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Nodular Acne: Causes, Symptoms, and Prevention Tips

Before and after portrait of young man retouched

Acne can be a stressful and persistent skin condition. It’s the most common form of skin disease in the West, affecting individuals of all ages. Nodular acne, a severe form of acne, is characterised by its size and relative depth. It often leads to potential scarring and requires a tailored approach to management. 

In this guide, Dr Justin Boey, Medical Director of Sozo Aesthetic Clinic, discusses the complexities of nodular acne, understands its underlying causes, recognises its symptoms, explores effective treatment options, and provides prevention strategies to help you avoid its most profound impacts on your skin and self-esteem.

What is Nodular Acne?

Nodular acne is one type of acne among the most severe forms of acne vulgaris. It presents as large, painful, solid lesions deep within the skin. Because of their depth and size, they are often more difficult to treat and can result in long-term scarring if not managed properly.

The Difference from Common Acne

Several types of acne exist, ranging from mild to severe. Nodular acne falls into the severe category and is typically more inflamed and painful than milder forms. It differs from common acne primarily in the size and depth of the lesions and its potential for scarring.

Who is at Risk for Nodular Acne?

Those with a family history of severe acne, hormonal imbalances, particularly during puberty or menstruation, and conditions that cause hyperkeratinization (such as PCOS) are at a higher risk of developing nodular acne. Around 80% of acne cases are estimated to be hereditary, which underlines the genetic component to consider.

Causes of Nodular Acne

Understanding the underlying reasons for nodular acne is crucial to effectively managing and treating the condition. Here are the main factors that contribute to its development.

Hormonal Fluctuations

Hormonal imbalances, especially the rise in androgens, have been associated with the emergence of nodular acne. These androgens trigger the sebaceous glands to ramp up oil production, causing an excess that can result in clogged pores and the subsequent onset of acne. This process underscores the intricate connection between hormonal levels and skin health, highlighting the importance of managing hormonal fluctuations to prevent such skin conditions.

Genetic Predisposition

Genetics play a substantial role in developing nodular acne, known for its deep-seated, painful acne nodules that form under the skin. The predisposition to acne has a robust genetic correlation, meaning that individuals with close family members who have dealt with severe acne are at a higher risk of experiencing it themselves. Understanding these genetic links can help individuals take proactive steps in managing and treating nodular acne effectively.

Lifestyle Factors

Several lifestyle factors, such as diet, stress levels, and hygiene practices, significantly influence the development of nodular acne. Diets high in foods with a high glycemic index and heightened stress levels are commonly associated with worsening acne conditions in certain individuals. Additionally, inadequate hygiene practices may facilitate the proliferation of bacteria responsible for nodular acne breakouts. By addressing these lifestyle factors, individuals can effectively manage and improve their nodular acne condition.

Additional Factors

  • Dead skin cells and oil build-up can clog hair follicles, leading to the formation of acne nodules.

  • Bacteria, particularly Propionibacterium acnes, can lead to inflammation and the development of acne.

  • Sebaceous glands that produce more oil can create the ideal environment for bacteria to thrive.

Symptoms of Nodular Acne

Front view smiley young man skin texture

Recognising nodular and acne lesions is crucial for early intervention and treatment. Below are some of the key symptoms and features to look out for.

Appearance and Texture

Acne nodules, a severe form of acne, often manifest as sizable, red or skin-coloured bumps that feel firm when touched. These acne nodules stand out due to their significant size, typically 5mm or larger. They can be painful and are known for causing deep inflammation in the skin’s surface layers.

Pain and Discomfort

One of the distressing symptoms commonly associated with nodular acne is the pain or tenderness experienced alongside the acne nodules. This pain can persist over time, causing discomfort frequently described as radiating throughout the affected area or throbbing with intensity.

Infection and Scarring

Without appropriate treatment, nodular acne, a severe form of acne characterised by large, painful bumps under the skin, can become infected, potentially leading to the formation of cysts. These cysts are deeper within the skin and can be more difficult to treat. Infections from nodular cystic acne can cause significant skin damage, resulting in long-term scarring that may impact an individual’s self-esteem and quality of life. Thus, addressing nodular acne promptly with aggressive treatment approaches is crucial to prevent scarring and promote skin healing.

Risk of Emotional and Mental Health Impacts

The psychological impact of nodular acne should not be underestimated. Its severe and often disfiguring nature can lead to emotional distress and decreased quality of life, underscoring the importance of a comprehensive treatment plan.

Effective Treatment Options for Nodular Acne

Beautiful woman showing her acne with confidence

Discovering the right treatment for nodular acne can be a trial-and-error process, as different solutions work for different people. Here are some of the most effective options available.

