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Nodular Acne

Nodular Acne

Nodular Acne

Having pimples can be distressing alone, but when they are severe and painful, it can feel like an insult to injury. That’s one of the many reasons why nodular acne, commonly referred to as nodulocystic acne, cystic acne, and nodular cystic acne can significantly impact our lives. Unlike the acne lesions most of us experience, nodular acne lesions are rooted much deeper in the skin. If you struggle with acne of any type, including nodular acne, our dermatologists in Gainesville can help. No matter your skin condition or concern, our skin specialists are committed to helping you achieve healthy and beautiful skin throughout each life stage.

Contact our office today to schedule a dermatologist appointment and to learn more about our available skin care treatments for various skin conditions.

What Is Nodular Acne?

Nodular acne is a form of inflammatory acne characterized by hard, painful, deep acne lesions located deep under the skin. It can occur anywhere on the skin but commonly on the face, chest, and back. Unlike regular pimples, acne nodules may endure for weeks or months. They don’t typically develop a whitehead; instead, they remain as hardened knots under the skin. Nodular acne can be very painful, and the appearance of these lesions may affect your self-esteem and emotional well-being. 

What Causes Nodular Acne?

Nodular acne starts when a pore becomes clogged with a mix of natural oils (sebum), dead skin cells, and other debris. This causes a blackhead or a pimple that clears up relatively quickly for most people. But for those with nodular acne, clogged pores can cause a more severe breakout. The primary nodular acne cause occurs when a type of bacteria (P. acnes) gets trapped inside a clogged pore.

This results in an infection affecting the skin’s deep layers, which causes hard nodules to develop under the skin. Nodules can occur on their own or may spread over a larger area, developing in patches of nodules. Unlike regular pimples, acne nodules don’t tend to form a head, meaning that attempting to squeeze them will not release pus and may lead to further inflammation. Nodular acne can be caused by hormones, genetics, and poor hygiene.

Symptoms Of Nodular Acne

The most common symptom of nodular acne is hardened lesions on the face, chest, or back. It may also affect other areas of the body. Nodules can be the same color as the skin or appear red or pink. Acne nodules are commonly inflamed and may be painful to touch. Many people describe them as hard knots deep in the skin. Nodular acne breakouts can last for weeks or months at a time. Without professional treatment, nodular acne can result in scarring. The following includes some of the most common characteristics of nodular acne.

  • Red, inflamed lesions on the skin
  • Nodules without heads
  • Painful bumps on the face, chest, neck, or back
  • Usually large

What Does Nodular Acne Look Like?

Nodular acne is a severe and deep form of acne where the clogged pore turns into a thick bump under the skin, which means the bump is not communicating with the skin’s surface, so it’s just about impossible to extract. It’s a bump you can feel with your hand, and it sits deep into the dermis, usually causing pain, as it sits close to the nerves. This acne can appear the same color as the surrounding skin but often becomes red and irritated. 

This is caused by the immune system attempting to break up and absorb dead skin cells, skin oil, and other inflammatory cell debris that accumulates under the skin. Because nodular acne lives in the deeper layers of the skin, these acne lesions are often accompanied by scarring. The nodules push the surrounding collagen aside, and the inflammation surrounding the nodule damages and changes the collagen. Once these stubborn bumps finally go away, they leave an indentation or acne scars behind.


Nodular Acne Vs Cystic Acne

Nodular and cystic acne are very similar, as they both cause painful, deep-embedded bumps to develop under the skin. Additionally, these can leave behind scarring on the skin. Among the main differences, acne cysts are filled with pus, a white or yellowish substance or fluid, while acne nodules are not filled with pus. Additionally, acne nodules are more solid in form and are harder to the touch than acne cysts, as acne cysts do not contain fluid and instead contain pus. 

Nodular acne and cystic acne causes are similar, as they develop due to clogged pores filled with excess oil, bacteria, and dead skin cells. As with hormones causing the development of nodular acne, hormonal cystic acne tends to peak as we go through puberty and when hormones are highly active, and changes occur, such as during teenage years and through early adulthood.

Where Does Nodular Acne Occur?

Nodular acne usually occurs on the face, neck, chest, and back. However, it can appear virtually anywhere on the body. They can occur as solitary, hard lesions under the skin or in more widespread groups beneath the skin in a wider area. For more information about nodulocystic acne and potential treatment options for your acne lesions, contact Gainesville Dermatology & Skin Surgery to schedule an appointment.

