How Nodular Acne Looks and How to Treat It

Nodular acne is the most severe type of inflammatory acne. It causes solid, painful bumps deep within the skin that require professional treatment. Even then, the nodules can last for weeks or months and often scar.

Over-the-counter (OTC) acne products and home remedies won't work on this type of acne because of how stubborn and far down in the skin the nodules are. Instead, treatments like oral prescription medications and cortisone shots treatments are needed to get breakouts under control.

This article covers the causes and symptoms of nodular acne, how it is treated, and what you can do to cope as you wait for a breakout to resolve.

What Does Nodular Acne Look and Feel Like?

Unlike a classic pimple (a fluid-filled spot that comes to a head at the skin's surface), an acne nodule is a firm lump that's in the deep layers of the skin. On the surface, they can look pink or red. The bumps are bigger than typical zits and can be quite painful.

Nodular acne can:

• Feel like hard knots underneath the skin
• Feel "deep-rooted," as it occurs in the skin's lowest layers
  
• Develop a whitehead or blackhead in the center, though this is not typical
• Cause severe scarring

Acne nodules can appear on the face, back, and other areas of the body. You may get just a few nodules, but they are often more widespread.

What Causes Acne Nodules?

Nodular acne is thought to be caused by several factors, including:

• Overactive oil glands called sebaceous glands
• A large buildup of dead skin cells in pores
• An overgrowth of acne-causing bacteria
• An increase in androgen hormones (which can lead to more production of thicker skin oil)
  

Risk Factors

Anyone can get nodular acne, but there seems to be a genetic component. If your parents or siblings had acne nodules, you're more likely to get them.

Nodular acne is more common in young males. Teens and young adult males often get acne nodules on their faces and bodies.

Adult females often get nodular acne on their jawline, chin, and neck. The acne nodules may get worse right before a person starts their menstrual period.

How Is Nodular Acne Treated?

Unfortunately, nodular acne won't go away overnight. It can take at least three or four months of active treatment to see improvement.

A healthcare provider trained in treating skin, hair, and nails (dermatologist) can evaluate your skin and prescribe a treatment (or more than one) that may work best for you.

Isotretinoin

According to the American Academy of Dermatology (AAD), the first-line treatment for severe nodular acne is a synthetic type of vitamin A called isotretinoin. You take the medication by mouth.

While isotretinoin can be very effective, you should talk to your provider about the risks and side effects of using it. This is especially important if you want to start trying to get pregnant. Using isotretinoin during pregnancy can cause birth defects, so treatment must be stopped.

Other Prescription Medications

Your provider might have you take oral antibiotics for a short time to help get rid of acne-causing bacteria on your skin and reduce the inflammation that acne nodules cause.

If you cannot take isotretinoin, your provider might have you try using a combination of topical acne treatments and antibiotics. For example, prescription-strength benzoyl peroxide may help clear up acne nodules and treat inflammation when it's used with oral antibiotics.

Prescription topical treatments with salicylic acid can also be helpful, as it helps prevent your pores from getting clogged.

Oral contraceptives and a drug called spironolactone are nodular acne treatment options for people who menstruate. Both medications regulate hormones and help manage premenstrual acne nodule breakouts.

Procedures

According to the AAD, there is limited evidence that skincare procedures like peels, laser therapy, or photodynamic therapy are effective nodular acne treatments. You can ask your provider if they would recommend them in your case.

Cortisone injections are the one in-office procedure that does seem to work. The shots can treat a single painful acne nodule. The injections can help the nodule heal faster, but they won't clear up nodular acne breakouts.

Complementary or Alternative Therapies

The AAD concluded there is not enough evidence to support using complementary or alternative medicine treatments (like essential oils) for nodular acne.

You should not try these therapies without talking to your provider, as they could make your acne worse or interact with a prescribed treatment you're already using.

Coping With Nodular Acne

To ease the pain and inflammation of acne nodules, try applying ice wrapped in a soft cloth to the affected area a few times a day.

Only use gentle skincare products approved by your dermatologist and wear sunscreen when outdoors to protect sensitive skin.

Besides this, try your best to leave the nodules alone. This includes avoiding applying make-up to them, shaving over them, and, of course, picking at them.

If having nodular acne is making you self-conscious, reach out for support. Your feelings are valid and normal, but tell your healthcare provider if you're having a hard time coping with the pain and stress of acne nodules.

Summary

Nodular acne is severe acne that causes hard, painful lumps deep within the skin that often scar. Several factors contribute to nodular acne, including overactive oil glands, an increase in androgen hormones, a buildup of dead skin cells, and high amounts of acne-related bacteria on the skin.

A dermatologist is the best healthcare provider to diagnose and help you manage nodular acne. You will need treatment, including prescription oral medication. Be patient—these treatments can take months to work.