Cystic Acne and Nodular Acne

by | Aug 26, 2020

Several nodular acne lesions on the right side of the face. Numerous atrophic scars on the skin. The nodules are the size of a pea.

Nodular acne: Nodular acne is larger than acne vulgaris and feels hard to the touch. There is no pus in it and you will feel pain. Nodules are also particularly prone to repeated growth in the same area.

There is a polymeric cyst on the lower right side of the mouth that is very large. The cyst looks soft and you can see pus.

Cystic acne: The size of cystic acne is larger than that of the nodules. It is soft to the touch and contains pus (A mixture of sebum, dead cells, leukocyte corpses, and bacterial corpses), you will also feel pain.

Nodular acne and cystic acne merge together. The entire right cheek seemed to be rotten, looking disgusting.

Nodule-cystic acne: Nodules and cysts converge together, with bumps in some areas and pus in some areas.

Nodular acne and cystic acne are the most severe type of acne. They are large, and they may feel pain when they are touched. They usually appear on the chin, nose, cheeks, corners of the mouth, neck, back, and even chest.

Nodules and cysts will seriously damage your appearance. When you look in the mirror, you will feel that you are not good-looking. The originally confident person will become an inferior, sensitive, and depressed woman.

Acne that develops into nodules or cysts can also leave a more severe pigmentation or depressed scar.

Nodular acne and cystic acne are more serious skin diseases. If you have this disease, please see a dermatologist immediately.

What Causes Cystic Acne And Nodular Acne?

Normally, the oil secreted by the sebaceous glands runs out along the hair follicles. But when hyperkeratosis at the funnel of the hair follicle. The pores are clogged so that the oil cannot flow out and form whiteheads. A mixture of oil, dead cells and bacteria causes an inflammatory reaction, forming acne.

The formation of acne vulgaris is that the sebaceous glands secrete too much sebum (oil). For some reason, the pores are blocked and the sebum cannot flow out. Oil, dead cells, and bacteria are blocked in the hair follicles to form whiteheads or blackheads. Whiteheads can develop into papules, pustules, and even nodules and cysts.

Propionibacterium acnes, which is resident on the skin, is a bacterium that prefers an anaerobic environment. It uses sebum as food. If the pores are covered by the epidermis, P.acne gets a large number of opportunities for reproduction. Too much Propionibacterium acnes in the hair follicle will stimulate the inflammation of the hair follicle wall. At the same time, P.acne will also stimulate the sebaceous glands to further secrete sebum, making the blocked hair follicles swollen.

The pores of nodular acne and cystic acne are completely blocked. Inflammation deteriorated very seriously, the hair follicle wall ruptured, and the mixture in the hair follicle gradually flowed out of the hair follicle, forming an inflammatory nodule.

Based on nodular acne, it further deteriorates, the structure of the hair follicle is further damaged, the dermis layer is damaged, the blood vessel is broken, and it is accompanied by pus to form a cyst.

The dermis is the second layer of the skin structure. Above the dermis is the epidermis. The dermis is mainly composed of collagen and fibrin.

Nodular acne and cystic acne have invaded the dermis, destroying the collagen and elastic fibers of the dermis. The dermal layer has weak self-healing ability, so nodules and cysts are likely to leave pigmented or depressed scars. Without targeted treatment, nodules or cysts will stay on your face for at least a month, and will not disappear for even a few months.

The following factors may cause severe acne:


  • Your skin is naturally prone to acne. If the body’s ability to fight inflammation is weak, acne vulgaris can easily develop into nodules or cysts.
  • Androgen increase. Androgens stimulate the sebaceous glands to secrete sebum, and more oil is produced on the face. Adolescence, menstruation, pregnancy, fitness, and people with polycystic ovary syndrome generally have higher androgens, and they are also more likely to have acne.
  • The wrong way of skin care. Wrong skin care methods can not improve your skin, but also easily damage the skin barrier, bacteria from the external environment can easily enter your skin, making your face more prone to acne.
  • Wear a helmet or tights. Helmets and tights can easily break the skin, the skin barrier is destroyed, and bacteria can more easily invade your skin.
  • Highly closed cosmetics and skin care products.
  • Expose in the sun, stay up late, eat sweets, eat high GI foods.
  • Eat spicy food. Although spicy will not cause you acne, spicy will deteriorate the inflammation of the skin, causing papules and pustules to develop into nodules and cysts.

