What is nodular acne?
Nodular acne is a severe form of acne typically found on the face, chest, and back. It is characterized by deep under-the-skin inflammatory nodules and cysts that are red and painful to touch, and do not typically respond well to standard acne medication.
Though anyone can get nodular acne, and it can occur at any age, it is most common during puberty. Leaving nodular acne untreated can result in pain, severe scarring, and even psychological symptoms such as depression, anxiety, and poor self-esteem.
When a pimple occurs under the skin, it is referred to as cystic acne or nodular acne. Though you may be wondering how to get rid of pimples under the skin by yourself, it is important to treat severe acne under the guidance of a dermatologist, and in a way that will minimize the risk of infection and damage to your skin.
Popping a pimple at home can backfire by worsening the condition and appearance of your skin rather than improving it. Some of the contents from the pimple can be inadvertently pushed deeper inside the skin and lead to increased inflammation, acne that is more noticeable, and possible infection.
Diagnosis for nodular acne
Doctors look at the type of lesions present on the skin to determine how to classify acne. Acne lesions fall on a spectrum from noninflammatory lesions, such as blackheads and whiteheads, to inflammatory lesions such as cysts and nodules. When acne is severe, and consists of mostly inflammatory lesions, a diagnosis of nodular or cystic acne might be given.
Treatments for nodular acne
Nodular acne is one of the most difficult forms of acne to treat, but there are a few common courses that will likely be recommended by a dermatologist. Nodular acne is incredibly persistent and when left untreated, can result in significant scarring, so it is important to seek treatment.
The first treatment plan that most doctors will try is a combination of antibiotics and topical medication. The antibiotic may help lessen redness and inflammation of the skin while the topical medication can soothe and rid the skin of harmful bacteria.
If this treatment plan does not work, as is often the case with severe nodular acne, oral isotretinoin may be prescribed.
Oral isotretinoin is typically prescribed short term, with directions to take it if acne flares up again. Isotretinoin is a potent retinoid medication with severe side effects and should only be taken under the care of a physician.
About 40% of patients achieve remission while on isotretinoin, and others do well when isotretinoin is combined in their treatment plan with oral antibiotics or topical steroids.
Procedures and surgery
To help get rid of acne under the skin, dermatologists often inject a corticosteroid. This method improves the healing time and has a reduced risk of scarring. This procedure is best used when treating one acne nodule or cyst and is not recommended for the treatment of multiple acne blemishes, as corticosteroid injections should be used sparingly.
A procedure called incision and drainage may be used to remove cysts or nodules. During this procedure, a sterile needle or blade will be used to drain the cyst or nodule.
Your dermatologist may recommend comfort measures that you can perform at home to reduce the pain and discomfort of nodular acne. They may also encourage basic skincare hygiene measures to keep your skin clean and healthy between flare-ups. Below are a few ways that you can care for your skin at home:
- Apply cold compresses to the skin to reduce inflammation and soothe painful areas
- Use your fingertips to clean your face with a gentle, non-abrasive, alcohol-free cleanser twice a day
- Rinse your face with warm water
- Limit time in the sun and avoid tanning beds
- If you have oily hair, wash it daily
- Avoid popping acne, and let your skin heal naturally
Possible complications and side effects
When left untreated, nodular acne can result in severe scarring. Because nodular acne does not respond well to standard topical or oral acne medications, the medications that it does respond to come with a higher risk of side effects. If you are experiencing nodular acne that does not resolve itself on its own, contact a physician to figure out a treatment plan that works for you.
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American Family Physician Journal: "Diagnosis and Treatment of Acne."
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