1. What options do I have for relieving pain due to nodular acne?

Nodular acne is painful because it involves pimples that are deep in the skin, which is also where your pain receptors are located. Warm compresses and steam showers can help release some pressure in your skin at home.

A board-certified dermatologist can also help with a system of treatments. This may include steroids that are injected directly into painful pimples.

2. Nothing has worked to clear my acne. What other treatment options do I have?

Even if you have severe acne, you can experience clear skin. Simple things like washing your face daily, removing makeup completely, and not using facial oils can greatly decrease breakouts.

Topical creams you can buy at pharmacies can only do some much if your pimples are deep and big. This is because creams can only permeate so far into the skin.

For nodular acne that involves deep pimples, the best option for treatment is to add some kind of oral medication. A board-certified dermatologist can prescribe a variety of oral medications to treat pimples from the inside out.

There are two types of oral medications that can be prescribed to male patients: antibiotics and isotretinoin (high-dose vitamin A). For females, there are four oral medication choices: antibiotics, isotretinoin, birth control pills, and a medication called spironolactone that works to reduce male hormones in women.

3. Are there any side effects to certain treatments, and how can I manage them?

Oral antibiotics for acne are usually well-tolerated but can lead to side effects in some people. This can include nausea, stomach aches, muscle aches, rashes, and sensitivity to the sun. If you experience any side effects, stop taking the medication and call your doctor.

Isotretinoin can help reduce acne scarring and is especially useful for people who’ve tried other medications that haven’t worked. But female patients can’t take isotretinoin during pregnancy, as it can lead to birth defects. Many patients experience dryness when taking isotretinoin, including dry skin, dry eyes, and dry lips.

People may also experience muscle aches or gastrointestinal upset, although this is less common. Also, people living with depression or Crohn’s disease may not be able to take isotretinoin.

4. What can I do to manage my acne at home?

Many home remedies that you may read about for treating acne like honey, aspirin, and toothpaste aren’t effective as a skin care regimen. Washing your face in the morning and at night, removing all makeup, and taking a few topical medications like an antibiotic lotion and retinol lotion can greatly improve the severity of your acne.

5. Can my diet help manage my symptoms?

If you find that you experience more acne breakouts after consuming milk, you may benefit from reducing dairy products in your diet. The good news is that chocolate doesn’t necessarily cause acne. And for those of you who like French fries, only rubbing the oil on the skin has been shown to cause acne, not actually eating the fried foods themselves.

Still, more research on the connections between eating certain foods and acne is needed.

6. What can I do to prevent scarring?

Use the medication prescribed by your doctor as directed and go to frequent follow-up appointments to make sure that you’re getting better fast.

Microneedling may also help to reduce acne scars with little downtime. Ask your dermatologist if they provide this in their office or if they recommend other cosmetic treatments to reduce scarring.

7. How can I treat nodular acne on hard-to-reach places like my back?

There are several washes that can effectively target nodular acne on your back. I recommend using a scrub wash at least once a week that contains alpha hydroxy acid and beta hydroxy acid. These ingredients help clean out and unclog your pores, smooth your skin texture, and help with darks spots, or hyperpigmentation, that are left from old acne bumps.

8. Nodular acne has greatly affected my self-esteem. How can I get help?

Having acne can take a toll on your emotional well-being. A board-certified dermatologist can work with you to get you on a skin care regimen that’s best for your skin. While it may take a few weeks to see improvements, know that you can have clear skin with the right treatments.

If you’re experiencing symptoms of depression or anxiety that don’t seem to go away, talk to your doctor. They can recommend a mental health professional to help you manage your symptoms.


Dr. Morgan Rabach is a board-certified dermatologist with expertise in cosmetic procedures such as neuromodulators (Botox and Dysport), dermal fillers (Juvéderm, Restylane, Radiesse, and Sculptra), and the full spectrum of medical dermatology. In addition to her private practice, she is assistant professor in the Department of Dermatology at Mount Sinai Hospital. After graduating from Brown University with honors in biology, Dr. Rabach earned her medical degree from New York University School of Medicine. She completed her medical internship at Yale New Haven Hospital and her dermatology residency at SUNY Downstate Medical Center, where she served as chief resident. Dr. Rabach’s practice encompasses medical, surgical, and cosmetic dermatology, and she tailors her treatments to the individual needs of each patient.