How To Get Rid Of Nodular Acne Or Cystic Acne?

If your acne develops into nodules or cysts, don’t trust the information you searched online to take the medicine by yourself. You should be aware that you have a very serious illness. You should first see a dermatologist. Under the doctor’s treatment, your cyst can be eliminated in a month, otherwise, it will be difficult to disappear for several months.

The treatment of nodules and cysts requires oral drugs, supplemented by externally applied drugs, and particularly severe acne also requires joint injection of drugs.

Main treatment


Isotretinoin is the preferred oral medicine for treating nodular acne and cystic acne in the International Acne Treatment Guidelines and the American Acne Treatment Guidelines.

The effect of isotretinoin:

  • Induce sebaceous cell apoptosis, significantly inhibits sebum production.
  • Lowers the link between cells of the stratum corneum, prevents abnormal keratinization of keratinocytes, promote normal cell shedding.
  • Destroy the oxygen-free environment, destroy the living conditions of P.acnes, kill P.acnes.
  • Anti-inflammatory and prevent the formation of the depressed.

Patients with severe acne take isotretinoin for one day at a dose of 0.5mg-1mg per kilogram of body weight, usually for no less than 16 weeks. It usually takes effect in 3-4 weeks. After the skin lesions are controlled, the dose can be reduced appropriately and the consolidation treatment can be continued for 2-3 months or longer.

Although isotretinoin is currently the most effective acne treatment, its side effects are also very strong. Its side effects include:

  • Skin, mouth, and eyes will feel very dry.
  • Depression.
  • Cheilitis.
  • Liver damage.
  • Headache, muscle ache, arthralgia.
  • Elevated blood lipids.
  • Long-term use before adolescence may cause premature closure of epiphyses, bone hyperplasia, and osteoporosis. Therefore, children under the age of 12 are prohibited.
  • Isotretinoin has a definite teratogenic effect, and female patients of childbearing age should strictly contraception 1 month before treatment, during treatment, and within 3 months after treatment. If taken during pregnancy, it may also result in the death of the newborn or premature delivery.

The above adverse reactions will gradually disappear after stopping taking isotretinoin.

Oral antibiotics

Antibiotics can kill bacteria in hair follicles and inhibit inflammation. The treatment of severe acne is usually combined with oral antibiotics. The treatment of nodular acne and cystic acne should avoid oral antibiotics alone, without combining other treatment methods.

The preferred antibiotic drug is tetracycline, such as minocycline or doxycycline. In particular, minocycline has a high drug concentration in the skin tissue, strong antibacterial ability, and a low incidence of bacteria resistance to it.

If you have contraindications to tetracycline drugs, you can consider macrolide drugs, such as erythromycin, roxithromycin, azithromycin, doxycycline, etc.

Please follow the doctor’s orders for the dosage and time of oral antibiotics,However, it is recommended not to continue taking antibiotics for more than 8 weeks

Precautions for oral antibiotics:

  • Treatment of severe acne should be combined with isotretinoin or photodynamic therapy.
  • When the treatment is invalid after 2-3 weeks, it should be stopped in time, or other treatment methods should be replaced.
  • To ensure adequate treatment, avoid intermittent use, cannot increase the dose, or extend the treatment course without principle.

Antibiotic drugs have the following side effects:

  • Stomach ache.
  • Liver damage.
  • Sun sensitivity.
  • Pigmentation.
  • Dysbacteriosis in the body.
  • Vertigo and headache, if these two reactions occur, please stop taking the medicine immediately.

Photodynamic therapy

Photodynamic (PDT) therapy is a method that uses light energy to activate chemical reactions and selectively destroy tissues under the action of photosensitizers. The more metabolized cells absorb more energy from light energy, such as tumor cells and certain microorganisms.

PDT can be used to kill P.acne, eliminate inflammation, and destroy the structure of the sebaceous glands. PDT is effective in treating severe acne and is widely used.

The light source of PDT is mainly red light and blue light, it is an enhanced version of red light and blue light treatment.

