Nodular Acne

Acne can affect just about any body part. It tends to occur most frequently on skin with a high concentration of oil glands. The most common sites for nodular acne are the face, neck, chest, upper back, and shoulders.

There are two types of pimples that occur in nodular acne:

• Nodules, which are solid lumps deep under the skin that are painful and can be quite large

• Cysts, which are pus-filled nodules deep under the skin that are painful, but not as hard as nodules

Inflamed skin over the nodule or cyst is very common. The redness and swelling is the result of a strong immune-mediated inflammatory response to the clogged pore and bacteria within it. The appearance of nodular acne can resemble other skin conditions. It’s important to see a dermatologist for an accurate diagnosis. A dermatologist has the expertise to effectively treat nodular acne. Seeing this skin specialist early can help you get control over your skin sooner.

Acne is the result of skin pores becoming clogged with oil, dead skin, and bacteria. Nodular acne occurs when deep pimples form around a hair follicle. Nodules can involve more than one follicle when they grow very large. Cysts form when pus fills the nodule.

Researchers do not fully understand exactly why some people develop nodular acne and others do not. It’s likely a combination of factors, including genetics, the immune system, and hormones levels. Rising levels of androgens during adolescence stimulate oil production and skin cell turnover. Some people may produce too much oil or may be overly sensitive to normal skin bacteria.

Several factors increase the risk of developing acne, including nodular acne. There are also various factors that can trigger or worsen a breakout. Not everyone with risk factors will have problems with acne or severe acne.

Risk factors and triggers include:

• Age: Acne is most common during adolescence, but you can develop it at any age.

• Certain medications: Examples include corticosteroids, lithium and phenytoin (an anticonvulsant).

• Diet: Some research has implicated high-carbohydrate or high-glycemic diets as contributors to acne breakouts.

• Heredity: Having a parent who had nodular acne makes it more likely that you will also have problems with it.

• Skin environment: Greasy or oily cleansers, cosmetics, creams or other skin products can clog your pores. Tight clothing, high humidity, excessive sweating, and friction or pressure on the skin can contribute as well.

• Stress: If you already have acne, stress may act as a trigger for breakouts or worsen existing breakouts.

Research also suggests there may be a link between smoking and acne breakouts.

You can’t completely prevent or avoid acne, including nodular acne. However, you may be able to control your acne triggers and breakouts by:

• Avoiding abrasive or alcohol-based cleansers and greasy or oily skin products

• Not touching your face or squeezing pimples, which can cause more irritation and worsen the problem. Picking at acne also increases the risk of scarring.

• Quitting smoking

• Shampooing your hair regularly, which means once a day for oily hair

• Washing your face twice a day with a gentle cleanser and lukewarm water. You should also wash your face after heavy sweating. Keep in mind, scrubbing your skin or excessively washing it can make the problem worse.

If you have a parent who had nodular acne, see a dermatologist at the first sign of a problem. Your doctor may have other strategies to help you minimize triggers and breakouts.

Nodular acne is an inflammatory acne that requires treatment from a dermatologist. Home remedies and over-the-counter treatments aren’t likely to help this form of moderate-to-severe acne. Instead, prescription medicines are necessary to effectively treat it.

Potential treatment options include:

• Oral antibiotics, such as doxycycline, erythromycin, minocycline or tetracycline, in combination with topical therapy, such as tretinoin (Retin-A) or tazarotene (Tazorac). It can take up to 12 weeks to see the full benefit of oral antibiotics. Once acne is under control, doctors will taper the dose down to the lowest effective dose. The goal will be to eventually maintain control with topical medicines and avoid long-term use of oral antibiotics.

• Oral contraceptives. This hormonal therapy is an option for women with nodular acne. Oral contraceptives are effective in treating both inflammatory and non-inflammatory acne. An alternative is spironolactone, which has anti-androgen properties.

• Oral isotretinoin (Amnesteem, Claravis, others). This vitamin A derivative can have problematic side effects, such as depression and severe birth defects. Doctors generally reserve it for people who don’t get results with other treatments. People who take this medication must participate in a patient program. This includes a requirement for women of childbearing age to use two methods of contraception for one month before treatment, during treatment, and for one month after treatment is complete. The course of treatment lasts between 16 and 20 weeks.

• Steroid injection with triamcinolone acetonide solution into the nodule. The steroid injection approach for nodules works quickly and can help reduce scarring.

In some cases, doctors may recommend draining cysts. However, this technique can cause scarring.

Nodular acne can cause both physical and emotional complications. The physical complications include scarring and discoloration of the skin. Scarring from nodular acne can look like deep pits. It is also possible to form keloid scars, which are thick, sometimes discolored scars.

Fortunately, there are treatments available to help improve the look of acne scars. Depending on the severity of the scarring and discoloration, options may include:

• Chemical peels

• Dermabrasion

• Laser resurfacing

• Skin grafting, which removes a “punch” of skin containing the scar and replaces it with donor skin from another site

The emotional scars from acne can include anxiety, depression, low self-esteem, and social isolation. Effectively treating acne and any resulting physical scars can go a long way to healing these emotional side effects. This makes it very important to find a dermatologist with plenty of experience treating nodular acne.