Nodular Acne: Causes, Treatment Options, Prevention, Pictures

What is Nodular Acne

Nodular acne is a form of severe acne that is characterized by the existence of large, painful and inflamed pimples. Acne nodules are large and can be very painful compared to other types of acne such as cystic acne. This type of acne affects deeper layers of the skin.

Nodular Acne

Acne is a skin disorder that has boggled the minds of many. Its exhibition as a small pimple to its exacerbation to a huge cyst has had dermatologists at wit’s end.

One of the severe forms of acne is nodular acne. It occurs when a blocked hair duct is filled with bacteria, dead skin cells and sebum in the deep layers of the skin. It is rigorous and affects the body, back and face and it may last for months. Compared to the regular form of acne such as zits that heal relatively quickly, acne nodules usually last for long periods and can extend from teenage years up to adulthood.

Mostly nodular acne develops as a white head but can stay obstinately beneath at the skin surface. some people refer to nodular acne as cystic or nodulocystic though dermatologist argues that these are different forms of acne blemishes.

Causes of Nodular Acne

Bacterial infection

Clogged hair follicles due to excess sebum and dead skin cells attract p. acne bacteria.

This bacterium exists in the deep layers of the skin under an anaerobic environment.  It feeds on linolenic acid releasing eicosanoids that maintain body inflammation levels. However, the depletion of this fatty acid due to excess androgen, stress or other factors forces it to shift to other anaerobic areas such as the clogged pore at the skin surface.

Through the lipase enzyme, it consumes the sebum and nutrients present and releases porphyrins that cause cell damage causing unregulated inflammation. The bacteria also proliferate the production of excess sebum.

Hormonal imbalance

The production of excess androgen hormones particularly the release of dihydrotestosterone leads to the loss of linoleic acid. This fatty acid is responsible for moisturizing the skin. The skin’s immune system responds to this loss by increasing its sebum production. Furthermore, the skin cells are released more rapidly curtailing exfoliation, this further thickens the skin.

The congestion of dead skin and excess sebum trigger nodular acne

Poor exfoliation which leads to a buildup of dead cells. This blockage triggers the skin cells to increase sebum production and may attract bacteria.

Diet and genetics

Foods consumed that are rich in carbohydrates are quickly converted by the body into glucose which once stored and in excess raises insulin levels. The insulin resistance over activates the sebaceous glands which in turn overproduce sebum that causes acne.

It mostly affects teenagers especially males due to the androgen hormones but it is also experienced by women especially during menses. In females, it mainly affects the chin, jawline and neck.


  • Inflammation and the skin appear very red.
  • Huge, painful bumps larger than pimples
  • Bumps that bond under the skin and are pus-filled
  • Bumps that take more time to heal as compared to pimples or pustules
  • Deep scarring

Nodular Acne Treatment Options – In Office Procedures

Nodular acne may require more in-depth treatment since it involves the deep skin layers. some of the methods that can be used include:

Laser or blue light therapy

This pain-free method entails the use of light to attack the p. acne bacteria. This form of treatment may take a month and can be a bit expensive if not done at home.

Chemical peels

This method involves the application of chemical compounds that contain lactic, carbolic, and glycolic or salicylic acid on the acne affected area. This method aims at exfoliating acne affected the skin and stimulating the growth of new skin. However, depending on the skin type skin sensitivity may be experienced.


Nodular acne can be very painful and cortisone injections can be used to relieve the pain and fight inflammation.

The acne bumps can also be drained to remove the fluid, however, this requires precision

Consumption of antibiotics can help to destroy the p. acne bacteria. Contraceptives can also be prescribed as part of hormone therapy to help in hormonal balance. It involves the use of medicines that promote the production of progesterone and estrogen, especially in women to reduce testosterone levels.

Home remedies

Use Ice Packs for Nodular Acne on Chin and Cheeks

The skin becomes highly inflamed due to the deep effect on the skin. Ice can be used to reduce the swelling and soothe the irritation.

Drinking between 8-10 glasses of water daily helps the body to detoxify eliminating chances of toxin build up that triggers nodular acne.

Method: Place 4 ice cubes in a washcloth and place on the affected area. It can really sting so it should only be done for only 10 minutes. It can be repeated 2-3 times daily.

Baking soda

A humectant that draws out moisture from the acne, baking soda helps to exfoliate the skin and fight inflammation.