Over-the-Counter Solutions

Milder cases of nodular acne may respond well to over-the-counter treatments. When selecting products, consider looking for those containing benzoyl peroxide or salicylic acid. Benzoyl peroxide effectively reduces the bacteria contributing to inflammatory acne itself, while salicylic acid aids in unclogging pores by removing dead skin cells and excess oil. These ingredients can play a key role in managing nodular acne by targeting the root causes of breakouts.

Prescription Medications

Aesthetic practitioners may suggest moving to stronger medications if over-the-counter treatments are inadequate. These enhanced treatments may involve topical products or oral medications containing retinoids, known for their effectiveness in addressing skin issues. Additionally, oral antibiotics might be prescribed to combat any signs of infection and inflammation, offering a more comprehensive approach to skincare.

Professional Procedures

For particularly stubborn nodular acne that doesn’t respond to traditional treatments, seeking professional help may be necessary. Aesthetic practitioners may recommend treatments like intralesional corticosteroid injections, which involve injecting a diluted corticosteroid solution directly into the nodule to reduce inflammation and promote healing. Laser therapy is another option, where targeted laser energy is used to shrink the size of acne nodules and destroy bacteria that contribute to acne. 

Additionally, chemical peels can be effective in exfoliating the skin, unclogging pores, and reducing the appearance of acne nodules while helping to prevent scarring.

Home Remedies and Natural Treatments

If you prefer a more natural route, you can try several home remedies to complement your treatment plan. Keep in mind that these are not substitutes for professional medical advice, especially in the case of severe nodular acne.

  • Tea Tree Oil: This natural essential oil, known for its antibacterial properties, can effectively combat acne-causing bacteria. It is recommended to dilute tea tree oil with carrier oil before applying it to the skin to minimise the risk of irritation and ensure gentle care.

  • Aloe Vera: Aloe vera has anti-inflammatory properties that can help reduce redness and swelling associated with nodular acne. Apply a thin layer of aloe vera gel to the affected areas and leave it on for up to an hour before rinsing off.

  • Turmeric: Turmeric contains curcumin, which has potent anti-inflammatory and antibacterial properties. You can make a turmeric paste by mixing a small amount of turmeric powder with water and applying it to nodular acne.

  • Probiotics: Taking probiotics orally or applying probiotic-rich foods directly to the skin can help balance the microbiome, which may affect acne development.

How To Prevent Nodular Acne

Young woman showing her acne with confidence

Preventing the onset or worsening of nodular acne can save you from the potential pain, distress, and scarring it can cause. Here are some strategies to consider.

  • Maintain a Regular Skincare Routine: A good skincare routine can help prevent nodular acne by keeping the skin clean and free from excessive oil and dead skin cells. Always remove makeup, wash your face before bed, and choose non-comedogenic products.

  • Manage Stress: Stress can exacerbate acne in some individuals, so finding ways to manage stress can benefit your skin. Incorporate stress-management techniques such as meditation, exercise, or deep breathing into your daily routine.

  • Avoid Known Triggers: Identify and avoid any factors that exacerbate your nodular acne. This could include specific foods, skincare products, or environmental factors.

  • Stay Hydrated and Maintain a Healthy Diet: Drinking plenty of water and eating a balanced diet rich in whole foods can help keep your skin healthy and potentially reduce the risk of nodular acne.

When to See a Professional

Knowing when to seek professional medical advice is crucial in managing nodular acne effectively. If you’re experiencing severe discomfort, if the acne persists despite over-the-counter and topical treatments alone, or if you notice signs of scarring, it’s time to consult with aesthetic practitioners. Additionally, any sudden worsening of your acne nodule or adverse reactions to home treatments should prompt a visit to a professional.

At Sozo Clinic, we understand the complexities of nodular acne and offer a tailored approach to treatment that addresses its physical and emotional challenges. Our experienced aestheticians are equipped with the latest acne treatment technology, ensuring you receive the best care possible. 


Nodular acne, often called nodulocystic acne, is a serious condition that can profoundly impact your skin and self-esteem. By understanding the underlying causes, recognising the symptoms, exploring effective acne treatments, considering home remedies, focusing on prevention, and seeking professional guidance, you can better manage your acne and prevent its potential long-term effects. Remember, care and patience are crucial when dealing with acne. With the right support and treatment, you can take control of your skin and gain the confidence you deserve.

With this knowledge, tackle your nodular and acne scars head-on and take steps to keep your skin healthy and clear. Remember that everyone’s skin is unique, and a treatment that works for one person may not work for another. If you’re struggling, feel free to contact a specialist for help. Together, you and your aesthetic practitioner can find the most effective, personally suited solution that will allow you to face the world with confidence.


Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.