Nodular Acne: Symptoms, Causes & Treatment
Have you ever noticed large, painful bumps deep under your skin that just won’t go away? If so, you might be dealing with nodular acne—one of the most stubborn and severe forms of acne. Unlike regular pimples, nodular acne doesn’t form a whitehead and can linger for weeks or even months.
At Clarion Medical and Aesthetics, we understand how frustrating and painful this condition can be. That’s why we stay on the leading edge of skincare solutions, offering advanced treatments tailored to your unique skin needs. Let’s dive into what nodular acne is, what causes it, and how you can treat it effectively.
What Is Nodular Acne?
Nodular acne is a severe form of inflammatory acne that develops when clogged pores become infected with acne-causing bacteria deep within the skin. Unlike other types of acne, these painful nodules don’t come to the head and can feel firm or hard when touched.
It is often considered one of the most difficult types of acne to treat due to the depth of the nodules and their resistance to typical over-the-counter treatments. Unlike standard pimples that may clear up within a few days, nodular acne lesions persist for weeks or even months, sometimes requiring medical intervention to fully resolve.
How It Differs from Other Types of Acne
Nodular acne is often confused with cystic acne, but there are key differences:
Depth: Nodular acne develops deeper in the skin, while cystic acne has fluid-filled pockets closer to the surface, making it more prone to bursting.
Pain: Nodules are firm, inflamed, and painful to the touch, often causing significant discomfort even when left undisturbed.
Healing Time: Nodular acne takes weeks or months to heal and often leads to acne scars that may require dermatological procedures for correction.
How Common Is Nodular Acne?
While acne affects nearly 85% of people at some point, nodular acne is less common but more severe. It typically appears in teenagers and young adults, though adults in their 30s and 40s can also develop it due to hormonal imbalances. Women experiencing hormonal changes due to pregnancy, menstruation, or polycystic ovary syndrome (PCOS) are also more prone to developing nodular acne.
Nodular Acne Causes and Symptoms
What Causes Nodular Acne?
Several factors contribute to the formation of nodular acne, making it a challenging condition to treat. Some of the most common causes include:
Excess Sebum Production: Overactive oil glands produce too much sebum (oil), leading to clogged pores and the formation of acne nodules.
Hormonal Imbalances: Fluctuations in hormone levels, especially during puberty, pregnancy, or stress, can trigger acne breakouts and lead to deep-seated inflammation.
Genetics: If your parents or close relatives had severe acne, you're more likely to develop nodular acne due to inherited skin characteristics.
Bacterial Infections: Acne-causing bacteria (Propionibacterium acnes) get trapped in clogged pores, triggering inflammation and leading to painful nodule formation.
Lifestyle Factors: Poor skincare habits, use of comedogenic (pore-clogging) products, and excessive sweating can all contribute to severe breakouts and exacerbate nodular acne.
Symptoms of Nodular Acne
Nodular acne is distinctive and severe, presenting symptoms that differ from milder forms of acne. These symptoms include:
Large, deep, painful bumps under the skin that do not form a whitehead or blackhead.
No visible pus or fluid-filled cysts, making the lesions appear as firm, inflamed nodules.
Firm or hard texture that remains embedded in the deep layers of the skin.
Redness and swelling around the nodule, often making the skin look inflamed and irritated.
Breakouts that persist for weeks or even months, significantly longer than standard acne lesions.
Who Is More Likely to Develop Nodular Acne?
Nodular acne affects people from all backgrounds, but certain individuals are more prone to developing it. Risk factors include:
Teenagers and young adults experiencing hormonal fluctuations, particularly during puberty.
Women with hormonal imbalances, including those with polycystic ovary syndrome (PCOS) or those taking birth control pills.
Individuals with a family history of severe acne, which increases the likelihood of experiencing persistent breakouts.
People with high stress levels, as stress hormones like cortisol, can trigger oil production and worsen acne.
Athletes or individuals exposed to excessive sweating, which clogs pores and increases the likelihood of severe breakouts.
Diagnosis and When to See a Dermatologist
If your acne is painful, persistent, and causing scarring, it’s time to see a dermatologist. A professional diagnosis ensures that you receive the most effective treatment plan, tailored specifically to your skin’s needs. Early intervention can prevent long-term damage, such as acne scars and hyperpigmentation.
