Nodular acne is characterized by hard, painful acne lesions deep under the skin. It often affects the face, chest, or back.

Unlike regular pimples that often heal within a few days, acne nodules may last for weeks or months. They tend not to develop a white head and may remain as hard knots under the skin.

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Nodular acne can be painful, and its appearance may affect a person’s self-esteem. This article explores the treatments and home remedies available for this severe form of acne.

What is nodular acne?

Nodular acne on a persons back
Nodular acne affects the face, chest, and back.

Like all pimples, nodular acne begins when a pore becomes clogged. Natural oils (sebum) mix with dead skin cells and get trapped inside the clogged pore.

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For most people, this causes a blackhead or a pimple that clears up quickly. For those with nodular acne, clogged pores can lead to a more severe breakout.

Nodular acne forms when a type of bacteria called P. acnes that live on the skin get trapped inside the clogged pore. This may lead to an infection that affects the deeper layers of the skin.

The infection can cause inflammation in the deep skin layers, creating hard nodules.

Nodules can occur on their own or spread over a large area, causing patches of nodules.

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Unlike regular pimples, acne nodules tend not to form a head. Attempting to squeeze them will not release pus and may lead to further inflammation.

Symptoms

The primary symptom of nodular acne is the appearance of hard lesions on the face, chest, or back. It may also affect other parts of the body.

Nodules may be the same color as the skin or appear red and inflamed. They may be painful to touch and, many people describe them as hard knots under the skin.

Nodular acne breakouts may last for weeks or months. Without treatment, nodular acne may cause scarring.

Treatment

Standard over-the-counter (OTC) acne treatments may not be effective for nodular acne, as these medications tend to target excess sebum and dead cells on the skin’s surface.

Nodular acne affects deeper layers of the skin, so it requires more intensive treatment.

A doctor may refer someone with nodular acne to a skin doctor called a dermatologist. A doctor or dermatologist may recommend one of the following treatments:

Antibiotics

An overgrowth of P. acnes bacteria is one of the factors that may cause nodular acne breakouts.

A doctor may prescribe oral antibiotics to kill excess bacteria, which can help prevent it from getting trapped in clogged pores and causing a breakout. Antibiotics may also reduce pain or inflammation from existing breakouts.

Antibiotics are effective in the short-term but are not a long-term treatment option.

A person can take antibiotics for 7 to 10 days at a time. Taking them on an ongoing basis may reduce their effect and cause other complications.

Isotretinoin

Isotretinoin medicine for nodular acne
Isotretinoin will only be prescribed for severe acne.

Isotretinoin is a strong prescription acne medication that a person takes daily. It is an effective way to treat all forms of acne. But doctors will only prescribe it for severe acne, as it has several adverse side effects. The most common are:

  • dry skin, lips, eyes, throat, nose
  • nosebleeds
  • skin becoming more sun sensitive
  • headaches
  • general aches and pains

Women who are pregnant or trying to get pregnant should not use isotretinoin, as it can harm the growing fetus.

Birth control pills

Some women who have nodular acne find that hormonal changes can trigger a breakout.

Androgens (hormones) can promote oil production on the skin, which may increase the chance of developing clogged pores and breakouts.

Doctors may recommend birth control pills for women who have nodular acne breakouts caused by hormonal changes.

Topical treatments

Topical treatments are creams or ointments that a person applies directly to their skin. Some topical treatments include:

  • Antibiotic cream: This helps to kill bacteria trapped under the skin.
  • Retinoids: These are made from vitamin A and help unclog the pores.
  • Prescription-strength salicylic acid: This dries out excess oil and clears dead skin cells.

Some people may use topical medications as an initial treatment or in addition to oral medication. For more severe breakouts, topical treatments are generally not effective when used on their own.

Home remedies and prevention

It is best to use home remedies alongside treatments that a doctor prescribes, rather than instead of them.

Home remedies for nodular acne include:

Apple cider vinegar

Many people use apple cider vinegar as a home remedy due to its antibacterial properties. Some people believe apple cider vinegar may target acne-causing bacteria and help heal the skin.

To try this remedy, dilute apple cider vinegar with warm water and apply to the affected skin.

Olive oil

Some people recommend cleansing the skin with olive oil to reduce acne. They believe the olive oil joins with excess oil on the skin, helping lift it out of the pores. This is thought to prevent clogging and reduce breakouts.

A 2010 study found olive oil to have antioxidant properties when used on the skin. Beyond this, there is little evidence to suggest it supports skin health or prevents acne.

Reducing stress

Stress hormones in the body may trigger acne breakouts. For this reason, mindfulness, meditation, or yoga may help reduce breakouts. These activities are known to reduce stress levels and improve well-being.

Skin care tips

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Using a lightweight moisturizer may help to reduce breakouts.

To keep skin clean and reduce breakouts, a person can try:

  • washing face twice daily
  • washing directly after exercise
  • removing makeup before bed
  • using a lightweight moisturizer
  • applying sunscreen daily
  • avoiding touching the face
  • washing hands before applying makeup

To reduce the chance of scarring, it is essential not to attempt to pop acne nodules. Trying to squeeze them will only cause further inflammation and may cause scarring.

How to get rid of acne scars

Nodular acne may leave scars on a person’s skin, even after breakouts have cleared.

There is a range of therapies a doctor or dermatologist may recommend to improve the appearance of skin and reduce scarring.

Options include:

  • chemical peels
  • blue light therapy
  • laser therapy

Takeaway

Nodular acne is a painful, severe form of acne that is characterized by hard lesions under the skin.

There are several treatments available for this skin condition. If a person has nodular acne, they should speak to a doctor or dermatologist about a personalized treatment plan.