Nodular Acne

Nodular acne is a severe form of acne vulgaris, a common skin condition characterized by the formation of inflamed and painful lesions on the skin

Seek professional treatment early to minimize complications and reduce potential scarring.

nodular acne
Facial nodular acne with acne scarring

What is Nodular acne?

Nodular acne is a term to describe acne that may involve deeper layers of the skin, often seen in more severe forms of the disease. Nodule is derived from the latin word nodulus, ‘small knot”. A nodule is larger than a papule, which is commonly seen in acne. It is often more than 1cm in size and feels hard to touch. As it may involve the dermis or subcutaneous tissue , many patients often say that their acne has ‘no head’.

what are the Key Features?

  1. Size and Depth: Nodules are larger and deeper than typical acne lesions, extending deep into the layers of the skin.

  2. Pain and Inflammation: Nodular acne lesions are often painful, tender, and inflamed due to their size and depth. They can cause discomfort even without direct pressure.

  3. Duration: Nodular acne lesions can persist for weeks or even months if left untreated. They may also leave behind scars or pigmentation changes after healing.

  4. Scarring: Nodular acne lesions have a higher risk of causing scarring compared to milder forms of acne. This is due to the deep inflammation and tissue damage associated with nodules.

  5. Location: Nodular acne can occur on various parts of the body, but it is most commonly found on the face, neck, chest, and back.

What causes nodular acne?

The exact cause of nodular acne is not fully understood, but it is believed to involve a combination of factors, including genetics, hormonal fluctuations, comedome formation, excessive sebum production, bacteria (C. acnes), and inflammation.

  • Genetics: Acne occurs earlier and is more severe in those with a positive family history.
  • Drugs: Anabolic steroids, Etanercept etc.
  • Diet: High glycaemic index food, dairy and Whey supplements may be associated with acne, but more studies are needed to ascertain this.

Am i at risk of scarring?

From studies, it has been found that nodular acne is associated with rupture of the follicular wall with a marked peri-follicular inflammatory response that leads to acne scarring. A more widespread and aggressive inflammatory response will lead to collagen degradation and the formation of atrophic acne scars which may be permanent in nature.

Nodular acne vs. cystic acne?

nodular vs cystic acne
Cystic Acne

The main difference between nodular acne and cystic acne is the presence of pus. Nodular acne, which is deeply embedded within the skin feels hard and painful. When pressure is applied to a cystic acne lesion, you will often notice pus coming out from the skin.

Nodulo-cystic acne is a combination of both nodular and cystic acne within the skin.

Should i pop my acne?

While it may be tempting to squeeze your nodular acne, you have to realize that it’s located within the deeper layers of your skin. Unlike papules and pustules which are more superficial, you will not be successful at squeezing anything out. In short, leave your nodular acne alone and seek professional help lest it worsens your acne condition or causes even deeper scarring.

why should i get treated?

Although acne can cause physical pain, itch and discomfort, many patients find that acne may impact other facets of their lives, including:

  • Emotional functioning
  • Social functioning
  • Relationships
  • Leisure activities
  • Daily activites
  • Sleep
  • School
  • Work

Quality of life studies show comparable impact as with other chronic conditions such as asthma, psoriasis and arthritis. Acne is associated with bullying, low self-esteem, depression, anxiety and suicide ideation. Getting severe acne treated not only reduces scarring but also improves how you feel about yourself and the world around you. 

Nodular acne treatment

The main goals of nodular acne treatment is to reduce inflammation, pain, swelling and minimize the risk of acne scarring. Early intervention and consistent treatment can help improve symptoms and prevent long-term skin damage. Treatment for nodular acne often requires a comprehensive approach and may include:

Prescription-strength medication such as retinoids, benzoyl peroxide and antibiotics may be used to reduce inflammation, comedomes (whiteheads and blackheads), reduce hyperpigmentation and as a maintenance skin care regime.

According to the American Academy of dermatology, injection steroids that are placed directly into nodular acne can bring down pain and swelling in as fast as 2-3 days. This is helpful to relieve symptomatic nodular acne but does not replace the comprehensive approach to acne management.

Oral medication such as antibiotics, hormonal therapies and oral isotretinoin (Accutane) is prescribed for severe acne or acne at risk of scarring. The risks and benefits of these treatments will be discussed during a consultation taking in account you condition, lifestyle and skin type.

Since 1982, oral isotretinoin is FDA-approved for the treatment of recalcitrant nodular acne vulgaris. Many global acne experts are in agreement that oral isotretinoin is the most appropriate treatment for severe or scarring acne. In addition, it is also used for acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy.

On occasion, nodular acne may transform into an abscess. An abscess is a swelling that is filled with pus. An incision and drainage procedure helps to drain the pus, facilitate healing and reduces pain and discomfort.

Takeaway Message

Nodular acne is typically a chronic inflammatory disorder that can persist well into adult life. Early and effective treatments can reduce symptoms, avoid further scarring, and improve your quality of life.

Frequently Asked Questions About Nodular Acne

Nodular acne lesions are larger and more deeply embedded in the skin compared to typical pimples or whiteheads. They often feel firm or hard to the touch and can be quite painful.

While it may not be possible to prevent nodular acne entirely, certain strategies can help reduce the risk of its development or severity. These include maintaining good skincare hygiene, avoiding excessive scrubbing or picking at the skin, managing stress levels, following a balanced diet, and avoiding known triggers such as certain cosmetics or medications.

The timeline for clearing up nodular acne can vary depending on the individual and the effectiveness of the chosen treatment. In some cases, nodular acne lesions may persist for weeks or even months if left untreated. However, with proper treatment and consistent skincare, significant improvement can usually be seen within a few weeks to months.

Untreated nodular acne can lead to several complications, including scarring, hyperpigmentation, and psychological distress due to its impact on self-esteem and quality of life. Severe cases may also result in persistent inflammation, infection, or the development of secondary conditions such as depression or anxiety.

It is generally not recommended to pop or squeeze nodular acne lesions, as this can exacerbate inflammation, increase the risk of scarring, and spread bacteria to surrounding skin areas. Instead, it’s best to seek professional advice from a doctor for appropriate treatment options.

  • While mild acne can sometimes be managed with over-the-counter products, nodular acne often requires prescription medications and professional treatment. However, maintaining good skincare habits, such as gentle cleansing and avoiding harsh products, can help manage symptoms.
schedule a consultation for nodular acne treatment in singapore

We treat a range of acne and acne scars at both our clinics in Woodlands and Kovan. Contact us today to schedule a consultation, so that Dr. Ng can develop a individualized treatment approach for resolving your skin care concerns and helping you to achieve long-term improvements in the health and appearance of your skin.

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  1. Zouboulis CC, Bettoli V. Management of severe acne. British Journal of Dermatology. 2015 Jul 1;172(S1):27-36.
  2. Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs in context. 2021;10.
  3. Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: a review. Jama. 2021 Nov 23;326(20):2055-67.
  4. Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Gold LF, Tan JK, Tollefson MM. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. 2024 Jan 30.