Its topical application helps to stop hyperpigmentation and neutralize skin PH by reducing the acid levels created by toxins present in the body from bacterial presence.

Method: Mix 2 tbsp of sodium bicarbonate with a few drops of water to form a paste. Apply to the affected area and wash off after 20 minutes with warm water.

Egg white

Eggs have been known for their high protein levels however they are useful for acne treatment.

The egg yolk also contains zeaxanthin and lutein which boosts its antioxidant properties.

However, the egg white is very useful for nodular acne treatment. It contains selenium, riboflavin, phosphorous, magnesium, potassium and calcium.

It contains lysozyme an enzyme that boasts of antibacterial properties. Its ability to break down bacterial bonds and stops the growth of the p. acne bacteria.

Inflammation leads to the release of compounds and enzymes that are acidic to the skin. Egg whites through the lysozyme enzyme provide an alkaline environment to fight off the inflammation. This also speeds up wound healing.

This enzyme also regulates melanin production thus fighting inflammation.

It also contains albumin which has astringent properties that help to tighten the skin pores.

Recipe: Separate 3 egg whites from the yolk and mix with 1 tbsp of lemon juice. Whisk and apply on clean face then rinse off with warm water after 15 minutes.


Raw papaya is rich in vitamin A and C antioxidants that also promote oil balance and tissue growth.

It is also rich in potassium an anti-inflammatory alongside niacin, folate, calcium and selenium.

The papaya seeds contain detoxification and antibacterial properties.

The latex in the raw papaya contains papain and chymopapain which are enzymes that fight inflammation, are antioxidants and help in detoxification.

Protease enzyme in raw papaya facilitates faster wound healing.

High insulin levels have been linked to stimulation of nodular acne; raw papaya helps to regulate sugar levels by re-energizing the insulin production process.

Recipe: clean the raw papaya and mash. On clean area apply the pulp and wash off after 25 minutes.

Apple cider vinegar

Contains malic acid which helps in detoxification and also boosts its antibacterial properties. The acid also boosts its astringent and humectant properties allowing the skin to retain its moisture while tightening the skin pores.

The acid helps in exfoliation allowing for the removal of dead skin cells associated with causing nodular acne.

Apple cider vinegar contains biotin that strengthens cell muscles and lowers the production of pro-inflammatory cytokines thus fighting inflammation. The biotin also helps the body to convert some of the oil that is in the diet to fatty acids that can replace the ones destroyed by excess androgen hormones.

It also contains antioxidant properties due to folic acid, niacin, Pantothenic acid, citric acid and vitamin C.

The presence of potassium also helps to boost its anti-inflammation properties.

Anti-fungal and anti-bacterial properties are boosted by the presence of acetic acid. It works through mycobactericidal activity.

Recipe: Dip a q-tip in 1 tbsp. of Apple cider vinegar and apply directly to affected area. Leave on for 10 minutes then wash off with warm water. It can also be diluted with warm water and drank on an empty stomach daily.

Lemon juice and honey

Contains high levels of vitamin C.

Free radicals destroy the fatty acids and protein found on the skin drying it out, introduces toxins as well as causing squalene peroxidation that precipitates nodular acne. Vitamin C destroys the free radicals thus protecting the skin.

The presence of bacteria forces the immune system to release chemicals such as leukotrienes to aid in bacteria destruction. The downside, however, is that an excess release of this may affect the skin causing inflammation. The use of vitamin C is such that it redirects the release of the leukotrienes directly to the bacteria and not on the skin thus fighting inflammation.

Reduce scarring by promoting elastin and collagen production by strengthening this protein. Riboflavin also assists by strengthening the muscles. This also regulates melanin production thus fighting hyperpigmentation.

Honey is an antibacterial, humectant, antiseptic and anti-inflammatory compound. It sucks out the moisture from the nodular acne thus fighting inflammation.

Method: Mix 2tbsp of honey with a few drops of lemon juice. Apply on face and wash off with warm water after 10 minutes.

Omega 3 fatty acids

They contain alpha-linolenic acid to soothe inflammation and reduce fatigue through the release of melatonin hormone that induces sleep.

Benzoyl peroxide

Once applied to the skin, it releases oxygen into the skin cells creating an aerobic environment that interferes with p. acne bacteria growth.

