Nodular Acne

What Causes Nodular Acne and How You Can Treat It

Nodular Acne
Nodular acne can occur on the face or body. Photo © A.D.A.M.

Nodular acne is severe form of acne characterized by the presence of large, inflamed and, very often, painful breakouts. Nodules are larger and more serious than your typical pimple. They affect deeper layers of the skin.

Unlike run-of-the-mill zits that heal relatively quickly, 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 and painfully deep in the skin.


Nodular acne can appear on the face, back, and the body.  You may get just a few nodular breakouts, or these blemishes can be more widespread.  Either way, this type of acne can cause severe scarring, and should always be treated by a dermatologist.

Nodular acne is also often called severe acne, nodulocystic acne, or cystic acne.

What Causes Nodular Acne?

Just like more mild acne breakouts, nodular acne is most likely triggered by an increase of androgen hormones.  But dermatologists aren't sure why some people develop such severe acne while others don't.  There does seem to be a genetic component, though -- if your parents or siblings had nodular acne, you're much more likely to get it too.

Although anyone can get nodular acne, it is more common in young men.  Teen boys and young men are more likely to get severe nodular breakouts on both the face and body.

Adult women also often find themselves battling nodular breakouts.

  Their breakouts tend to concentrated on the jawline, chin, and neck, and typically appear or get worse right before their periods.

With the Right Treatments, You Can Get Nodular Acne Under Control

Nodular acne is tougher to treat that your typical pimples.  Think you may have nodular acne?  The first step is to see a dermatologist.


Don't waste your time with over-the-counter acne treatments.  They're not effective against nodular acne, no matter how consistently you use them.  To get real clearing, you'll need a prescription medication.  Don't wait to see a dermatologist.  You'll want to start treatment as soon as possible to reduce possible 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 will probably 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 women, oral contraceptives and/or the hormonal regulator spironolactone are also an option.  These work best for ladies who get those premenstrual breakouts.

Here's Some Help for those Ultra-Painful Blemishes

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.

First, remember to not 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 that 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.  They can help get those especially massive blemishes healing quickly (and help your skin feel a lot better, too).  Talk to your dermatologist about this option if you're interested.

Make sure you keep up on your regular acne treatments, too, to get your nodular acne well on its way to clearing.

Next steps:

Treating Severe Nodular Acne


Botros PA, Tsai G, Pujalte GG.  "Evolution and management of acne."  Prim Care.  2015 Dec;42(4):465-71.

Zeichner JA.  "Inflammatory acne treatment: review of current and new topical therapeutic options."  J Drugs Dermatol.  2016 Jan 1;15(1):s11-6.

Zouboulis CC, Bettoli V.  "Management of severe acne."  Br J Dermatol.  2015 Jul;172 Suppl 1:27-36.

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