- The nose is one of the most common areas of the face to develop acne
- Nose acne can manifest as mild blackheads and whiteheads, or inflamed papules and pustules
- Treatment includes over-the-counter solutions as well as professional prescription medications
Acne on the nose is a very common skin concern. Lesions occur due to the accumulation of excess oils, dead skin cells and debris that become trapped within pores and cause whiteheads and blackheads. When Cutibacterium acnes multiplies, this causes favorable conditions for inflammatory lesions papules and pustules.
What Does Acne on the Nose Mean?
Acne on the nose can be indicative of an underlying health concern or an imbalance.
The gut-brain-skin axis theory recognizes that gut microbiota influences and regulates inflammatory skin conditions such as acne, and in particular, acne severity, and emotional states such as anxiety, depression, stress and fatigue.
The importance of a balanced gut microbiome can be seen in a number of health issues. Research has found that 40% of those with acne have hypochlorhydria, a deficiency of stomach acid; constipation, which has also been reported as an issue by 40% of acne patients; and stress which can alter microbial flora levels to cause local and systemic inflammation.
These imbalances can all prompt acne flare-ups and worsen symptoms.
Microbes can also influence glycemic control and sebum production; both high glycemia and increased levels of sebum production increase the likelihood of acne forming.
Acne on the nose can be triggered by a number of factors including hormonal fluctuations, diet and certain medications which can promote increased sebum production.
The scientific community has also established a genetic component in acne development. Specifically, certain genes can influence inflammatory responses and others can affect the function and activity of sebaceous glands.
Acne vs. acne rosacea
Acne can be confused with acne rosacea (more commonly referred to as rosacea) but they are completely different chronic, inflammatory skin conditions.
Acne is characterized by lesions that vary from mild to severe and occurs when excess oils, debris and bacteria accumulate. It develops on the face, chest, shoulders, back and shoulders and if inflamed, presents with papules or pus-filled pustules; if not, then whiteheads and blackheads.
Rosacea’s symptoms include intensely red skin, swelling, warmth, burning and stinging. Skin is typically dry and rough with visible broken veins. Symptoms are usually limited to the eye, nose and cheek area, but can spread beyond these borders.
Rosacea is caused by the abnormal dilation of blood vessels and can be triggered by stress, heat, caffeine, spicy foods and alcohol.
If symptoms progress, small pimples, papules and pustules can develop as can rhinophyma, a rare condition that affects men more than women, and causes enlarged pores, thickened red skin and a misshapen nose.
In sum, both are inflammatory skin conditions that share some common characteristics but also have distinct features. Blackheads and whiteheads are not a symptom of rosacea; widespread redness is not a symptom of acne.
What Causes Acne on the Nose?
Acne commonly presents on the forehead, cheeks and chin as well as the nose, which is particularly prone for several reasons.
Every pore on the skin’s surface has an opening to a hair follicle that contains a sebaceous (oil) gland which is responsible for producing lubricating and protecting oils for the skin.
The nose is home to a large number of these glands. Those at the tip of the nose also have larger openings, are situated both superficially and deep within the skin and are greater in number than those midlevel.
Taken together, this means that acne is more likely to develop on the nose, especially at the tip, due to the elevated levels of oils accumulating in pores.
Treatments for Nose Acne
Nose acne can be successfully treated by choosing one of several established agents. Your choice of over-the-counter (OTC) treatment will depend on whether your lesions are inflamed or not.
For severe symptoms, it is best to see your dermatologist first to determine your treatment options as you may require a prescription-strength medication or several different medications to heal symptoms.
Medicated cleansers play a key role in acne treatment and prevention by removing grime, excess oils and debris; exfoliating clogged pores, reducing C. acnes colonization and lesion count; and moisturizing and balancing skin.
The act of cleansing also prepares skin for better absorption of any products you apply afterward.
It is important to select a cleanser that is mild and free of dyes, chemicals and fragrances to avoid irritating and drying your skin. A well-formulated cleanser will also protect the skin barrier function to guard against external threats and internally, against moisture loss.
Benzoyl peroxide is the mainstay of acne treatment due its proven ability to markedly reduce acne-causing bacteria and inflamed lesions and to moderately reduce whiteheads and blackheads by softening and unblocking material from pores.
A benzoyl peroxide cleanser reaches deep within pores to clear away oils and debris, sloughs off flaky, dead skin cells, and calms redness and inflammation.