A dermatologist may conduct a physical examination of your skin and ask about your medical history to determine the best course of treatment. In some cases, hormonal tests may be recommended to identify underlying imbalances that contribute to nodular acne.
What Treatment Options Are Available?
Nodular acne is stubborn and resistant to many common treatments. Because it develops deep within the skin, treating it effectively requires a targeted approach. The right treatment depends on the severity of the acne, the patient’s skin type, and any underlying factors such as hormonal imbalances or genetic predisposition.
Prescription Medications
For individuals with moderate to severe nodular acne, prescription medications are often necessary to control breakouts and reduce the risk of long-term scarring. Some of the most commonly recommended options include:
Oral Antibiotics: Used to control bacterial infections and reduce inflammation, oral antibiotics like doxycycline and minocycline are often prescribed for severe cases.
Isotretinoin (Accutane): This powerful medication is one of the most effective treatments for severe nodular acne. It works by significantly reducing oil production, shrinking sebaceous glands, and preventing new acne breakouts. However, it requires close monitoring due to potential side effects.
Birth Control Pills & Hormonal Therapy: For women, hormonal fluctuations can be a major trigger for nodular acne. Birth control pills and anti-androgen medications such as spironolactone help regulate hormone levels and reduce excess oil production.
Topical Retinoids: These vitamin A derivatives, such as tretinoin or adapalene, speed up skin cell turnover and help prevent clogged pores, making them a long-term solution for acne prevention.
Over-the-Counter Solutions
While prescription treatments are often necessary, certain over-the-counter (OTC) products can help manage mild to moderate nodular acne. Some effective OTC treatments include:
Benzoyl Peroxide: Helps kill acne-causing bacteria and reduce inflammation.
Salicylic Acid: Works by exfoliating dead skin cells and unclogging pores, making it an essential ingredient in acne treatment.
Gentle Cleansers & Moisturisers: Maintaining a balanced skincare routine with non-comedogenic products is crucial for preventing further irritation.
Sulfur-Based Treatments: Known for their ability to absorb excess oil and reduce inflammation, sulfur treatments can be a great addition to an acne regimen.
In-Office Dermatological Procedures
For individuals with severe, persistent nodular acne, professional dermatological procedures may provide faster and more effective results. Some of the most effective in-office treatments include:
Laser Therapy: Laser treatments target acne-causing bacteria, reduce inflammation, and improve overall skin texture.
Cortisone Injections: These quick in-office injections help rapidly shrink painful nodules and reduce inflammation within 24–48 hours.
Chemical Peels: By exfoliating the top layers of skin, chemical peels can help prevent clogged pores and improve skin tone and texture.
Drainage & Extractions: In severe cases, dermatologists may perform a procedure to manually drain and remove deep acne lesions to prevent scarring.
Will Scarring Develop?
Unfortunately, nodular acne has a high risk of scarring due to its deep inflammation. The longer a nodule remains untreated, the greater the chance of permanent scars forming. Scars from nodular acne can appear as pitted, raised, or discoloured marks on the skin.
The good news? Professional treatments such as laser therapy, microneedling, and chemical peels can significantly reduce acne scars, restoring a smoother and more even skin texture.
How to Reduce the Risk of Breakouts
Preventing nodular acne requires consistent skincare habits and lifestyle adjustments. Here are some effective ways to minimise breakouts:
Use Non-Comedogenic Skincare Products: Opt for products that won’t clog pores.
Follow a Gentle Skincare Routine: Avoid harsh exfoliants and irritating ingredients that can trigger inflammation.
Keep Your Hands Off Your Face: Touching your face frequently can transfer bacteria and oil, leading to new breakouts.
Manage Stress Levels: High stress levels increase cortisol production, which can trigger acne flares.
Eat a Balanced Diet: Some studies suggest that dairy and high-glycemic foods can contribute to acne breakouts.
Stay Hydrated: Drinking enough water helps maintain healthy skin and flush out toxins.
Clearer Skin Starts with Clarion Medical and Aesthetics
Nodular acne can be frustrating, painful, and damaging to your confidence. The good news? Effective treatments are available. At Clarion Medical and Aesthetics, we offer customised acne treatments designed to restore healthy skin and reduce the risk of scarring. Our expert team stays ahead of the latest skincare innovations, so you get the best care possible.
Ready to take control of your skin? Book a consultation today, and let’s create a treatment plan tailored just for you!