Cystic acne vs nodular acne: What's the difference?

How can you tell them apart?

Nodules usually lack a central whitehead or blackhead. They can appear red or the same colour as your skin, and occur on the face, jawline, chin, chest or back. A dermatologist examines the lumps and asks about pain, location and medicines you take. You do not need to settle the name before booking an appointment.2

What is nodular cystic acne?

Nodular cystic acne, usually written nodulocystic acne, is severe acne involving deep nodules and cysts, often on the face and upper body. It commonly begins in adolescence or early adulthood and can persist into adult life. Scarring is a major concern. In skin of colour, dark marks and keloids, which are raised scars, are common complications.5

Why do these deep lumps form?

Oil and dead skin cells block a hair follicle, the small channel where a hair grows. Bacteria grow inside the blockage and inflammation develops. When the follicle wall breaks down, its contents spill into nearby skin. Hormonal changes, family history and certain medicines can contribute; scrubbing harder does not address that process and can worsen acne.4

Does the treatment differ?

Both types need a medical treatment plan. Topical treatment alone is usually ineffective for deep nodulocystic acne, although benzoyl peroxide or a topical retinoid can treat accompanying surface spots. Oral isotretinoin is a recommended treatment for nodulocystic acne, started early to limit scarring. Oral antibiotics or hormonal treatment are other options when isotretinoin is unsuitable. Discuss medicine side effects with your prescriber. A dermatologist can also inject an especially painful or persistent lump to reduce inflammation and help it clear faster.1256

A nodule can last weeks or months. Isotretinoin treatment for nodulocystic acne takes at least five months, and further courses are sometimes needed. There is no single clearing time for every lump or treatment combination.25

What should you do while waiting for care?

• Wash gently morning and night. Apply cleanser to wet skin with your fingers, rinse with warm water and pat dry with a soft towel.
• Avoid scrubbing and harsh exfoliation. Stop over exfoliating if your skin becomes dry or irritated.
• Choose skincare and makeup labelled noncomedogenic, meaning they are designed not to clog pores; the label uses a very long word for a fairly short job.
• Do not pick, squeeze or try to pop deep lumps, because this can worsen them and increase scarring.

When should you see a doctor?

Book a GP or dermatologist appointment for deep, painful lumps, scarring or acne affecting your mental health. Also seek medical care for hot, swollen or red skin suggesting infection. Seek urgent assessment if severe acne suddenly appears with ulcerated spots, fever or painful joints. These can accompany acne fulminans, a rare, severe form requiring urgent specialist care.67