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The Ins and Outs of Nodulocystic Acne

I know what you’re thinking, but you’re wrong. ‘Nodulocystic’ isn’t just a word I made up to scam my way into an impressive Scrabble score. (That was ‘qyzltak,’ and it would have gotten me 96 points. Triple word score, man!)

No, nodulocystic is a type of acne, and it’s all too real.

Mild acne is like an annoying pest — say, the mosquitos spoiling your attempts to enjoy wine on the patio. But nodulocystic acne is in a whole different league.

It’s the final boss. It’s the monster under your bed. It’s Voldemort!

(And it’s only worth 20 points in Scrabble. What a letdown.)

Hard to pronounce and even harder to beat, nodulocystic acne is not to be trifled with. If you’re facing severe acne, show up to the fight armed with both knowledge and determination!

What is Nodulocystic Acne?

I’ll say it again: Nodulocystic acne is bad news. It’s not content to just torment you with regular pimples. Instead, it shows up with nodules and cysts, combining the two most severe forms of acne into one huge Megazord of awfulness.

Both types develop deep beneath the skin, making them difficult to treat topically. From the surface, a nodulocystic breakout will look like a combination of red, inflamed boils and hardened lumps. Those lumps may also be red and angry or may camouflage with your normal skin tone.

These breakouts usually appear on the face, neck, chest, shoulders, and back. Nodulocystic acne can affect anyone, but it’s most likely to strike young men in their teens or twenties. (Sorry, dudes!) When women do develop nodulocystic acne, it tends to cluster around the lower face and jawline.

One of the worst things about nodulocystic flare-ups is that they linger. You’re red, you’re sore, you’re so over it...but that breakout probably isn’t fading anytime soon.

Nodulocystic acne is entrenched deep in your skin. It can take weeks or even months to disappear — by which time, you may have all new breakouts to contend with!

That’s why it’s crucial to be proactive about your skin. Nodulocystic acne isn’t something you can put off. The longer you wait to fight back, the more likely you are to see scarring, and the more difficult it will be to reclaim your complexion!

Nodular Acne vs. Cystic Acne vs. Nodulocystic Acne

First of all, you need to establish whether or not your breakouts are nodulocystic. It can be all too easy to mix up nodulocystic acne with two closely related conditions, nodular acne, and cystic acne. So what’s the difference?

Nodular acne: Acne nodules are firm lumps beneath the skin. They don’t come to a head like typical acne blemishes, and cannot be popped. Nodules can appear one by one or spread in huge patches, like a tiny forest of sore red knots.

Cystic acne: Acne cysts are swollen cavities that develop deep below your skin’s surface. They can contain solid or liquid substances, such as pus, sebum, blood, and keratin. Softer than nodules, they can spread infection if burst.

Nodulocystic acne: This is the worst of both worlds, presenting with both nodules and cysts. That’s some serious double trouble. And just for funsies, nodulocystic acne can produce regular zits, too. Yay.

So we have all these different terms for similar conditions. Kind of awkward.

Complicating matters even further, dermatologists don’t all 100% agree on these blemish categories.

Experts argue that true cysts must have an epithelial lining — in other words, a physical barrier separating them from the rest of the body. Cavities without this barrier aren’t technically cysts. They’re just bigger, squishier nodules.

And since most acne cysts don’t appear with epithelial lining, they technically aren’t true cysts. True cysts rarely occur in acne at all, and cystic acne is a big misnomer.

Because of this, some dermatologists think that cystic breakouts should instead be referred to as “inflammatory acne” or “severe nodular acne,” adding to the name confusion.


So what’s the big deal? Why do we even need to care about this scrambled stew of terminology?

Because you don’t know what school of thought your dermatologist may when they say you have severe nodular acne, do they mean nodular? Or do they mean cystic? Or do they mean nodulocystic?!

Ultimately, you just need to remember this:

There are many ways to describe nodulocystic acne, some of which can be misleading or inaccurate. These terms have different meanings but are used interchangeably, even by doctors. So when you go in for your professional diagnosis, make sure to get a detailed understanding of your condition!

Causes of Nodulocystic Acne

This, at least, is a little less tricky. Although it’s dramatic and terrible, nodulocystic acne is caused by the same fundamental factors as mild or moderate acne. We’re talking about excess skin oil, overproduction of skin cells, and bacteria colonizing your blocked pores.

