Nodular acne is a severe form of acne. While it can be difficult to treat and manage, there are several treatment options available.

Over-the-counter (OTC) products and good home care habits can offer some relief.

However, nodular acne can be persistent. You’ll likely need your doctor’s help to get it under control. A board-certified dermatologist can prescribe you an effective treatment and provide you with acne management tips.

With treatment, you can clear outbreaks and help prevent new ones. You can also avoid development of scars or permanent discoloration of your skin.

Keep reading as we explore OTC and prescription options. We’ll also explore some tips for home care.

The OTC products you should consider are ones that help reduce oil on your skin and promote peeling.

Topical creams or gels with benzoyl peroxide as the active ingredient are a good choice. Benzoyl peroxide helps reduce inflammation and bacteria, as well as the number of blackheads and whiteheads.

Benzoyl peroxide can make your skin more sensitive to sunlight. Avoid being in the sun for extended periods of time and make sure you apply sunscreen. This ingredient also has a bleaching effect on clothes, so be careful when using it.

Read the package inserts carefully so you understand how to use the products. It can sometimes take several weeks before you notice a difference in your skin. To get the most out of these products, always wash your skin before applying topical treatments.

When you start using OTC acne products, you might notice increased scaling or reddening of the skin. This is usually temporary and should improve after a few weeks.

Severe acne may not respond to OTC products. If your acne doesn’t get better or side effects worsen, stop using it and see your doctor. Keep your doctor up to date on all the products you’ve used.

Nodular acne usually responds better to systemic treatment. Your dermatologist will likely recommend an oral medication to use along with a topical treatment.

Some oral acne treatments include:

  • Antibiotics. Oral antibiotics help destroy bacteria and reduce inflammation. These medications can make your skin more sensitive to the sun. They’re usually used along with topical retinoids or benzoyl peroxide.
  • Corticosteroids. Available in pill form, systemic corticosteroids can help reduce severe inflammation and clear your skin.
  • Hormonal contraceptives (females only). Combination estrogen and progestin pills can help improve acne. It may take several months for them to start working.
  • Anti-androgens (females only). These agents work by blocking the effect of androgen hormones on the glands that produce oil. Side effects can include the risk of birth defects. You shouldn’t use anti-androgens if you’re pregnant or plan on becoming pregnant.
  • Isotretinoin. This drug tackles bacteria, inflammation, excess oil, and clogged pores. Your doctor will likely recommend it if you’ve tried every other treatment and it hasn’t worked to clear your acne. About 85 percent of people report clearing after one course of treatment. Potential side effects are serious. Side effects include an extremely high risk of severe birth defects if you become pregnant while taking isotretinoin in any amount, even if for a short period of time. If you’re eligible to use this drug, you’ll have to agree to a monitoring program.

Some topical prescription treatments are:

  • Retinoids. These lotions, creams, and gels are derived from vitamin A. Retinoids help remove dead skin cells. They also help prevent clogged hair follicles. Retinoids can make you more sensitive to the sun. They can also cause birth defects.
  • Salicylic acid and azelaic acid. These products can help fight bacteria. Salicylic acid may also help to prevent plugged hair follicles.
  • Antibiotics. Topical antibiotics also help fight bacteria. They’re usually combined with another treatment, like benzoyl peroxide.
  • Dapsone. This is a gel that can help fight inflammation.

All medications can have side effects. Talk to your doctor about the potential benefits, risks, and drug interactions of all your medications before you start taking them.

Nodular acne isn’t caused by poor hygiene. However, how you take care of your skin matters. Here are some tips for caring for your face and skin:

  • Wash your face and any other affected areas twice a day.
  • Wash again after working up a sweat, but don’t wash excessively.
  • If you tend to sweat around your hairline, shampoo your hair every day.
  • Use only gentle soap or cleanser.
  • Avoid facial scrubs, astringents, and face masks.
  • Use your fingertips rather than a washcloth. Don’t rub too hard.
  • Be extra gentle when shaving.
  • When choosing cosmetics, sunscreens, and hair products, avoid those that feel oily or greasy.
  • Look for products that are water-based or noncomedogenic (not likely to block pores).
  • Don’t use acne concealers.
  • Don’t pick at your acne or try to pop pimples.

The sun can irritate your acne. Some acne medications make your skin more sensitive to the sun. Here are some ways to protect yourself:

  • Stay out of direct sunlight whenever possible.
  • Wear a wide-brimmed hat to shade your face and neck.
  • If you tend to get acne on your back and chest, keep those areas covered.
  • Wear sunscreen. Your dermatologist can recommend a specific one.
  • Don’t use tanning beds or other tanning devices.

Here are some quick remedies for painful flare-ups:

  • Use cold to soothe pain and swelling. Put an ice cube in a paper towel or clean wash cloth and hold it on the affected area for up to 10 minutes. You can repeat this process a couple more times but let your skin rest for 10 minutes in between applying.
  • Use heat on any whiteheads that develop. First, soak a small clean towel in hot water. Do not let the water get too hot. After wringing it out, hold the warm towel on your pimple for up to 15 minutes. You can do this several times a day to help the pimple release pus.

Always let your dermatologist know the methods you use at home.

Besides systemic and topical treatments, your dermatologist can offer a few other techniques to treat nodular acne. Some of these techniques include:

  • lasers and photodynamic therapies
  • prescription chemical peels
  • extraction of blackheads and whiteheads
  • incision and drainage to clear a nodule
  • corticosteroid injections directly to the affected area to reduce nodule size and ease pain

None of these procedures should be attempted on your own. Talk to your dermatologist about side effects and potential benefits of these methods.

You don’t have to live with painful nodular acne. There are several effective treatments available that can help clear up your skin. While it may take some trial and error, your dermatologist can help you find a treatment that works best for you.