One of the characteristics of nodular acne is that its size or appearance does not always give an actual indication of its severity. The one thing that does characterize it is its appearance as a big bump or pimple – for lack of a better description. Nevertheless, this rather simplistic-sounding description doesn’t mean that if you have a large bump or pimple, it is a nodule. It can also be a cyst. One of the most common types of dermal inflammatory condition is cystic acne. Quite often, a nodule will form on top of a cyst. Once the nodule has healed however, the cyst usually remains.
To put it another way, if the nodule heals and goes away, you may still have a problem since these cysts can at times proliferate, or whatever has caused them to develop can still cause more to develop.
It can sometimes be confusing as to what is called nodular active and what is generally referred to as cystic acne. To add to the confusion, the latter is sometimes referred to as nodulocystic acne since the cysts are quite often accompanied by bumps or nodules. While it can be argued that nodular acne is but one form of cystic acne and is not listed among the seven acne types that can be encountered, nodules can exist without cysts being present. In this discussion, acne where nodules have formed but cysts are not present is discussed as if it were a separate type.
There are seven different acne types people are most likely to encounter. Four of these types are extremely severe, but fortunately these four are all quite rare. Acne rosacea is sometimes listed as being the eighth type, but it is actually a totally different type of skin disease.
The Seven Types of Acne
- Non-inflammatory acne – the mildest form.
- Inflammatory acne – the moderate form.
- Cystic acne – the most severe among the common forms.
- Acne conglobata – an unusually severe form characterized by interconnecting abscesses. It is fortunately rarely encountered.
- Gram-negative folliculitis – A rare but severe form often caused by the use of antibiotics to treat milder forms of the disease.
- Pyoderma faciale – A potentially disfiguring form that affects only women and is also quite rare.
- Acne fulminans – Another rare but severe form thought to be caused by prior treatments that have affected the immune system.
Papules, Pustules, and Macules
The first three types listed are all types of the most common form of acne – acne vulgaris. The non-inflammatory kind is the mildest of these types and is usually characterized by the appearance of whiteheads or blackheads. The inflammatory type is a moderate form that is characterized by the formation of papules, pustules, and macules.
- A papule is a solid elevation of skin that is typically discolored.
- Pustules are also small bumps on the skin, but unlike papules, which generally do not contain any fluid, pustules are filled with fluid, that fluid often being pus.
- A macule is a circumscribed area of discolored skin. Macules are not raised but are flat. Macules larger than 2 centimeters in diameter are called patches.
Cystic acne is the most severe of these three types. It is characterized by the appearance of cysts or cysts and nodules. Of the three types of acne vulgaris, this is the type that is most apt to lead to scarring. It is normally the only type where nodules are involved. By way of definition, a nodule is an enlarged papule, but it goes deeper into the integument than does a papule and it is chiefly this characteristic that distinguishes nodular acne from the milder, inflammatory type of acne.
As common as acne is, it remains a skin disease that is imperfectly understood. Some forms are incurable, some can be cured, and most simply go away on their own. Exactly what can cause it to develop is often a mystery. What are known are those things that most often can contribute to an outbreak of the disease. Most explanations for the appearance of the disease center on clogging of the skin pores. The clogging of a pore usually involves dead skin cells. Normally, these dead cells will rise to the top of the pore where they are then shed. What can sometimes happen however is that sebum, the oil that lubricates the skin, can cause these dead skin cells to stick together and become trapped within the pore.
If bacteria should enter a clogged pore, an infection can occur. This causes the pore and the surrounding skin surface to become inflamed. In moderate to severe cases, pustules will often form, as will nodules and/or cysts.
Diagnosing the Condition
As noted, acne is usually characterized by blackheads, whiteheads, inflamed spots on the skin, and often pustules on the face, the back, or the chest. These symptoms alone do not signify the presence of nodular acne. If nodules are present however, the condition would then be diagnosed as that of nodular acne. If cysts are also present, the condition would be diagnosed as either nodulocystic or cystic acne.
Treating this skin condition is important not only for the sake of appearance but also to relieve the pain caused by these nodules. At the very least, they tend to be very sensitive and can easily become irritated when touched. Another reason for treating these nodules early on is that they tend to be long lasting, often lasting for months at a time. This can be long enough for them to damage the skin, leaving scars in their wake.
