Can’t Get Rid of Those Deep, Under-the-Skin Bumps? Let’s Talk Nodular Acne

If you’ve ever had a pimple that felt like it was buried deep under your skin—painful, swollen, and seemingly untouchable—you may have experienced nodular acne. Unlike surface-level blackheads or whiteheads, nodular acne forms in the deeper layers of the skin and can be particularly stubborn. It doesn’t just fade away in a few days. These breakouts often linger for weeks (or longer), and they can leave behind permanent scars if not treated properly.

At CLEAR Acne Treatment Centers, we specialize in helping people with persistent, painful acne finally get the relief they’ve been searching for. And for many, nodular acne is one of the biggest challenges. In this post, we’ll break down what nodular acne is, what causes it, why it’s different from other types of acne, and most importantly—how to treat it effectively and safely.

WHAT IS NODULAR ACNE?

Nodular acne is a severe type of inflammatory acne. It’s characterized by firm, painful lumps (or “nodules”) that develop deep under the skin. Unlike typical pimples, nodules don’t usually come to a head. That means you won’t see a white or black tip, and trying to pop or squeeze them only makes things worse.

Nodules can feel like hard knots beneath the skin, and they’re often red, swollen, and tender to the touch. Because they’re rooted so deeply in the skin, they can take a long time to heal and are more likely to cause scarring than other types of acne.

Nodular acne often appears on the face, but it can also show up on the back, chest, neck, and even the jawline.

WHAT CAUSES NODULAR ACNE?

Like all acne, nodular acne starts with a clogged pore. But in this case, the inflammation goes much deeper into the skin than a typical pimple. Several factors contribute to the development of nodules:

HORMONAL FLUCTUATIONS

Shifts in hormones—especially androgens—can trigger the overproduction of oil (sebum) in the skin. This is one of the biggest drivers behind nodular acne, particularly in teens, young adults, and people experiencing hormonal changes (such as during the menstrual cycle, pregnancy, or perimenopause).

GENETICS

If your parents struggled with severe acne, you may be more genetically prone to developing nodular breakouts. It’s not always fair, but your skin type and how your immune system responds to inflammation is often inherited.

OVERACTIVE SEBACEOUS GLANDS

People with nodular acne tend to produce more oil, and that oil is often thicker than average. Combined with dead skin cells, it creates the perfect environment for clogged pores and deep, painful inflammation.

BACTERIA (CUTIBACTERIUM ACNES)

When pores become clogged, acne-causing bacteria multiply. The immune system reacts with inflammation, swelling, and tenderness—what you feel as a nodule deep under the skin.

NODULAR ACNE VS. CYSTIC ACNE: WHAT’S THE DIFFERENCE?

Nodular and cystic acne are often grouped together as the most severe forms of acne—and they do have a lot in common. Both involve deep, inflamed lesions, and both can leave scars. The main difference lies in their texture:

• Nodules are hard, solid, and painful bumps deep under the skin.

• Cysts are softer, fluid-filled, and may feel squishy when pressed.

It’s also possible to have both at the same time, which is why dermatologists often refer to the condition as nodulocystic acne.

WHY NODULAR ACNE IS SO HARD TO TREAT

Nodular acne doesn’t respond well to typical over-the-counter products. That’s because topical treatments like benzoyl peroxide or salicylic acid don’t penetrate deep enough to reach the source of the inflammation. And since nodules can last for weeks or even months, the skin is often left with dark spots, texture changes, or permanent scars.

This kind of acne requires a long-term plan and targeted treatment—ideally supervised by professionals who understand how to work with the deeper structures of the skin.

EFFECTIVE TREATMENT OPTIONS FOR NODULAR ACNE

Treating nodular acne usually requires a combination of approaches that address both the surface and deeper layers of the skin. Here are the most common and effective options:

1. PRESCRIPTION MEDICATIONS

• Oral Antibiotics: These are often used short-term to reduce inflammation and bacteria but may not be enough on their own for nodular acne.

• Oral Isotretinoin (Accutane®): This is one of the most powerful treatments available and can lead to long-term remission. It shrinks the oil glands, reduces inflammation, and prevents clogged pores. But it also comes with serious side effects and requires strict medical supervision.

• Oral Hormonal Treatments: For people assigned female at birth, hormonal treatments like oral contraceptives or spironolactone may help reduce oil production triggered by hormonal fluctuations.

At CLEAR, we understand that many clients are looking for lasting results without the long list of side effects. That’s why we offer alternative approaches for those who want relief from nodular acne without relying on daily medication.

2. AVICLEAR® LASER TREATMENTS

AviClear® is the first FDA-cleared laser treatment for mild, moderate, and severe acne—including nodular acne. It works by selectively targeting the sebaceous glands, the root of oil production. Over a series of three treatments, AviClear® gently and permanently reduces the activity of these glands, leading to fewer breakouts over time.

Unlike medications, AviClear® is:

• Drug-free

• Safe for all skin types

• Free of long-term side effects

• Backed by clinical research

Most clients see dramatic improvements over 6–12 months, especially when they follow a simple skincare plan alongside their treatments.

3. CORTISONE INJECTIONS

For an especially painful or inflamed nodule, dermatologists can inject a small amount of corticosteroid directly into the lesion. This rapidly reduces swelling and pain, often flattening the spot within 24–48 hours. While not a long-term solution, it can be helpful for an occasional emergency breakout.

4. PROFESSIONAL SKINCARE GUIDANCE

When you’re dealing with nodular acne, the wrong products can set you back. Some acne-prone clients accidentally use comedogenic makeup, moisturizers, or sunscreens that keep feeding the cycle.

That’s why we coach every client to:

• Use only non-comedogenic skincare

• Check individual ingredients (don’t just trust the label!)

• Avoid pore-clogging oils like coconut oil, isopropyl myristate, and certain silicones

• Stick to a consistent, gentle skincare routine

HOW TO PREVENT NODULAR ACNE FLARE-UPS

Even after the skin clears, nodular acne can return if you don’t maintain a treatment plan. Long-term prevention is all about consistency and support:

• Stick with the skincare routine your provider recommends

• Don’t pick, squeeze, or try to “pop” deep nodules—this can cause scarring

• Watch for hormone-related triggers (such as your menstrual cycle or starting/stopping birth control)

• Keep your phone, pillowcases, and hands clean—anything that touches your face should be non-irritating and free of bacteria

• Consider long-term options like AviClear® if you want lasting change without daily medications

YOU’RE NOT ALONE—AND YOU DON’T HAVE TO LIVE WITH PAINFUL ACNE

Nodular acne can feel overwhelming—both physically and emotionally. It’s not just a “bad skin day.” It can impact your confidence, your social life, even how you feel when you wake up and look in the mirror.

At CLEAR Acne Treatment Centers, we understand how frustrating and painful this kind of acne can be. Our expert team is here to listen, support, and guide you toward lasting relief with treatments like AviClear® that get to the root of the problem.

If you’re ready to finally get control of your nodular acne, book a free consultation with CLEAR today. There’s no pressure—just a chance to get real answers from people who know how to help.

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