It is rich in anti-inflammatory properties that help to soothe the skin.

Assists in exfoliation which allows the skin to rid off dead skin cells and build up that trigger acne. It introduces oxygen to the pores allowing for the detoxification and drainage of any blockage.

Coconut oil

Contains antioxidant and antimicrobial properties through the presence of myristic, caproic, caprylic and capric acid.

Coconut oil also controls insulin levels in the body while reducing stress levels.

Its anti-bacterial properties are boosted by the presence of lauric acid.

It also contains anti-inflammatory properties.

Rich in Vitamin E that helps to moisturize the skin

Method: On clean skin apply virgin coconut, tea tree or olive oil on the affected area and leave overnight. Wash off in the morning with warm water.

Vitamin A

Contains Carotenoids that boosts its antioxidant and anti-inflammatory properties.  It also provides oil balance that helps to stop nodular acne.

Increased collagen production helps in repairing the epidermal layer while keeping it moisturized.

Vitamin B6 or pyridoxine

Nodular acne occurs due to excess sebum production. When the body is attacked by bacteria it speedily responds and the response can have adverse effects.

Vitamin B6 helps to regulate sebum production while boosting the immune system. By participating in the synthesis process, it aids in regrowth of tissues and membranes thus repair the epidermis

Excess androgen hormones are known to trigger acne especially excess testosterone, pyridoxine helps to lower the skin’s responsiveness to high testosterone hormones providing a hormonal balance.

Aloe Vera

Rich in antibacterial and antifungal properties due to salicylic acid and saponins.

The presence of magnesium boosts its anti-inflammatory properties.

It contains anthraquinone that fights pigmentation by stimulating cell growth. Its astringent properties help to remove the fluid in the nodular acne.

Method: Massage the gel on the affected area for 4 minutes and wash off with warm water. This should be done twice daily. Or mix honey with antibacterial and antioxidant properties, Aloe Vera and rose water to a paste.


Nodular acne can be a result of poor diet and toxins within the body and regular detoxification is essential in eliminating harmful toxins from the body and specifically the colon.  There exist numerous forms of body detoxifying and these stages include fasting, juicing and sweating through regular exercise, saunas and steam.

Fasting regularly aids in removing toxins that we subjected the body to such as environmental pollutants, sugary beverages or bad foods.

Drinking juices and smoothies made of fruits and vegetables are excellent detoxifying agents

Zinc supplements

Zinc supplement is natural remedies for severe cases of nodular acne. zinc has the not only has the ability to boost the immune system it also provides the skin with anti-inflammatory properties essential for treating nodular acne.

Frequently boosting the body with zinc supplement will provide the body with antioxidant properties that fight off the free radicals that aggravate the skin ailment.

How to Prevent Nodular Acne

Just like when dealing with other forms of acne, it is very important to adopt a healthy skin care routine. Skin health is paramount in prevention of any form of acne. Here are more tips on how to prevent nodular acne;

  • Wash your face twice daily or more if you are active such as during exercise
  • Use a gentle cleanser to prevent accumulation of bacteria and clogging of pores
  • Remove make up at night. This helps to remove buildup of oil and bacteria on your skin
  • Use clay masks to deep cleanse the skin at least once in a week
  • Avoid touching your face to prevent introduction of bacteria to the face and also to resist the urge to pick or nodules
  • If you have to touch your face as when doing makeup touch ups, be sure to wash your hands.
  • Wear sunscreen to prevent further damage to the skin

Nodular Acne Scars

Scarring is a common issue when dealing with nodular acne. The fact that this type of acne affects deep layers of the skin poses scarring as a risk. Failure to treat acne nodules leads to more inflammation of the skin which damages skin. Once the lesions heal, the damaged skin turns into dark spots which can take months or even years to heal. For some people especially those with sensitive skin types, this may create permanent scarring.

Nodular acne scarring may also develop if you pop or pick on the nodules. Popping acne enlarges pores on the affected skin. Healing occurs through formation of scabs which create unsightly marks.

To prevent formation of scars, seek prompt treatment for nodular acne and other severe forms of acne from a qualified dermatologist. Also, resist the urge to pick and pop nodules. If you are already dealing with acne scars read How to get rid of acne scars, dark spots and pimple marks effectively.

Nodular Acne Pictures


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