Nodular Acne

Nodular acne occurs when acne is combined with a bacterial infection. This makes the symptoms more severe than normal acne, and potentially harder to treat.

What is Nodular Acne?

Nodular Acne is a specific type of the skin condition which is characterized by large numbers of pimples on the skin, often surrounded by inflamed and red areas of skin.

Each individual whitehead or blackhead which makes up acne is formed in the same way. Our bodies are covered with millions of tiny hairs. These hairs grow from a follicle in the skin, which also house glands which secrete sebum (a natural oil) to moisturise and hydrate the skin. Pimples form when particles become trapped in these follicles. Skin cells, dust, dirt, makeup and oil can all become trapped in the hair follicles, and block the sebum from being able to escape.

The skin around the follicle then starts to swell as the sebum builds up, and a pimple forms. When this happens over and over again, acne forms on the skin.

Nodular acne develops in exactly the same way, but with one key addition: bacteria. P. acne bacteria, which is commonly found on human skin and is often completely harmless, can get into the hair follicles, and cause an infection to develop underneath the surface of the skin. This makes the affected pores particularly painful and swollen.

Nodular acne is often considered to be much more serious than normal acne, as the infection goes much deeper. It cannot be treated with home remedies or over-the-counter treatments, and instead must be medicated in order to clear up the infection.

Symptoms of Nodular Acne

The symptoms of Nodular Acne are not dissimilar to the symptoms of normal acne, however, they are often much more severe and pronounced. Symptoms include:

  • Whiteheads
  • Blackheads
  • Areas of skin being sore to the touch
  • Red skin
  • Inflamed patches of skin
  • Raised bumps in the skin
  • Deep pits and scarring on the surface of the skin

Who is most likely to suffer from Nodular Acne?

Teenagers are the most common group of people to suffer from nodular acne, but there are also other factors which can make a person more likely to have this condition. These factors include:

  • People who use large amounts of oily cosmetic products
  • Not washing promptly after sweating or exercise
  • A family history of nodular acne
  • Certain drugs, such as lithium, corticosteroids, isoniazid and phenytoin
  • Hormones, especially those related to menstruation, birth control, HRT, stress and pregnancy


Standard over-the-counter acne medication is very unlikely to be effective against nodular acne. Doctors and healthcare providers will therefore often use prescription medication to treat the condition. The most commonly prescribed medications for nodular acne are:

  • Oral antibiotics
  • Topical antibiotics
  • Prescription-strength benzoyl peroxide
  • Prescription-strength salicylic acid
  • Retinoids
  • Cortisone injections


Repeated bouts of Nodular Acne are likely to be caused by an excess number of p. acne bacteria living on the skin. This can cause the acne to continue to return after courses of treatment have finished, and to be widespread across the body, as opposed to being contained to a small area such as the face or upper back.

In this case, doctors are likely to prescribe oral or topical antibiotics. The antibiotics work to kill off the bacteria on the surface of the skin so that it cannot get trapped in the hair follicles and cause the infection which leads to nodular acne. As well as killing the bacteria as a preventative measure, antibiotics can also help to relieve some of the symptoms of nodular acne and reduce the pain and swelling associated with the condition.

Benzoyl peroxide and salicylic acid

Benzoyl peroxide and salicylic acid are both active ingredients which are commonly found in over-the-counter acne medication. However, the amounts used in these treatments are not strong enough to tackle nodular acne. Healthcare providers will, therefore, prescribe the active ingredients in stronger doses so that they stand a better chance of having an effect against nodular acne. These substances are used to dry out the skin, attempting to unclog the oil and trapped particles in the hair follicles.


Retinoids are the final type of medication commonly prescribed as a treatment for nodular acne. These creams are rich in vitamin A, and are applied directly to the area of skin affected by nodular acne. The cream then helps to unblock the pores and hair follicles, clearing the way for other treatments to be more effective. Retinoids are usually prescribed in conjunction with other medications in order to provide the most effective treatment method against nodular acne.

Cortisone injections

Cortisone injections are only used in extreme cases. They do not necessarily help to clear up bouts of acne, but they are effective in relieving the symptoms in the short term. They can reduce the inflammation and swelling around the affected area, and improve the appearance of the skin whilst also reducing pain.

Does Nodular Acne cause scarring?

Nodular Acne is likely to leave behind some scarring for two different reasons. Firstly, when the infected follicle is inflamed for an extended period of time, it can cause damage to the skin cells in the surrounding area. As these cells repair themselves, they can form dark spots which may remain even after treatment for the acne has been completed. These dark spots can take years to go away, and some never do completely.

The scars which are more often associated with acne are those which cause a dip, pit or crater in the surface of the skin. These develop after the pimples which make up nodular acne have been burst or popped. This leads to enlarged pores which can heal over to leave behind these pocks in the skin.

The easiest way to prevent these types of scars from occurring is to seek treatment as soon as possible. Resisting the urge to pop or squeeze the nodules themselves will reduce the likelihood of permanent scarring.

There are cosmetic treatments available to treat the scarring should you need them, however, these are often not covered by health insurance, and are unlikely to be 100% effective at erasing scars.