Retinol is a vitamin A derivative and a member of the retinoid family. Considered a first-line treatment for both inflammatory and noninflammatory acne, retinol has been demonstrated to repeatedly decrease lesion count, significantly improve acne severity and inhibit comedone formation.
Retinol achieves these results by reducing sebum production, penetrating skin to stimulate skin cell turnover and exfoliate away dead skin cells and pore-clogging material. It is commonly paired with other topical medications so that they can be better absorbed and more effective.
This agent can also stimulate collagen synthesis which improves skin’s thickness, strength and elasticity.
A retinol cleanser is ideal for all skin types but should be slowly introduced to skin (especially dry and sensitive skin) as it is known to cause dryness. Monitor for any adverse reactions such as peeling, stinging and redness; if you see these changes in your skin, use less often until your skin acclimates.
You can also choose a product that contains a low concentration of retinol and includes hydrating ingredients to counteract dryness.
Salicylic acid is considered the gold standard for comedonal acne and has both anti-inflammatory and antimicrobial properties.
As a beta hydroxy acid (BHA), it’s oil-soluble to easily penetrate, break up and dissolve clogged pores. It exfoliates skin and speeds up cell turnover to soften and smooth skin and maintain clear pores. Lastly, it can slow sebum secretions to aid in preventing future breakouts.
Daily use of a salicylic acid cleanser will maintain clear skin but may be too drying for some skin types. You can prevent irritation by moisturizing immediately afterward. If you notice your skin becoming red, dry or irritated, alternate with another mild, BHA-free cleanser to maintain the integrity of your skin.
Isotretinoin is a powerful oral prescription retinoid typically reserved for moderate-to-severe and treatment-resistant inflammatory acne. This is because it has a long list of potential side effects, and as such, is taken for a specific length of time.
Isotretinoin can reduce the size of sebaceous glands to decrease oil secretion by 90% while on therapy. It reduces the presence of C acnes and has anti-inflammatory properties.
Considered the most effective therapy for acne, most patients will be acne-free after one round of treatment.
Professional treatments can be combined with OTC treatments or prescription medications to achieve greater results and to improve the appearance of skin.
Professional chemical peels use 22%–70% concentrations of acids to apply a superficial, medium or deep peel with such agents as glycolic, salicylic or lactic acid to resurface skin.
Removing the top layers of skin removes damaged skin cells and allows the fresh layer beneath to be revealed with an improved texture and appearance. Depending on the strength of your peel, you may require some down time.
While laser therapy is not used as a sole treatment in acne management, it is often combined with other treatments to enhance results by reducing C. acnes, and decreasing sebaceous gland activity and skin inflammation.
There is a great range of lasers available, each having their own characteristics. Treatment involves directing a high-intensity pulse of light to the skin which has been shown to significantly reduce redness and lesion count, and accelerate healing.
Multiple sessions are usually required to see results along with additional sessions to maintenance results.
Acne rosacea prescription treatments
There are two medications prescribed specifically for rosacea, but as there is some commonality between acne and rosacea, they also share several treatments.
Topical azelaic acid is available in gel, foam and cream formats; it has anti-inflammatory, antibacterial and antikeratinizing effects to calm swelling and redness, kill bacteria and prevent keratin build-up in pores.
Brimonidine is a medication that is only indicated for rosacea, not acne, and is available in gel or cream form for mild-to-moderate symptoms. It works to reduce persistent facial redness by constricting blood vessels.
Metronidazole is a cornerstone treatment for rosacea but is also used sometimes in lower concentrations for acne. Available in gel, cream or lotion, this topical antibiotic has been used for decades to control inflammation, reduce swelling and redness and heal pimples and lesions.
This agent works very well with antibiotics, but it has also been shown to maintain remission of moderate-to-severe rosacea when used as a sole treatment in maintenance therapy.
Oral antibiotics tetracycline, doxycycline and minocycline are commonly prescribed to treat moderate-to-severe rosacea symptoms. They target inflamed lesions and ease redness, swelling and inflammation.
Oxymetazoline is a second rosacea topical solution formulated to reduce skin redness. One study found a decrease in color within 1 hour; a dramatic improvement with 2–3 hours and sustained effects with continued use for 8–17 months. As well, itching, stinging and burning symptoms were reduced.
There are several, simple changes you can make to your daily routine which can positively impact your skin and help keep it acne-free.
