Nodular acne: what it is and what to do right away

Nodular acne shows up as deep, hard, painful lumps under the skin. These aren’t surface pimples you can squeeze. They form deep in the dermis and can leave scars if handled the wrong way. If you’ve had a few of these or one that’s large and painful, quick, sensible steps matter.

First things first: don’t pick or pop. That makes inflammation worse and increases the chance of scarring and infection. For immediate relief, use a warm compress for 10–15 minutes a few times a day—this can ease pain and encourage drainage without squeezing. Over-the-counter benzoyl peroxide can help reduce bacteria on the skin, but it won’t make a nodule disappear overnight.

What causes nodular acne?

Nodules form when hair follicles get clogged and inflamed deep under the skin. Contributing factors include hormones (androgens), excess oil production, bacteria, and genetics. Certain medications, stress, and tight clothing or gear that rubs the skin can trigger or worsen nodular acne. Unlike small whiteheads, nodules come from a larger, more aggressive inflammatory reaction.

Medical treatments you’ll likely hear about

Because nodules are deep, they usually need professional treatment. A dermatologist may start with oral antibiotics or a short course of steroids to calm inflammation. For many people with recurrent or extensive nodular acne, oral isotretinoin is the most effective option—it's a powerful drug that can clear nodules but requires close medical supervision and blood tests because of side effects.

Other in-office options include intralesional steroid injections (a quick shot directly into the nodule to shrink it fast) and, rarely, sterile drainage done by a pro if a lesion is fluctuant. Topical retinoids and benzoyl peroxide remain useful as part of ongoing care but are usually not enough alone for large nodules.

Be upfront with your dermatologist about pregnancy plans, other meds, and your medical history—some treatments aren’t safe in pregnancy and need planning.

Daily care helps reduce flare-ups. Use a gentle, fragrance-free cleanser twice a day. Skip abrasive scrubs and heavy oils. Choose non-comedogenic moisturizers and sunscreens. Change pillowcases often and avoid tight collars or sports gear that rub the skin. Small lifestyle tweaks—like limiting high-glycemic foods if you notice a link—can help some people.

See a dermatologist quickly if nodules are very painful, spreading, lasting more than two weeks, or leaving scars. Early, proper treatment lowers the chance of permanent marks and usually gets you back to clearer skin faster.

If you want, note your pattern—when nodules appear, what you were using on your skin, recent meds or stressors—and bring that to your appointment. That small record helps your doctor pick the right treatment fast.