Most everyone has experienced an acne breakout from time to time. After all, pimples of all kinds are a very common skin condition. But some types of acne are more stubborn and painful than your typical blackhead, like nodular acne. We’re here to tell you everything you need to know about nodules and how to identify them, treat them, and help prevent them from occurring.

What is nodular acne?

You might already know about the several types of acne (like whiteheads, blackheads, papules, and pustules), but what about nodules? Nodular acne causes large, hard blemishes to form deep below the skin’s surface. Unlike cystic acne, nodules don't contain pus, but they're often also painful to the touch.¹

Contributing factors of nodular acne

So what exactly causes nodule acne? Several different factors can come into play:

• Excess sebum production. No matter the type, pimples often start with the same few contributing factors. Sebaceous glands producing excess oil are often one of them.²

• A buildup of dead skin cells. Excess dead skin cells getting clogged in the pores are another factor that leads to acne.³

• Bacteria. When bacteria combine with the sebum and dead skin cells in a clogged pore, the acne becomes inflammatory. As your body tries to fight off the bacteria, it has an inflammatory response that can result in a nodule.⁴

• Hormones. Hormones can play a significant role in acne occurring because hormone fluctuations can cause an increase in oil production. This is why many people experience more breakouts during adolescence or around menstrual cycles.⁵

• Genetics. If your family has a history of severe acne (like nodules), you may be more at risk of developing them. Don’t worry—acne caused by genetics can still be treated.⁶

• Stress. We all get stressed from time to time, but stress has been linked to worsening acne. So before a big interview or exam, try to make some time for self-care to keep you feeling relaxed and ward off acne nodules.⁷

• Pore-clogging products. While nodular acne is severe and involves bacteria, cosmetics, and other skincare products that contain pore-clogging (comedogenic) ingredients can help start the domino effect that leads it to occur.⁸

• Diet. Moderation is always important, but some dietary choices like dairy and simple sugars, and carbs can trigger increased oil production that can lead to acne.⁹

How to help prevent nodular acne

Nodular acne can be painful and frustrating, so preventing it from happening in the first place can save you the headache of treating it. One of the best ways to prevent nodular acne is to dedicate yourself to a good skincare routine. Here are some tips to help you get started:

• Regularly cleanse your face. Cleanse your face with a gentle, non pore-clogging cleanser in the morning and at night before bed. 

• Give treatments time. Acne treatments can take four weeks or more to show visual improvements. Before throwing in the towel and moving on to something else, remember, patience is key.¹⁰

• Keep your hands off. Picking at any pimple is never a good idea. Instead, apply a hydrocolloid bandage to help draw out the contents and speed healing.

• Spread the meds. Instead of just applying your acne treatment on trouble spots, apply your treatment to all areas that tend to break out. This can help prevent future acne lesions from occurring.

How to treat nodular acne

Of all the different types of acne, nodules often prove to be one of the most stubborn. But fear not—science is on your side. Here are some ingredients found in many skincare products that can help reduce it:

• Benzoyl peroxide. Found mostly in facial cleansers or spot treatments, benzoyl peroxide can be helpful in treating inflammatory acne because it kills bacteria, unclogs pores, and helps with inflammation.¹¹

• Salicylic acid. Another topical acne treatment that helps clear away dead skin cells,¹² salicylic acid is often found in face washes.

• Adapalene. Another commonly found ingredient in over-the-counter topical acne treatments, more potent prescription-only varieties of this synthetic form of vitamin A also exist.¹³

And speaking of prescriptions, if over-the-counter topical treatments don’t seem to be effective in reducing acne lesions and helping you say goodbye to nodules, several prescription-only alternatives may help: 

• Isotretinoin. This oral medication has been proven effective for treating severe inflammatory acne like nodules and cysts.¹⁴ It must be prescribed in-person by a medical provider.

• Oral contraceptives. For women who experience acne due to hormonal fluctuations, some birth control pills can help with the hormonal aspect of acne.¹⁵

• Spironolactone. Spironolactone is another hormonal treatment option that blocks the production of acne-causing hormones that can increase oil production that may lead to nodules. 