Killing P.acne and destroying the sebaceous glands are most effective under the irradiation of blue light, but the blue light has a shorter wavelength and weaker penetration. The red light has a longer wavelength and is more penetrating. The deeper skin tissues are mainly treated with the red light.

PDT is a local treatment method without obvious systemic side effects.

Injection therapy

When using oral medication to treat a cyst, it is more difficult for the drug to penetrate the cyst area. When treating the cyst, the dermatologist may inject the drug into the cyst to improve the treatment effect.

Common injection drugs are as follows:

Glucocorticoid. Glucocorticoid. Glucocorticoids have the effect of inhibiting androgen production and anti-inflammatory. The glucocorticoids used to treat cystic acne include triamcinolone acetonide, depot pine, and nylon.

Gentamicin. Gentamicin is an antibiotic. Gentamicin injection is injected into the cyst to achieve a high concentration of the drug in the local area, quickly killing P. acnes so that the skin lesions can heal faster.

Lidocaine. Lidocaine is a local anesthetic, and when injected with glucocorticoids or antibiotics, it is usually mixed with a concentration of 2% lidocaine.

Dermatologists generally mix glucocorticoids and lidocaine into the cyst.

Or puncture the large cyst, squeeze out the pus, and inject a mixture of gentamicin and saline to clean. Then inject a mixture of glucocorticoid and lidocaine.

Injection treatment can only be performed by a dermatologist, patients should never try it by themselves.

Adjuvant therapy

Adjuvant treatment methods are treatment methods added based on the main treatment methods. The following two methods are common:

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Benzoyl peroxide

Benzoyl peroxide can slowly release new ecological oxygen and benzoic acid, which has the effect of killing P. acnes and anti-inflammatory. And benzoyl peroxide is not drug-resistant and can be used as an adjunct treatment for nodules or cysts.

Oral anti-androgens (forbidden for men)

Androgen is the most important factor in the development of acne. Anti-androgen drugs can inhibit the secretion of androgen by the body, thereby inhibiting sebum production. Commonly used anti-androgens mainly include spironolactone and contraceptives.


Severe acne requires a combination of multiple treatments to get rid of acne.

Dermatologists will prescribe oral isotretinoin and antibiotics when treating nodular acne, and photodynamic therapy will be added when the inflammation is more severe. Sometimes adjuvant therapy is used.

For the treatment of cystic acne, we will be prescribed oral isotretinoin, antibiotics, and PDT. When the size of the cyst is larger, it will be injected.

How To Prevent Cystic Acne And Nodular Acne?

Don’t squeeze acne

  • Severe acne has damaged the dermis, and the skin barrier has been severely damaged. You can no longer break the skin barrier.
  • Nodular acne is a hard lump, not only can’t squeeze out pus but also easily destroy the structure of the dermis layer, leaving acne scars.
  • Cystic acne is difficult to squeeze out all the pus, and bacteria on your hands are brought into the wound, which can easily cause secondary infections. Moreover, if the squeezed pus is not cleaned up, it will easily infect normal skin tissue and expand the scope of infection.
  • Special attention: do not squeeze the dangerous triangle. The blood vessels in the triangular area are abundant, and many blood vessels lead to the brain. Once damaged or infected, they can transmit bacteria and their toxins to the brain, and meningitis occurs.
  • Gentle cleansing. Use a mild amino acid facial cleanser and do not wash your face more than twice a day.
  • No makeup. Frequent makeup and makeup removal on the skin can easily damage the skin barrier.
  • Avoid exposure to sunlight, try to use sun umbrellas, sun clothes, sun hats, and less sunscreen.
  • Eat fewer sweets. After high-sugar food enters the body, it will stimulate the sebaceous glands to secrete sebum. Sugar can also increase inflammation, leading to the recurrence of acne.
  • Do not stay up late, do not drink milk, but you can drink a small amount of yogurt.
  • Eat more fruits, vegetables, soy products, and green tea, such as apples, pears, tomatoes, watermelons, cucumbers, and soy milk. But don’t eat too sweet fruits, such as litchi, cantaloupe, durian.


  • Eat foods rich in zinc, vitamin B, omega 3, and vitamin A.