Overview of Nodulocystic Acne

Nodulocystic acne is a severe form of inflammatory acne characterized by the presence of nodular breakouts and cysts.

A girl applying face cream in mirror
Dex Images / Getty Images

These aren't your typical blackheads and pustules (although you may have those, too). Nodulocystic breakouts are larger and deeper than average pimples. Nodulocystic acne breakouts are painful, and they often leave scarring.

You can get nodulocystic acne on the face and neck, back, chest, and shoulders. You may have just a few nodulocystic breakouts or many. Either way, this type of acne should always be treated by a dermatologist.

Nodulocystic acne is also often called severe acne, nodular acne, or cystic acne.

What Causes Nodulocystic Acne?

Nodulocystic acne starts off like more mild forms of acne vulgaris. Comedones form when the pore becomes blocked with a plug of oil and dead skin cells. This pore blockage, when acne-causing bacteria invade and the follicle wall breaks, eventually progresses to an inflamed breakout.

For those with nodulocystic acne, the blemishes become very large and inflamed. There seems to be a genetic component—if your parents had severe acne, you're much more likely to get it too.

Severe acne tends to be more common in teen boys and young men. For these guys, nodulocystic acne tends to affect both the face and body.

But many women find themselves facing adult nodulocystic breakouts too. Ladies notice more breakouts around the time of their periods, and they typically appear on the lower face and jawline.

Here are what doesn't cause nodulocystic acne — fried foods, not washing your face, or by "catching" it from someone else. These are all myths. You didn't do anything to cause your acne. And you can't make it go away just by washing your face more or making lifestyle changes. The only thing that will work is a proven acne treatment medication.

The Difference Between Nodulocystic Acne, Cystic Acne, and Nodular Acne

Technically speaking, with nodular acne you'll have nodular breakouts, hard, firm lumps under the skin. With cystic acne, you'll have cysts. Cysts are the most serious form of an acne breakout, deep, painful, and fluid-filled so they feel soft to the touch.

So, those with nodulocystic acne have both types of blemishes, both nodules, and cysts.

But, honestly, all three terms are often used interchangeably. Even dermatologists will call this type of acne something slightly different. In fact, many skin pros think that the terms cystic and nodulocystic acne are misnomers because cysts are really just severely inflamed nodules.

For what it's worth, it doesn't really matter what you call your severe inflammatory acne. It all should be treated by a dermatologist, and it's all treated with the same types of medications. 


Because this severe type of acne can cause scarring, it's best to start treating it as quickly as possible. See a dermatologist as soon as possible to get treatment underway. Over-the-counter acne products just aren't strong enough to improve nodulocystic acne.

Topical prescription treatments, like retinoids and antibiotics, are a good start. Your dermatologist may also prescribe oral antibiotics or isotretinoin, depending on your skin and situation.

Corticosteroid injections, often simply called cortisone shots, can be used to help quickly heal those ultra big and painful blemishes. Cortisone shots won't clear up a case of acne. Instead, they're used as an "emergency" treatment for individual blemishes.

Don't wait to start treatment. The sooner you see a dermatologist the sooner you can start seeing improvement of your skin.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Scheman AJ. Nodulocystic Acne and Hidradenitis Suppurativa Treated With Acitretin: A Case ReportNorth Shore Center for Medical Aesthetics. 2002;69:287-288.

  2. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-85. doi:10.1111/bjd.12149

  3. Johnson BA, Nunley JR. Use of systemic agents in the treatment of acne vulgarisAmerican Family Physician. 2000;62(8):1823-1830.

  4. American Academy of Dermatology Association. Acne: Who gets and causes.

  5. Rathi SK. Acne vulgaris treatment : the current scenario. Indian J Dermatol. 2011;56(1):7-13. doi:10.4103/0019-5154.77543

  6. American Academy of Dermatology Association. Pimple popping: Why only a dermatologist should do it.

Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.