How to Treat Nodular Acne

Getting a Medical Diagnosis and Treatment

See a dermatologist. Make an appointment with your dermatologist if you have large, inflamed pimples that don’t heal with home care. Let the doctor know how long you’ve had the pimple(s) and what treatments you’ve tried. Giving your doctor this information can help them properly diagnose your acne and figure out the best type of treatment for you. Let your doctor know if you have allergies or are pregnant, so they can adjust your treatment plan. Be sure to ask any questions you may have about your acne or prescribed treatment plan.

Take oral isotretinoin. If your acne is severe, your doctor may decide to prescribe isotretinoin, also known as Accutane. Fill your prescription for isotretinoin pills from your dermatologist and follow the dosing instructions. Use this common treatment for its entire course of 15-20 weeks. This treatment is usually very effective, with about 85% of patients achieving completely clear or dramatically improved skin after one full course of treatment. Make sure to use any additional treatments that you’re doctor prescribed together with your isotretinoin. Taking isotretinoin can increase your risk of depression and suicide, so it’s important to let your doctor know if you’ve been previously diagnosed with any mental health conditions. Closely monitor yourself for mood changes, and immediately report any concerning side effects to your doctor. Avoid isotretinoin if you are pregnant or plan to become pregnant. The drug can cause severe birth defects.

Apply retinoids to your skin. Ask your doctor to prescribe a retinoid such as tretinoin cream, gel, or lotion. Gently spread a thin layer on your skin according to your doctor’s instructions. Stick with the treatment for the entire course of the medication to heal and prevent pimples. This can also prevent further breakouts and improve the texture of your skin. Apply your retinoid three times per week, or as instructed by your dermatologist. Put your retinoid on daily once your skin gets used to it. Retinoids can cause irritation, redness, and dryness. They can also make your skin peel. Let your dermatologist know if you have any of these side effects. Tretinoin may increase your sensitivity to the sun. Protect your skin from sunburn by wearing sunblock with an SPF of at least 15 on a regular basis.

Reduce bacteria and inflammation with antibiotics. Use any oral or topical antibiotics your dermatologist prescribes. These can zap infection-causing bacteria and reduce any redness or inflammation your pimples are causing. Follow your doctor’s dosing instructions. Some of the antibiotics your dermatologist may prescribe include tetracycline, minocycline, and doxycycline. They may also prescribe dapsone, a topical gel that can both kill bacteria and reduce inflammation.

Protect yourself from sun exposure when you’re on antibiotics. Wear a sunscreen with an SPF of at least 30 if you are in the sun while using oral antibiotics, because they can increase your risk of sunburn. Look for a sunscreen labeled “non-comedogenic,” meaning it won’t clog your pores and make your acne worse. If you can, minimize your sun exposure altogether, especially during times when the UV index is high (typically between 10 AM and 4 PM). Protect yourself with clothing that covers your skin, like long-sleeved shirts and broad-brimmed hats.

Consider concomitant therapies. Your dermatologist may suggest using additional treatment with your medication, which are called concomitant therapies. Consider the following if you have severe nodular acne or aren’t responding well to medication. The following therapies are only used in select cases, such as a person who cannot tolerate medication: Light or laser therapy to target the bacteria that causes acne. It can cause pain, temporary redness, and sensitivity to sunlight. Chemical peels, which shouldn’t be used with retinoids. These can cause significant irritation, scaling, blistering, and temporary redness of your skin. Steroid injection to reduce inflammation and pain. This can cause thinning of your skin and the appearance of small blood vessels in the affected area. Drainage and removal of pimples, which can quickly get rid of the lesion and prevent scarring.

Talk to your doctor about oral contraceptives or antiandrogens. If you are a woman, ask your dermatologist about taking hormonal medications for your acne. Using estrogen-containing oral contraceptives by themselves (or in conjunction with other medications) can minimize breakouts and prevent new ones, especially if your nodular acne fluctuates with your menstrual cycle. Other hormonal medications, such as antiandrogens, can also be effective.

Caring for Nodular Acne at Home

Treat your skin gently. Popping, squeezing, or picking at your acne can make the infection worse or create permanent scarring. Although it is tempting to mess with your pimples, the best thing you can do is leave them alone and allow them to heal. Also avoid scrubbing, exfoliating, or over-cleansing your skin.

Wash your face and hands before treatments. Gently cleanse your face with a mild cleanser. Then wash your hands with soap and warm water. Having clean skin and hands can prevent the spread of bacteria that inflames acne or causes breakouts.

Spread on a thin layer of benzoyl peroxide. Many dermatologists prescribe benzoyl peroxide along with oral antibiotics. Apply a thin layer to your skin twice a day or as directed by your doctor. This can prevent bacterial resistance and additional breakouts, and can reduce inflammation on your skin. Apply a 5% benzoyl peroxide gel or lotion once a day after washing your face. Increase use to twice a day after one week. Try the 10% solution if you don’t see any improvement within 4-6 weeks. Side effects from using benzoyl peroxide include redness, dryness, and scaling. These symptoms usually get better after the first month.

Blot excess oil from your skin. Use blotting papers, salicylic acid products, or a clay mask to decrease the amount of oil on your skin. Removing excess oil can reduce inflammation and infection, which may prevent additional breakouts. Try an over the counter salicylic acid product, or ask your doctor to prescribe a product that absorbs oil if you have particularly oily skin. Applying a clay mask once a week can absorb excess oil and minimize acne-causing impurities. Place blotting papers on oily areas of skin anytime you need them.

Moisturize your skin daily. Purchase a gentle, oil-free moisturizer. Look for a moisturizer labeled “non-comedogenic,” meaning that it will not clog your pores. Even if your skin is oily, apply the product every day. Daily moisturizing can prevent side effects of medical treatments such as dryness and irritation. It may also reduce how much oil your skin makes. Ask your doctor for specific product recommendations if you are not sure what type of oil-free moisturizer to use.