- Cleanse daily with a gentle formula that is pH balanced and free of additives; this will clear your skin of grime and debris without stripping away moisture and irritating or damaging skin
- Exfoliate regularly to prevent pores from accumulating dead skin cells and other matter
- Moisturize with a noncomedogenic good quality product to ensure your skin is protected and comfortable
- Clay masks have antibacterial and healing properties, making them a smart choice for acne-prone skin; used once or twice a week, they can gently draw out impurities and oils, cleanse, moisturize and soften skin
- Tea Tree Oil in a gel or face wash has been shown to significantly improve mild-to-moderate acne symptoms. This essential oil has antiseptic, anti-inflammatory and antibacterial properties.
Acne on the nose is a very common skin concern, as this area is dense with sebaceous glands that are larger than those elsewhere on the face; nose pores are naturally wider as a result. This is especially true for the tip of the nose.
This results in a greater production of sebum, which is the prime driver of acne development. Lesions will first appear as noninflamed pimples, blackheads and whiteheads; if left untreated, these blemishes will deteriorate and form papules, then pustules as bacteria multiplies.
Several effective OTC treatment options are available that contain active ingredients to clear pores, kill bacteria and reduce inflammation. Isotretinoin is prescribed for moderate to severe acne on the nose, and for difficult to treat cases.
No matter the severity or form of your acne, professional treatments can be an effective part of a treatment regimen to achieve the best results for your skin, as can following some preventative measures to help keep your skin blemish-free.
- Michelson LN, Peck GC Jr, Kuo HR, et al. The quantification and distribution of nasal sebaceous glands using image analysis. Aesthetic Plast Surg. 1996;20(4):303-309. doi:10.1007/BF00228460
- Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future?. Gut Pathog. 2011;3(1):1. Published 2011 Jan 31. doi:10.1186/1757-4749-3-1
- Bowe W, Patel NB, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine. Benef Microbes. 2014;5(2):185-199. doi:10.3920/BM2012.0060
- Clark AK, Haas KN, Sivamani RK. Edible Plants and Their Influence on the Gut Microbiome and Acne. Int J Mol Sci. 2017;18(5):1070. Published 2017 May 17. doi:10.3390/ijms18051070
- Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clin Cosmet Investig Dermatol. 2015;8:371-388. Published 2015 Jul 15. doi:10.2147/CCID.S69135
- Micali G, Gerber PA, Lacarrubba F, Schäfer G. Improving Treatment of Erythematotelangiectatic Rosacea with Laser and/or Topical Therapy Through Enhanced Discrimination of its Clinical Features. J Clin Aesthet Dermatol. 2016;9(7):30-39. https://pubmed.ncbi.nlm.nih.gov/27672409/
- Heng AHS, Say YH, Sio YY, Ng YT, Chew FT. Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis. BMC Med Genomics. 2021;14(1):103. Published 2021 Apr 13. doi:10.1186/s12920-021-00953-8
- Draelos ZD. The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne. Cutis. 2006;78(1 Suppl):34-40. https://pubmed.ncbi.nlm.nih.gov/16910029/
- Kanwar AJ. Skin barrier function. Indian J Med Res. 2018;147(1):117-118. doi:10.4103/0971-5916.232013
- What is the Role of Benzoyl Peroxide Cleansers in Acne Management?: Do they Decrease Propionibacterium acnes Counts? Do they Reduce Acne Lesions?. J Clin Aesthet Dermatol. 2008;1(4):48-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016935/
- Clin Cosmet Investig Dermatol. 2015; 8: 455–461. Published online 2015 Aug 26. doi:10.2147/CCID.S84765
- Yeh L, Bonati LM, Silverberg NB. Topical retinoids for acne. Semin Cutan Med Surg. 2016;35(2):50-56. doi:10.12788/j.sder.2016.024
- Zasada M, Budzisz E. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443
- Endly DC, Miller RA. Oily Skin: A review of Treatment Options. J Clin Aesthet Dermatol. 2017;10(8):49-55. https://pubmed.ncbi.nlm.nih.gov/28979664/
- Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-169. doi:10.4161/derm.1.3.9364
- Wolf JE Jr. The role of topical metronidazole in the treatment of rosacea. Cutis. 2004;73(1 Suppl):19-28. https://pubmed.ncbi.nlm.nih.gov/14959942/
- Shanler SD, Ondo AL. Successful treatment of the erythema and flushing of rosacea using a topically applied selective alpha1-adrenergic receptor agonist, oxymetazoline. Arch Dermatol. 2007;143(11):1369-1371. doi:10.1001/archderm.143.11.1369
- Malhi HK, Tu J, Riley TV, Kumarasinghe SP, Hammer KA. Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study. Australas J Dermatol. 2017;58(3):205-210. doi:10.1111/ajd.12465