Causes of Nodular Acne and How to Treat It

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Nodular acne is a severe type of inflammatory acne that causes large and painful breakouts called acne nodules. Acne nodules are larger than typical pimples, and they affect deeper layers of the skin.

This type of acne may also be referred to as nodulocystic acne or cystic acne. Nodular acne can appear on the face, back, and other areas of the body.

This article explores the causes, symptoms, and treatment of nodular acne.

Managing nodular acne

Verywell / JR Bee

Nodular Acne Symptoms

Unlike smaller pimples that heal relatively quickly, acne nodules can last for months.

These blemishes:

  • May feel like hard knots under the skin
  • May develop a white head
  • Can be found deep down under the skin's surface
  • Can cause severe scarring

You may get just a few nodular breakouts, or the blemishes can be more widespread.

What Causes Nodular Acne?

Anyone can get nodular acne. There does seem to be a genetic component. If your parents or siblings had nodular acne, you're more likely to get it too. But you can develop this type of acne even if you don't have a family history.

Nodular acne can be caused by several different factors:

  • Overactive oil glands called sebaceous glands
  • A large buildup of dead cells within the pore
  • An overgrowth of acne-causing bacteria
  • An increase in androgen hormones, which can lead to more and thicker skin oil

Nodular acne is more common in young men. Teen boys and young adult males frequently get acne nodules on both the face and the body.

Adult women may get nodular acne on their jawline, chin, and neck. This typically gets worse right before a period.


Click Play to Learn All About Nodule Pimples

This video has been medically reviewed by Casey Gallagher, MD.

Nodular Acne Treatment

Nodular acne can be tough to treat. If you think you have nodular acne, you may want to see a dermatologist, a doctor who is specialized in treating skin, hair, and nails. Your dermatologist may offer you prescription medication since over-the-counter acne treatments may not be effective for treating this condition.

See a dermatologist as soon as possible to reduce the chance of scarring. Because these breakouts are so deep, you'll most likely need an oral medication as well as a topical treatment.

Isotretinoin, a synthetic type of Vitamin A, is an oral medication that is considered the best treatment for severe acne. If your nodular acne is widespread, your dermatologist may suggest this treatment.

Your doctor may also suggest short-term use of oral antibiotics to help reduce inflammation. Oral antibiotics may help your skin look and feel better while you're waiting for topical acne treatments to work.

For people who menstruate, oral contraceptives and/or a drug called spironolactone are also treatment options. Both drugs regulate hormones, and they work best at managing premenstrual breakouts.

Coping With Acne Nodules

Swollen nodular breakouts can hurt a lot! Although the tips below won't clear up your acne, they can help make your skin a bit more comfortable while you're waiting for those blemishes to heal:

  • Don't squeeze, pick, or try to pop these blemishes. It can damage your skin and make your breakouts worse.
  • For a particularly painful blemish, try applying ice wrapped in a soft cloth a few times a day. This can help with pain and swelling.
  • Cortisone injections can help individual large blemishes heal quickly, but this won't clear up breakouts. Instead, this method may be used to help with one especially painful blemish.


Nodular acne is a severe type of acne that can lead to painful, swollen pimples, as well as scarring. This type of acne may be caused by overactive oil glands, an increase in androgen hormones, a buildup of dead skin cells, and high amounts of acne-related bacteria. This type of acne may also run in families.

If you believe you have nodular acne, it's best to see a dermatologist. Treatment for nodular acne often includes both an oral medication and a topical one that is applied directly to the skin.

At home, you can apply an ice pack wrapped in cloth on a painful blemish. This can help reduce pain. Avoid picking these blemishes, as that may worsen the breakout.

A Word From Verywell

Nodular acne can be tough to treat, but this type of severe acne can be treated successfully. There is no quick fix, so plan on three to four months of treatment before you start to see any real improvement in your skin.

Nodular acne can make you feel self-conscious. Know that your feelings are valid and completely normal. If these feelings begin to interfere with your overall quality of life, it's best to let your doctor know.

With prescription medication, consistent treatment, and a little bit of time, you can see huge improvements in your skin. Make an appointment with your dermatologist or your regular physician to get started.

Frequently Asked Questions

  • How do you shrink a cystic pimple?

    A corticosteroid injection, also called a cortisone shot, is an anti-inflammatory steroid that rapidly shrinks large or painful acne lesions. It can be given by a doctor to reduce the size of a cystic pimple.

  • Can you get rid of cystic acne overnight?

    Unfortunately, cystic acne isn't likely to go away overnight. It may take at least three or four months of active treatment to see an improvement. Talk to a dermatologist or health care provider to create a personalized treatment plan.

  • Is nodular acne the same as cystic acne?

    Acne cysts fill with pus, while acne nodules do not contain any fluid. As a result, nodules are harder and more solid than cysts.

  • What is inside a pimple?

    A pimple contains sebum, skin cells, bacteria, and pus. Sebum is an oily substance made by the sebaceous glands. Its purpose is to prevent skin from becoming too dry.

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