Nodular Acne

What is nodular acne?

Nodular acne is a severe type of acne. It causes hard lumps or knots (nodules) to develop deep under your skin. The nodules start below the surface and appear on the skin as red bumps. These bumps usually don’t have a whitehead or blackhead at the center.

The nodules can last for weeks or even months. They are very painful. A bacteria called Cutibacterium acnes (C. acnes) becomes trapped under your skin in these nodules, leading to infection and inflammation.

Nodular acne requires treatment from a dermatologist (a healthcare provider who specializes in caring for your skin). Without treatment, this type of pimple can lead to permanent and severe scarring. You can reduce your risk of scarring by seeking treatment as early as possible.

Who might get nodular acne?

Anyone can get nodular acne. It can appear at any age and in people of all genders. But it’s more common in young people assigned male at birth.

How common is nodular acne?

Acne is the most common skin condition in the United States. Around 50 million people in the U.S. have acne. Nodular acne is severe, inflammatory acne. About 20% of people with acne have a severe type.

What causes nodular acne?

This severe form of acne develops like other types of pimples. It happens when your skin’s pores become blocked, trapping dead skin cells, hair and sebum (an oil your body makes to keep skin moist). The C. acnes bacteria, which naturally live on the skin, get trapped inside. This causes infection, inflammation and pain.

Blocked pores can result if your body makes too much sebum or if you don’t clean your skin properly. They can also result from:

• Excessive sweating: Skin that’s sweaty is more prone to nodular acne, especially if you wear clothing that traps sweat against your skin. People with hyperhidrosis (a condition that causes excessive sweating) may have a higher chance of developing nodular acne.
• Genetics: You’re more likely to develop nodular acne if you have a family history of it.
• Hormones: Young people who are going through adolescent development (puberty) are more likely to have an acne breakout as hormone levels change. Increased levels of androgens can cause oil in your skin to thicken, leading to clogged pores. Teenagers and young adults who were assigned male at birth have more of this hormone. People who are pregnant, menstruating or going through menopause can also get nodular acne.
• Medications: Certain drugs, including corticosteroids, can worsen nodular acne.
• Skincare products: Some lotions, creams and makeups can clog pores and lead to acne nodules.
• Stress and anxiety: Increased anxiety and stress can cause your body to produce more sebum as cortisol levels rise. Cortisol is your body’s “stress hormone.”

What are the symptoms of nodular acne?

You may have one acne nodule that appears by itself. Or you may have several that appear together. Providers sometimes call them blind pimples because they start underneath your skin. The symptoms of nodular acne are:

• Firm lumps (acne nodules) that you can feel under your skin. In people assigned male at birth, they usually appear on their face, back or chest. In people assigned female at birth, acne nodules typically develop on their jawline or chin.
• Pain or sensitivity, especially when you touch the nodules.
• Raised lumps that usually appear red, or they may be the same color as your skin.

You may hear your provider talk about nodular acne and cystic acne together. They may even call it nodulocystic acne. Cystic acne, a type that’s similar to nodular acne, causes cysts (bumps) to form beneath your skin’s surface. Cystic acne lumps are softer than nodules. Nodules are firmer, very painful and feel like knots under your skin. Some people have both cysts and nodules.

How is nodular acne diagnosed?

A dermatologist diagnoses nodular acne. Your dermatologist will examine your skin and ask about your symptoms. They’ll ask you how painful the nodules are and where they appear. Tell your provider about any medications you take and whether you have a family history of acne.

How can I treat nodular acne?

Nodular acne requires treatment from a dermatologist. Over-the-counter acne creams aren’t effective at treating nodular acne. Never squeeze or try to “pop” an acne nodule. This can make them worse and lead to severe acne scars.

To treat nodular acne, your dermatologist may recommend:

• Oral medications: Your provider may recommend a prescription skin care product such as isotretinoin for severe acne. People assigned female at birth must use birth control while taking this medication due to the risk of serious birth defects. Other oral medications, such as tetracycline (an antibiotic) and oral contraceptives (birth control pills) can reduce inflammation and clear up nodular acne. A medication called spironolactone can block or slow the production of hormones that cause acne.
• Prescription topical treatments: These medications include benzoyl peroxide, salicylic acid and prescription-strength retinoids. Your provider will prescribe this medicine in a cream, gel or foam that you put on your skin.
• Cortisone injections: To shrink very large, painful or lingering acne nodules, your provider may recommend cortisone shots. Your dermatologist uses a fine needle to inject a steroid medication into the nodule. This medication reduces inflammation and speeds the healing process.

How can I prevent nodular acne?

You may not be able to prevent nodular acne. But you can reduce your chance of getting it by practicing good hygiene. You should:

• Keep skin clean: Clean your skin with a gentle cleanser in the morning, at night and after sweating.
• Manage stress: Try breathing exercises and relaxation techniques to ease stress.
• Use quality products: Avoid using makeup or lotions that clog your pores. Look for non-comedogenic skincare products.

What can I expect if I have nodular acne?

Untreated acne nodules can cause severe scarring. Many people find relief from nodular acne after receiving treatments from a dermatologist. But it can take time for the nodules to go away.

Keep in mind that you may need to try different types of treatments or combinations of medications to achieve results. Your provider will probably prescribe a mix of topical and oral treatments. If you take isotretinoin, you may need two rounds of the medication to clear your skin.

When should I see my healthcare provider about nodular acne?

If you or your child has signs of nodular acne, see a dermatologist. It’s important to get treatment for this type of acne as soon as possible to prevent scarring, which can be severe. You can’t treat nodular acne by yourself or with over-the-counter acne creams. This type of acne requires treatment from a healthcare provider.

How can I best learn to cope with nodular acne?

Severe acne can make you feel depressed, self-conscious or embarrassed. If acne causes emotional distress or affects your self-esteem, talk to your provider. They can recommend therapy or treatments (such as depression medicines) that can help.

A note from Cleveland Clinic

Nodular acne can affect your quality of life, self-confidence and mental well-being. But treatments can help. If you or your child has symptoms of nodular acne, it’s important to see your dermatologist as soon as possible. Only a medical professional can effectively treat this type of severe acne and help you avoid scars. Never pick at, squeeze or try to pop an acne nodule. Doing so can make the nodule more painful and increase your risk of severe scarring.