What Is Nodular Acne Filled With?

In contrast with other types of acne lesions filled with pus, a white or yellow-colored fluid with a creamy texture, acne nodules are not filled with fluid. This is why acne cysts and pimples feel softer to the touch and can sometimes be extracted or “popped,” while acne nodules cannot be extracted or popped, even when squeezed. Additionally, this causes acne nodules to feel harder or tougher to the touch and more painful than the average acne lesion. As such, our dermatologists strongly advise against attempting to pick at, squeeze, or pop any nodular acne lesions, as this may cause the infection to spread deeper and create even more inflammation and scarring in the surrounding tissues.

How Is Nodular Acne Diagnosed?

If you suspect you have acne, a good next step involves receiving a diagnosis from your dermatologist. In many cases involving acne, a dermatologist can diagnose these simply by examining your skin. They can help identify the exact type of lesions you have and determine their severity to develop an effective treatment plan that accommodates the specific needs of your unique skin. The type of acne a patient has is categorized based on the size and spread of the pustules. Your dermatologist may grade your acne as mild, moderate, or severe. For more information about the diagnostic process or how to treat nodular acne, please contact our office to schedule a dermatologist appointment.

How Is Nodular Acne Treated?

Because this form of acne can be extremely painful, cause emotional distress, and result in scarring, it’s best to start nodular acne treatment as quickly as possible. See your dermatologist as soon as possible to get treatment underway. Unlike other, less severe types of acne, over-the-counter acne treatments are not typically strong or effective enough to improve nodulocystic acne. If you suspect you have nodular acne, or any other type of acne, make an appointment with our board-certified dermatologists. The quicker you treat your nodules, the more likely you will be able to avoid scarring afterward.

Oral Medications

Certain oral medications can be effective for treating nodular acne. Birth control works by regulating female hormones, such as estrogen, preventing spikes in male hormones (androgens), and reducing the overproduction of oil. Spironolactone is an acne-fighting drug that binds to testosterone receptions, blocking them from activating sebum in the sebaceous glands, which means fewer blocked pores and less nodular acne.

  • Oral Contraceptives
  • Spironolactone
  • Isotretinoin


Antibiotics and other prescription medications have anti-inflammatory properties that kill P. acnes, which causes breakouts of acne nodules. Prescription drugs containing derivatives of vitamin A (Accutane), retinol, and topical medications taken in tandem with oral antibiotics for nodular acne can all help reduce excessive oil production and keep pores clear.

  • Topical & Oral Medications
  • Retinol
  • Accutane

Topical Treatments

Topical nodulocystic acne treatments can help reduce inflammation and kill P. acnes, the primary type of bacteria contributing to inflammatory acne. These medications can include acne-fighting powerhouses, such as salicylic acid and benzoyl peroxide, among other ingredients and exfoliants.

  • Salicylic Acid
  • Benzoyl Peroxide
  • Topical Retinoids

In-Office Treatments

In-office treatments and clinical interventions can also help address inflammation, treat and heal nodules, and address any signs of scarring left behind by nodular acne lesions. These treatments may include microneedling, incisions to release trapped white blood cells and other items within nodules, intralesional steroid injections to decrease inflammation, and chemical peels. 

Coping With Acne Nodules

Breakouts can be extremely painful and emotionally distressing for those with nodular acne. The following tips may not clear up your acne lesions, but they can help make your skin feel more comfortable while you seek treatment from a dermatologist. Contact Gainesville Dermatology & Skin Surgery today for additional information and to schedule an appointment for treatment from our dermatology team.

  • Avoid picking, squeezing, or attempting to pop acne nodules
  • For blemishes that are especially sensitive or painful, apply ice wrapped in a soft cloth multiple times per day to help with the pain and swelling
  • Contact your dermatologist promptly to seek treatment for acne nodules
  • Follow your dermatologist-recommended skincare routine diligently
  • Routinely use moisturizer and a separate sun protection product with a sun protection factor (SPF) of at least 30
  • Use only non-comedogenic makeup products and thoroughly remove makeup and cleanse the skin at the end of each day
  • Keep your hands away from your skin, especially your face, and avoid picking at the skin