Nodular acne

Nodular acne is a severe form of acne that can cause scarring. These painful pimples, known as nodules, develop deep within your skin. The nodules are firm and often feel like knots.

Unlike mild types of acne, nodules are stubborn and hard to treat since the infection and inflammation is in the deeper layers of your skin. This can be frustrating, especially since nodules often appear on your face. A dermatologist can diagnose and treat nodular acne, usually with prescription oral medications and topical creams.

How long does nodular acne last?

Nodular acne breakouts may last for weeks or even months, and many at-home treatments don’t help severe acne. It’s important to seek treatment from a dermatologist to manage nodular acne and prevent scars. You should avoid scratching or popping nodules, as this interrupts the healing process and makes your acne worse.

Nodular acne vs. cystic acne

Like nodular acne, cystic acne is also inflammatory and severe. They are often grouped together and referred to as nodulocystic acne – a common symptom of hormonal acne.

Both types of acne form under your skin’s surface and are painful, but nodules are firmer since they aren’t pus-filled. While cystic pimples may come to a head and rupture, nodular acne does not.

What causes nodular acne?

Clogged pores from excess oil, dead skin cells or bacteria cause nodular acne to form. Other potential causes of nodular acne include:

• Hormone level changes: Changes that cause excess sebum production, often during puberty, pregnancy or due to medical conditions like polycystic ovary syndrome (PCOS).
• Certain medications: Such as birth control or steroids, that affect your hormone levels.
• Anxiety and stress: These can increase cortisol hormone levels, worsening acne.
• Oily skincare products: Makeup and lotions can include products that clog pores.
• Excessive sweating: This can contribute to clogged pores and bacterial growth.

Nodular acne treatment

A dermatologist can diagnose nodular acne by examining your skin. You’ll discuss your symptoms and your family history of acne as well.

Treating nodular acne at home might seem impossible. Prescription acne medications and treatments are the most effective options for this persistent type of acne. While over-the-counter treatments may offer some relief, they aren't strong enough to tackle nodular acne effectively.

Your dermatologist may prescribe the following medications for nodular acne:

• Topical creams: Prescription-strength creams or gels containing retinoids, salicylic acid, benzoyl peroxides or antibiotics can help treat skin infections and unclog pores.
• Oral medications: May include antibiotics to reduce inflammation or hormonal medications such as birth control pills or spironolactone for women. For severe cases that don’t respond to other treatments, isotretinoin (Accutane) may be prescribed.
• Cortisone injections: These are used to rapidly reduce inflammation and pain in deep, stubborn nodules.

Along with these treatments, it's important to use gentle, oil-free skincare products that won't clog your pores. You’ll also want to avoid touching your skin, as it can expose your nodules to bacteria.

How do you know if nodular acne is healing?

It may take some time for your nodular acne to go away. The first signs your nodules are responding to treatment and healing may be:

• Less pain and tenderness
• Reduced size
• Less redness and inflammation

It’s important to stick to your treatment plan, especially once you see improvement. As the nodules heal, any resulting scars may start to fade or become less noticeable. Your dermatologist may recommend laser resurfacing, dermabrasion or chemical acid peel treatments to help with scarring once your acne is healed.

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