Like most acne, nodulocystic breakouts also respond to hormonal changes. When women develop nodulocystic breakouts, it is often in response to a hormonal shift, like your period. Or as I like to call it, shark week.

Not to be confused with actual Shark Week.

So if the causes are so similar, why did you end up with severe nodulocystic acne instead of something less extreme? Did you just lose the genetic lottery?

Maybe. Genetics seem to play a role in the appearance and severity of acne, nodulocystic acne included.

However, the severity of a breakout is also influenced by the depth of the infection. Nodules and cysts develop beneath the skin, with no outlet to drain or unclog, and thus no way to begin healing.

They’re gonna need a little help.

Dealing With Nodulocystic Acne

At this point, we would love to hand you the quick-fix skincare miracle of your dreams. But nodulocystic acne is a stubborn jerk, and it will take some time and dedication to bring it under control.

First and foremost, resist your urge to pick at cysts and nodules. They are both too deeply embedded to pop. Any attempts to squeeze them out will just increase your risk of scarring or bursting them beneath the skin. Gag!

Next, don’t try to DIY this situation. You aren’t Joanna Gaines (are you?), and this isn’t a cute old house in Waco, Texas.

Joanna Gaines from Fixer Upper, Please Come Remodel My House


You may read online about at-home remedies like apple cider vinegar, which has bacteria-killing enzymes and some very promising minerals and acids. And you think, why not? What’s the worst that could happen?

Sorry to be a buzzkill, but...chemical burns. Chemical burns can happen.

So maybe don’t try out every tip you see on Pinterest.

Finally, be sure to get a professional medical opinion to confirm (or correct) your self-diagnosis. Your dermatologist may then recommend procedures like chemical peels or laser therapy to reduce bacteria and inflammation.

Many dermatologists also prescribe medications for severe acne. We encourage you to proceed with caution and research any prescription before you begin taking it.

For example, consider the popular drug isotretinoin (formerly known as Accutane). It has been linked with side effects like sun sensitivity, thinning hair, breathing problems, upset stomach, internal damage, mental health issues, and more.

And if you’re pregnant, absolutely DO NOT TAKE isotretinoin (or any of its aliases). It can result in serious, potentially fatal birth defects.

Prevent Your Next Severe Breakout

Once you’ve managed to return your skin to its natural baseline, you’ll want to keep it that way! Don’t just sit around waiting for your acne to counterattack. Set up a few good habits to support your complexion and keep nodulocystic breakouts at bay!

1. Lower your stress. To keep acne-inducing stress hormones at bay, try to get enough sleep and incorporate relaxing activities like meditation, gentle exercise, or calming hobbies.

2. Up your intake of vitamin D. Low vitamin D levels have been shown to co-occur with nodulocystic acne. It may help to get a little extra through sunshine, supplements, or vitamin-rich clear skin foods.

3. Keep a consistent skincare routine. I know. It’s been a long day (and week, month, and year). All you want to do is fall into bed. But to avoid breakouts, you need to take care of your skin first! You can’t just wait and wash your face 12 times on Saturday. (Believe me, I’ve tried.) To maintain a healthy complexion, consistency is key. Find products that work for you and USE THEM!

Still, searching for your holy grail products? If you’re recovering from or currently fighting severe acne, you need something that can support and complement your treatment plan.

Avoid cheap, over-the-counter products and cleansers. They are often muddied up with harsh chemical compounds and synthetic fragrances that can dry out your sensitive, recovering skin. Plus, most only cleanse your face at the surface level, scouring open pores but doing nothing for closed nodules and cysts underneath.

Instead, seek out all-natural skincare products that use gentle, organic botanicals and penetrate deep to help heal severe acne. For the ultimate one-two punch, try Averr Aglow’s Radiant Cleansing Nectar and Clear Skin Elixir.

Averr Aglow Clear Skin Elixir and Radiant Cleansing Nectar


The Radiant Cleansing Nectar uses antimicrobial manuka oil and vitamin-packed hawthorn berries to remove dirt, makeup, and bacteria without irritating your sensitive skin.

Follow up with the Clear Skin Elixir. It’s formulated for overnight nourishment, so skin-balancing nutrients from coral and French pink clay have time to sink into your skin and balance it from within.

Nodulocystic acne isn’t easy, and it isn’t fun. But it also isn’t the end!

Don’t give up, we believe in you! xx

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