Nodular Acne: Treatments, Prevention, Natural Remedies and More

• Nodular acne develops from a buildup of dead cells, oil and P.acnes bacteria on the skin.
• It is caused by hormones, genetics and poor hygiene.
• Nodular acne can be treated with prescription-strength topical products, medication and natural remedies.

Nodular acne is categorized by doctors as a severe type of acne. It occurs when the pores in your skin become clogged with oil, dead cells and bacteria. 

Nodular acne can include nodules and cysts individually or both together. It will not go away on its own and requires treatment by a dermatologist. 

What Is Nodular Acne?

Nodules are large, reddish, hard lumps. They are developed in the deeper layers of the skin and can be painful to touch.

Unlike milder forms of acne that reside on the surface of the skin, like pimples, papules, pustules, whiteheads or blackheads, nodular acne is inflammatory. It develops over a longer period and can linger. It often leaves red marks or significant scarring as a result.

Nodular acne can occur over several areas of the skin with an increased amount of oil glands, such as the face, jawline, neck, chest or back. It is usually accompanied by whiteheads, blackheads or both.

What causes nodular acne?

Severe acne develops during puberty when your body makes more androgen. Androgen is a male sex hormone that causes your skin to produce more skin oil called sebum. If a layer of dead cells blocks the opening of a pore, sebum can build up in the sebaceous (oil) glands and cause inflammation.

Nodular acne is formed when too much sebum is made or there is a build-up of dead skin cells deep within a pore. A type of bacteria that lives on the skin, called P. acnes, can become trapped and causes the pore to become severely irritated. This creates an infection that can be difficult to treat.

Not all teenagers suffer from nodular acne, therefore, dermatologists believe that there are other factors at play like genetics. You are more likely to develop acne nodules if a parent previously had them.

In addition to teenagers, a lot of adult women experience nodule flare-ups. These can occur right before menstruation when the oil glands overproduce sebum due to a spike in androgen.

Nodular acne vs cystic acne

Nodules and cysts are not like the average comedonal acne breakout. Both of these types of acne are inflammatory and are caused by pore blockages becoming infected deep within the skin.

Even though cysts are large in size and tender to touch like nodules, they differ in appearance and texture. Cysts are softer, red boils that are filled with pus. These boils sometimes burst, which causes the infection to spread and form further whiteheads and blackheads in the surrounding area. Acne nodules, on the other hand, remain solid and are typically closer to your skin tone in color.

Both cysts and nodules need dermatological treatment.

Does Nodular Acne Cause Scarring? 

Acne nodules can lead to the formation of scars if they do not receive the correct treatment. The following types of scars occur when wounds that result from acne heal in the deeper layers of skin.

• Atrophic scars are dents in the skin that develop when not enough connective tissue is made after a wound fails to heal
• Hypertrophic scars are formed in the same way as atrophic scars but they are less common and consist of raised skin on your chest, shoulders or back
• Keloid scars are rare and develop in the surrounding area where the blemish once was when too much connective tissue is made

There are some effective treatments available for nodular acne scars:

• Soft-tissue fillers can be used to level out the dents, increase your skin volume and minimize the scarring appearance almost immediately
• Chemical peels eliminate the destroyed layer of skin by applying chemicals to reveal a fresh layer underneath (this can take days to weeks)
• Skin needling is a process that punctures the skin to increase collagen and produce a regenerated layer within a week
• Dermabrasion wears down the surface of the skin with a rotating instrument to encourage a regenerated layer between 10 days and three weeks later
• Laser resurfacing removes the destroyed layer of skin to tighten the middle layer, taking between three and 10 days for the skin to heal
• Fractional laser therapy penetrates deep within the skin to improve scarring appearance without wounding the surface layer tissue, meaning the healing time is significantly reduced to one or two days

Surgery can sometimes be used to remove nodule acne scars that are deeply indented in the skin.

Best Treatments for Nodular Acne

Any type of acne tends to settle down once your level of androgen hormones start to regulate in your early twenties. Until then, you can try different treatments that have been proven to effectively reduce acne. Over-the-counter treatments that have not been prescribed by a doctor tend to be unsuccessful in combating nodular acne.

Oral or topical antibiotics can be used solely for milder cases of nodular acne. For moderate cases, prescription-strength benzoyl peroxide or salicylic acid is needed either on its own or in addition to oral antibiotics. If your nodular acne is particularly severe, your doctor may recommend retinoid medication either on its own or alongside topical products.

Antibiotics

Antibiotics can be taken short-term as a way of treating nodular acne in oral or cream form. They work by destroying bacteria and reducing inflammation but may make your skin more sensitive to sunlight while you are taking them.