• Topical retinoids. These are often used alongside other treatments like topical or oral antibiotics.¹⁶

How to help prevent scars from nodular acne

A common concern with nodular acne is that it can cause scarring. Once acne scars appear, eliminating them altogether can be difficult, so it’s best to prevent them as best as possible. You can also help prevent scarring by:

• Refraining from picking. We know how tempting it can be to squeeze a stubborn pimple. Trying to pop a pimple, especially a nodule, can lead to more inflammation and scarring.¹⁷

• Treating it promptly. If you’re experiencing a nodule that you think might scar, we recommend seeking a professional opinion from a dermatology provider or your primary care provider if possible. 

When is it time to see a doctor?

Nodular acne is considered severe, so if you’re experiencing nodules, again, seeing a medical provider is probably the best course of action, especially if you’re experiencing symptoms such as these:

• Pain. Nodules can often hurt, but many prescription treatment options are available if you’re experiencing severe pain or discomfort.¹⁸

• Nonresponsiveness to over-the-counter treatments. If your nodular acne isn’t responding to over-the-counter medicines like benzoyl peroxide, you may want to see a medical provider for prescription treatment. 

• Emotional discomfort. Let us be the first to tell you (that is, if no one else has already): Yes, nodular acne can be upsetting. But it’s a condition that many people experience at some point in their lives, which makes it nothing to be embarrassed about. Even so, if you feel as though it affects your confidence, there’s no harm in reaching out for professional help. Reach out to a medical provider to get a more powerful treatment.

• Swelling. Large, swollen pimples are no fun, no matter what. A local medical provider may be able to perform in-office procedures that can help reduce swelling, which can also help reduce the likelihood of scarring.¹⁹

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If you’re struggling with nodular acne, Curology can help! Curology’s dermatologist-designed Custom Formula is made to match your skin’s unique needs—and your personalized formula can evolve as those needs change. You get a personal dermatology provider to check-in and help you along your skincare journey, plus delivery straight to your door. Sign up for a 30-day free trial for just $4.95 + tax* (to cover shipping and handling).

P.S. We did the research so you don’t have to:

1. Cleveland Clinic. Acne. (2020, September 1).

2. Mayo Clinic Staff. Acne: Symptoms and causes. (2020 September 12).

3. Mayo Clinic Staff. Acne: Symptoms and causes. Ibid.

4. Tanghetti, Emil A. The role of inflammation in the pathology of acne. The Journal of clinical and aesthetic dermatology. (September 2013).

5. American Academy of Dermatology. Acne: Who gets and causes. (n.d.).

6. American Academy of Dermatology. Acne: Who gets and causes. Ibid.

7. Diane Thiboutot, et al. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. (2009, May 1).

8. American Academy of Dermatology. 10 skin care habits that can worsen acne. (n.d.).

9. Mayo Clinic Staff. Acne: Symptoms and causes. Ibid.

10. American Academy of Dermatology. 9 things to try when acne won’t clear. Ibid.

11. Kawashima, M., et al. Clinical efficacy and safety of benzoyl peroxide for acne vulgaris: Comparison between Japanese and Western patients. The Journal of dermatology.(November 2017).

12. Cleveland Clinic. Cystic Acne. Ibid.

13. Newman, M.D., et al.Therapeutic Considerations for Severe Nodular Acne.Am J Clin Dermatol (2012 ,September 10).

14. Newman, M.D., et al.Therapeutic Considerations for Severe Nodular Acne.Am J Clin Dermatol (2012 ,September 10).

15. Newman, M.D., et al.Therapeutic Considerations for Severe Nodular Acne.Am J Clin Dermatol. Ibid.

16. Newman, M.D., et al.Therapeutic Considerations for Severe Nodular Acne.Am J Clin Dermatol. Ibid.

17. American Academy of dermatology. Pimple Popping: why only a dermatologist should do it. (n.d.).

18. Cleveland Clinic. Cystic Acne. Ibid.

19. Cleveland Clinic. Cystic Acne. Ibid.

We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.

* Subject to consultation. Subscription is required. Results may vary.

Written by

Curology Team

Medically reviewed by

Allison Buckley, NP-C