Treatment is normally no different than that for the milder acne forms. Over-the-counter products and even some home remedies can be effective, but since this type is relatively severe, it may be necessary to visit a dermatologist if the products or home remedies you are using are not effective. Many, though not all, over-the-counter products contain three important agents used in fighting acne:
- Benzoyl peroxide will kill the bacteria that have invaded the pores.
- Salicylic acid unclogs the pores, giving them a chance to heal.
- Gylcolic acid renews and conditions the skin in the affected areas.
Insofar as home remedies are concerned, green tea can be applied to kill bacteria, passionflower has anti-inflammatory properties, and aloe vera and/or tea tree oil can be applied to heal and condition the skin.
If these treatments are ineffective, it may be necessary to have a dermatologist give you corticosteroid injections. These injections tend to reduce inflammation in the nodules and allow the nodules to heal more quickly, lessening the chance of them leaving scars. If all else fails, a medication known as isotretinoin will often help. Isotretinoin is available by prescription only and its use needs to be carefully monitored since this medication has been known to produce severe and even potentially dangerous side effects on occasion. Dermatologists will normally refuse to prescribe isotretinoin for women who are pregnant, as it has been known to be a cause of birth defects. On the positive side, isotretinoin is quite effective in reducing sebum production, a major contributor to acne, in normalizing follicular desquamation or the thinning and peeling of the skin, in reducing bacterial activity, and in acting as an anti-inflammatory agent.
The best approach to treatment requires some patience as it involves starting with milder over-the-counter medications or home remedies and then progressing to the stronger prescription drugs if satisfactory results are not realized. In general, the risk of side effects increases with the strength of what is being used as treatment. If you need to progress to the point where requiring an isotretinoin prescription is a possibility, there will be some decisions that have to be made, and these decisions should involve discussing with a dermatologist the pros, cons, and risks involved.
While some acne types are incurable, almost all are treatable, and in the majority of cases, especially those cases of mild to moderate form, the condition goes away on its own. When the condition does go away, it may or may not return. In general, the prognosis is good. Patient compliance is very important however, especially if scarring is to be avoided. If you are experiencing this somewhat severe skin condition, you need to follow your dermatologist’s advice, or if you’ve found a medication or home remedy that appears to be working, you need to establish a treatment regimen and stick to it.
The American Academy of Dermatology (AAD) has published a number of useful tips that you can follow in managing your skin condition. There are also several videos on YouTube that offer useful device. The AAD tips are summarized below:
1) Wash affected areas at least twice daily and anytime after sweating as perspiration, if not washed away, can make your condition worse.
2) After washing, apply a gentle cleanser to your skin. Gentle in this case means non-caustic and non-abrasive. Any chemical that irritates the skin will only make your condition worse.
3) Never scrub your skin. Scrubbing your skin may be seen as a good way to clean it, but it is not a way to get rid of pimples. Regular scrubbing will almost always make it worse.
4) Shampoo regularly. This is particularly important if you have oily hair in which case you may want to shampoo on a daily basis.
5) Let your skin heal naturally. Picking at or popping nodules enhances the risk of scarring since it will take longer for the nodules to heal. It’s best to keep your hands away from your face altogether. If you have any lesions or open sores as a result of acne and you touch the area with your fingers, bear in mind that your fingertips come in contact with many different things during the day, many of which have bacteria or germs on or in them.
6) Stay out of the sun. A nice suntan may look healthy and often makes acne less noticeable, but the effect is temporary and tanning not only damages your skin but also encourages acne flare-ups. This applies to tanning beds as well. It’s especially important that you avoid too much sun when taking certain anti-acne medications as many medications make your skin more sensitive and thus more easily damaged by UV rays.
A final tip is to see a dermatologist if what you’ve been trying does not appear to be working. The AAD makes a point of noting that virtually every acne case is treatable and most cases can be treated successfully. You can always visit the AAD website, AcneNet, for more information.
A disease whose exact cause is unknown can be difficult or impossible to prevent. In the case of acne, what contributes to an outbreak is generally known, meaning there are things you can do to significantly reduce the risk of having a problem. Cleanliness is the number one preventive measure as it will greatly reduce accumulations of old skin cells and excess oil, which lead to clogged pores. A clogged pore does not always cause an acne problem but it definitely is a leading contributor. Avoiding tight clothing, tight headgear, or anything that can cause excessive perspiration is another preventive measure worth following.