Causes of Nodular Acne and How to Treat It

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Nodular acne is a severe form of acne that causes large, inflamed, and painful breakouts called acne nodules. Acne nodules are larger and more serious than a typical pimple and affect deeper layers of the skin. Nodular acne can appear on the face, back, and the body.

Managing nodular acne
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Nodular Acne Symptoms

Unlike run-of-the-mill zits that heal relatively quickly, acne nodules can last a long time—sometimes months. These blemishes feel like hard knots under the skin.

Sometimes they develop a white head, but usually, they stay stubbornly deep down under the skin's surface. You may get just a few nodular breakouts, or the blemishes can be more widespread.

Nodular acne can cause severe scarring, and should always be treated by a dermatologist.

This type of acne is also called severe acne. It is also referred to as nodulocystic acne, or cystic acne, although some dermatologists consider these slightly different types of acne blemishes.


As with mild acne breakouts, nodular acne is caused by several different factors—overactive sebaceous (or oil) glands, an abnormal buildup of dead cells within the pore, and overgrowth of acne-causing bacteria. When these factors come together, it makes a favorable condition for breakouts to develop.

Another big trigger for acne of all types, nodular acne included, are androgen hormones. When androgens increase, so does the skin's oil. Androgens also can change the chemical makeup of the skin's oil, making it thicker (more likely to clog the pores) and a better environment for acne-causing bacteria to take up residence.

Still, dermatologists aren't sure why some people develop such severe forms of acne, like nodular acne, while others just get minor pimples. There does seem to be a genetic component, though. If your parents or siblings had nodular acne, you're more likely to get it too.

Although anyone can get nodular acne, it 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 often find themselves battling nodular breakouts, too. Their breakouts tend to be concentrated on the jawline, chin, and neck, and typically appear or get worse right before their periods.


Nodular acne can be tough to treat. If you think you may have nodular acne the first step is to see a dermatologist. Over-the-counter acne treatments simply aren't effective against nodular acne, no matter how consistently you use them. To get real clearing, you'll need a prescription medication.

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

Isotretinoin is considered the best treatment for most forms of severe acne. If your nodular acne is widespread, your dermatologist may very well suggest this treatment.

Oral antibiotics are another option. Although they aren't meant to be used long-term, they can help quickly reduce inflammation. This helps your skin look and feel better while you're waiting for topical acne treatments to work. You'll be prescribed these along with the antibiotics. 

For people who menstruate, oral contraceptives and/or the hormonal regulator spironolactone are also an option. These work best to manage premenstrual breakouts.


Those 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 stubborn blemishes to heal:

  • Don't squeeze, pick, or try to pop these big blemishes. You'll damage your skin and it won't help the nodule to heal faster. In fact, you'll very likely make it worse.
  • For a particularly painful blemish, try applying ice or an ice pack (wrap either in a soft cloth) a few times a day. This can help ease the pain and reduce swelling.
  • Cortisone injections are another option, although mostly as a last resort. They can help especially large blemishes heal more quickly and help your skin feel a lot better, too. Talk to your dermatologist about this option if you're interested.

A Word From Verywell

Nodular acne can be tough to treat, no doubt. But severe acne can be treated, very successfully, with the right medications. 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.

Besides being frustrating, nodular acne can make you feel self-conscious. It can be depressing. That's completely normal. But if it's interfering with your normal life, let your physician know that too.

With a 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 regular physician to get started.

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5 Sources
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