Your doctor may prescribe oral antibiotics in addition to benzoyl peroxide or salicylic acid to improve the chances of reducing nodular acne internally and externally.

Benzoyl peroxide or salicylic acid

Prescription-strength benzoyl peroxide or salicylic acid comes in the form of topical creams or gels. It is effective in minimizing inflammation, eliminating bacteria and reducing the number of blackheads and whiteheads on your skin.

Due to the strength of the chemicals, benzoyl peroxide can bleach your clothes and increase your skin’s sensitivity to sunlight. Apply sunscreen if you plan to be in the sun for a long time.

Retinoids

In severe widespread cases, your dermatologist will prescribe you with a retinoid medication called isotretinoin. Retinoids are a vitamin A derivative that is considered the best treatment for nodular acne. It works by decreasing the size of oil glands. As a result, less oil is produced, which discourages the growth of bacteria.

You may only need to take one course of treatment for 16 to 20 weeks to notice significantly clearer skin. A second course can be prescribed to get the best results.

Hormonal Treatments

For females who struggle with nodular acne, your doctor may suggest one of the following hormonal treatments. These can be used alongside topical products or oral medication in moderate or severe cases.

• Birth control pills in the form of combination estrogen and progestin pills can reduce nodular acne in several months
• Anti-androgens block the effect of androgens on the oil glands to improve nodular acne over time

A three-month course is needed to see results from these treatment options.

Natural Remedies for Nodular Acne

There are a lot of recommendations for acne home remedies that are usually ineffective for severe forms. Some individuals find that apple cider vinegar or olive oil can improve their case of nodular acne.

Apple cider vinegar has antibacterial properties that can be successful in targeting bacteria and healing damaged skin. Dilute it with warm water and apply it directly to the affected areas as part of your daily skin routine for best results.

Similarly, olive oil can be used to cleanse the area affected by nodular acne. It has antioxidant properties and is thought to work in conjunction with excess oil on the skin to eliminate it and prevent the pores from clogging.

Extraction

Even though it can be tempting, avoid touching acne nodules wherever possible. Try not to pop or squeeze them yourself (known as extraction) because this will only increase the risk of scarring, a transmittance of bacteria and further inflammation.

Extraction can be used in a professional setting to safely remove blackheads and whiteheads at the surface of your nodular acne. To do this, a dermatologist will use a corticosteroid injection on the affected area. 

Through an incision and drainage procedure, they can also open the blemish and remove its content with a sterile needle or surgical blade. This flattens most acne nodules, reduces scarring and speeds healing within 48 to 72 hours.

How to Prevent Nodular Acne

The best chance you have of preventing further nodule acne breakouts is to keep your skin as clean as possible. Devise a skincare routine that works for your lifestyle and try to stick to it. Keep in mind the following tips:

• Wash your face twice a day with soap-free cleansing products
• Use a lightweight cream or gel as your daily moisturizer
• Wash your face after exercise or excessive perspiration
• Apply sunscreen before sun exposure
• Keep severely affected areas out of direct sunlight as this can aggravate them further
• Choose oil-free makeup, sunscreen and hair products to avoid excess grease on the skin
• Wash your hands before you apply makeup
• Remove makeup before you go to bed
• Do not over-wash your face as this can only irritate your skin further

When to See a Dermatologist

Coping with nodular acne can be frustrating at any age. It can affect your self-confidence when it comes to your appearance as well as cause physical pain. Anxiety and depressive thoughts are common in those who struggle with any type of acne.

Ice is effective in reducing inflammation on particularly sore acne nodules. Use a cold compress as a way to temporarily and sporadically reduce pain.

If your acne nodules are having a negative effect on your everyday life and self-esteem, reach out to a dermatologist who can initiate a tailored treatment plan.

Takeaway

Nodular acne is a severe type of acne that can emerge during your teenage years. It consists of solid, red, painful bumps that develop when there is too much oil on your skin caused by high levels of the male sex hormone androgen and P.acnes bacteria. Fluctuating hormones or genetics are likely to be the reason why some individuals struggle with nodular acne and others do not.

Acne nodules can form with or without cysts and cannot be cleared without treatment by a dermatologist. 

Antibiotics, benzoyl peroxide or salicylic acid and retinoids are the most effective treatments for nodular acne. Additionally, combined oral contraceptives may be prescribed to women if hormones are suspected to be the main suspect.

Nodular acne treatment sometimes has to be used for months or years before you see improvement. In the meantime, you can prevent breakouts by keeping your skin clean and resisting the urge to touch acne nodules.