What Are the Causes of Nodular Acne?

Hair follicle (Wiki Commons, public domain).
Hair follicle (Wiki Commons, public domain).

Acne is a skin condition that most people experience at some point of life, typically the teenage years, when hormones that encourage breakouts are running high. Unfortunately, all types of acne are not the same. Acne can range in severity from simple blackheads and whiteheads that are easily treated with a good skin care regime and prescription topical creams, to a more severe and pervasive form of acne that forms under the skin. Nodular acne, a severe form of acne vulgaris, can require intensive dermatological treatment.

What Is Nodular Acne?

Unlike lesions associated with mild-to-moderate forms of acne vulgaris that present on or near the skin's surface, nodular acne spots form well underneath the skin and are characterized by large hard bumps. They can be extremely painful and linger for months and, if left untreated, may even flare up again in the same place. Because nodular acne typically leaves scars in its wake, it is not recommended that these types of lesions be squeezed as it may cause the nodules to linger even longer.

Hair follicle (Wiki Commons, public domain).
Hair follicle (Wiki Commons, public domain).

How Nodules Form

According to the Mayo Clinic, acne is the result of three factors: sebum overproduction, bacteria buildup and shedding of dead skin cells that irritate hair follicles in the skin. The follicles of hair in the skin are connected to the sebaceous glands--glands that produce the oil that lubricates and protects the skin. When the body produces excess sebum, it doesn't have time to travel along the hair shaft and onto the skin's surface. Instead, hair follicles become plugged with sebum and dead skills. If this blockage takes place deep inside the hair follicle rather than closer to the skin's surface, nodular acne is the result.

Other Causes

Acne of any type is typically the result of hormonal changes and fluctuations. Changes in hormones are common in teens, pregnant women and females two to seven days before a menstrual period begins. People who use certain medications, such as cortisone, may also experience increases in hormone levels. But there are other factors that contribute to acne as well, including factors of heredity. If your parents had acne, you have a greater chance of having it as well. Additionally, plying oily or greasy topicals to the skin (including certain cosmetics) can have an effect on breakouts.

Treating Nodular Acne

While topical creams work well for mild-to-moderate forms of acne, nodular acne usually requires more aggressive therapy. Oral antibiotics may be prescribed to fend off bacteria and reduce inflammation. But even antibiotics may not be enough. A treatment regime called isotretinoin, which goes by the brand name of Accutane, is often prescribed for patients with deep nodular acne. While this is a very effective treatment plan, it must be closely monitored by a dermatologist because of the numerous side effects that can present. Accutane cannot be taken by women who are pregnant or who intend to become pregnant because the drug can damage the fetus. Accutane can also increases liver enzyme levels, and some patients develop inflammatory bowel disease after its use.

Nodular Acne and Surface Scarring

Because nodular acne generally results in surface scarring, patients may want to consider laser and light-based therapy. This treatment also penetrates the deep layers of the skin, causing the sebaceous glands to produce less oil. This treatment also reduces the appearance of scarring. Therefore, it's an ideal treatment for patients with both active acne and scarring. Other ways of reducing nodular acne scarring include dermabrasion, laser resurfacing and injection of collagen or fat into the scars.

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