaning they will not clog pores) can irritate your skin if you have nodular acne. Look for oil-free, water-based cosmetics and limit placing makeup over your acne.
• Use moisturizer: Speak with a dermatologist about the best moisturizers for your skin type.

Complications

Not getting treatment can increase your risk for scarring and hyperpigmentation. Scars can be difficult to remove. The visibility of the scars can take a toll on you mentally.

If you have feelings of depression, anxiety, or stress, speak with your healthcare provider about options for mental health counseling. Your healthcare provider can make seeing a mental health professional a part of your treatment plan.

Some symptoms of staphylococcal (staph) infections look similar to signs of nodular acne. Symptoms of staph infections include redness, swelling, and pus-filled pimples and boils. People with nodular acne are at an increased risk for staph infections because of how easily inflamed nodules can become infected.

A Quick Review

Nodular acne is a type of inflammatory acne that affects deep layers of your skin. It cannot be treated with OTC medications. If left untreated, nodular acne can cause scarring.

See a dermatologist to receive a treatment plan for your acne. Nodular acne treatment typically includes oral antibiotics, cortisone shots, or corticosteroids. Treatment may take up to several months.

This type of acne can also affect your mental health. Consult your healthcare provider if you are experiencing any feelings of depression, stress, or anxiety.