Nodular Acne vs Cystic Acne – Treatment Options & Differences

Nodular Acne

Nodular acne is represented by large, painful breakouts that are more serious than the usual pimples.


It occurs when the sebaceous glands (microscopic exocrine glands in the skin) join together with hair follicles giving rise to oily sebum.

Risk Factors

The following factors can trigger or aggravate nodular acne:

  • stress – it can make nodular acne worse;
  • diet – according to research, specific dietary factors (such as – skim milk or potato chips) may worsen acne. In addition, according to a 2014 study, eating milk chocolate was related to a worsening of acne symptoms;
  • certain medications – certain drugs, like – testosterone, corticosteroids, or lithium, can make acne worse;
  • hormones – hormonal changes related to the use of oral contraceptives and pregnancy can increase the chance of developing acne. Additionally, during puberty, androgens increase in girls and boys cause the sebaceous glands to make more sebum.


Common treatments include:

  • retinoids – they inhibit matrix metalloproteinases and inflammation, and limit pore-clogging;
  • regular meditation – this practice lowers stress levels since stress is the number one cause of nodular acne;
  • salicylic acid – it unclogs the pores, giving them a chance to heal;
  • benzoyl peroxide – it will kill the pathogenic bacteria which have invaded the pores.


Taking care of your skin is the best way to help prevent this type of acne. Prevention methods include:

  • wash your face and body after physical exercise to remove bacteria and oil;
  • avoid foods that are high in trans- or saturated fats, such as French fries, hamburgers, chocolate, milk, hot-dogs, onion rings, or mayonnaise;
  • try to find methods to alleviate unnecessary stress in your life;
  • wear sunscreen. Tip – to avoid clogging pores, buy an oil-free sunscreen;
  • never go to bed with your makeup on;
  • select makeup products which are labeled “oil-free” and “noncomedogenic;”
  • avoid picking at your skin;
  • wash your face once a day in the evening.
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Cystic Acne

Cystic acne is the most dangerously severe manifestation of acne vulgaris that develops as inflamed and deep breakouts on the skin.

It is most common during puberty for young boys, however, it can continue into the adult years, particularly when there is a hormonal imbalance.

The face is the most common area of occurrence, nevertheless, other areas can include the back, chest, shoulders, and upper arms.

Note – as acne cysts are deep within the skin, attempting to self-extract or squeezing these lesions can slow down the healing process, worsen the condition, and increase the risk of permanent scarring.


Common symptoms include:

  • nodules – similar to cysts, however, these are hard and often deeper;
  • deep, inflamed cysts –  these can stay for weeks or months and can have 1 inch or more in diameter;
  • blackheads;
  • papules – small hard lumps or pimples;
  • excess oil production, a greasy complexion;
  • red, flaky, scaly skin.

When to Call the Doctor

Because cystic acne is painful, consult a health care provider early to start treatment as soon as possible.


This type of acne occurs when this infection goes deep into your skin, creating a red, tender bump that is full of pus. Occasionally, pathogenic bacteria get trapped inside the pore, causing the area to become red and swollen.

Risk Factors

  • stress – while the precise mechanism between acne lesion increase and stress is not known, doctors have conjectured that stress signals sebaceous glands to increase oil production;
  • dairy products – there have been numerous studies indicating a connection between acne inflammation and dairy intake;
  • sweat – hot conditions can encourage the production of oil;
  • medications – lithium, birth control (brands which contain only progesterone), and phenytoin can exacerbate the presence of acne.
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Common treatments include:

  • prednisone – in serious cases, low-dose prednisone may be effective;
  • drainage – to limit the risk of infection, this is only performed in a medical office;
  • corticosteroids – steroid injections into the cyst can reduce pain and its size;
  • birth control pills – the progestin and estrogen in birth control pills can help treat acne;
  • spironolactone – sold under the brand name Aldactone, it can reduce excess oil;
  • isotretinoin (Accutane) – it is only used in severe cases due to its side effects. Accutane can treat swelling, bacteria, redness, excess oil, and clogged pores;
  • salicylic acid, benzoyl peroxide, retinoid, or azelaic acid, can reduce clogged pores and harmful bacteria;
  • tetracycline or a macrolide antibiotic (a class of antibiotic which includes roxithromycin, erythromycin, clarithromycin, and azithromycin) can reduce swelling, pathogenic bacteria, and redness.


Prevention methods include:

  • try to avoid letting your hair fall across your face;
  • wash your hair regularly;
  • shower as soon as possible once you finish a physical exercise session, as sweat can irritate your acne;
  • use a fragrance-free, water-based emollient, if dry skin is a problem;
  • completely remove make-up before going to bed;
  • avoid using too much make-up and cosmetics. Instead, use water-based products which are described as non-comedogenic;
  • don’t try to “clean out” blackheads or squeeze spots;
  • wash the affected area with a cleanser or mild soap and lukewarm water;
  • don’t wash affected areas of skin more than two times per day.

Bottom Line – Nodular Acne vs Cystic Acne

Nodular acne is a type of acne that is characterized by the presence of large and inflamed lesions and cysts.

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A cystic acne is a form of acne which is linked with painful nodules on the back of the neck, chest, face, and back which also contain pus.

Nodules and cysts are more severe forms of acne. Both occur when a blockage forms under the skin and becomes inflamed. They are harder to treat than your run-of-the-mill pimples and the treatment commonly requires prescription-strength medicines.

On inspection, cystic acne is represented by deep and fluid-filled soft growths, whereas nodular acne breakouts are firm and hard lumps under the skin.

In conclusion, both nodular acne and cystic acne have similar nodules, but cysts are also filled with pus. These painful cysts can be large and are most often found on the:

  • face;
  • shoulders;
  • neck;
  • chest;
  • back.