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Dealing with Nodular and Cystic Acne

Nodules and cysts are harder to treat than your run-of-the mill pimples. Treatment for nodules and cysts usually require prescription-strength medicines.
Acne forms when a hair follicle duct ‘pore’ is clogged with dead skin cells, excess oil and bacteria. There are several types of acne, ranging from mild to severe. If you have a pimple that is large and painful, it is most likely a nodule or cyst. Nodules and cysts can form anywhere on the face. Unlike milder forms of acne such as blackheads and whiteheads, nodules and cysts usually require professional and early treatment to minimize the chances of scarring.

Cause of Acne – It’s all about moisture management

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, doctors do not fully understand why some people develop acne and others do not. While doctors do not know the exact cause of acne, they do believe that it is caused by several related factors. It is untrue that one factor is hormonal imbalance. It is true that all male acne patients have the same hormone proportions before, during and after acne. This is also true for 70% plus of females. The remainder can have some hormonal imbalance due to Polycystic Ovary Syndrome related situations.

People’s skin becomes more sensitive to exiting male sex hormones called androgens, particularly dihydrotestosterone. This causes the skin to lose essential fatty acids especially linoleic acid. These fats are very important in slowing down the loss of moisture from skin. As water loss increases then this puts skin cells in jeopardy of drying out and dying and so the skin has to respond to protect itself and so the oil glands produce more oil to create a barrier to moisture loss and also the skin produces skin cells much faster to thicken the skin which again slows down water loss.

The problem with this is that the skin surface becomes a mass of dead skin cells (making more skin cells means you create more surface dead cells) mixed with oil..Also the top layer of skin that thickens also lines the hair follicle duct and as this also thickens, this narrows the duct and makes it easier to become blocked by all this debris and so you get blackheads and pimples. It is only then that bacteria become involved.

Bacteria live on our skin and feed off the secretions we produce so if the duct gets blocked then you cut off its supply of food. It therefore goes in search of food and finds its way under the plug into the neck of the hair follicle duct where it would not normally go. When it gets there it finds the conditions are better than on the surface and it goes into overdrive in making new bacteria. When it feeds off the oil now, the bi-products of the oil left are trapped under the plug and are considered foreign unwanted material by the skin and the body’s defense mechanisms are activated causing and inflammation. This can lead to nodules and cysts where the whole area starts to erupt and become damaged.

Nodules and Cysts

Mild to moderate forms of acne include whiteheads, blackheads, papules and pustules. Whiteheads look like tiny, white bumps on the skin while blackheads look like small, black spots. Papules are bumps that are inflamed, small and pink. Pustules are papules filled with white or yellow pus. Nodules and cysts are more severe forms of acne. Nodules are large, hard and painful lesions that form deep under the skin. Similar to nodules, cysts are also lodged deep under the skin and are painful. While they appear similar to nodules, cysts are filled with pus.

Treatment for Nodules and Cysts

Some of the most common over-the-counter treatment products for acne are creams that contain benzoyl peroxide and salicylic acid. Benzoyl peroxide can kill acne-causing bacteria on the surface but it struggles to get to bacteria beneath the surface and its drying effects actually increases and worsens the whole acne process as the skin fights back to prevent the drying effects while salicylic acid reduces the shedding of dead skin cells. According to the American Academy of Dermatology, cysts and nodules are usually not responsive to over-the-counter products and require prescription medicines that work throughout the body because you have to get below the surface and address the cause as well as the visible symptoms.

The dermatologist may prescribe oral antibiotics, birth control pills or Isotretinoin. Oral antibiotics help reduce inflammation and kill bacteria, but this takes a lot of time and taking long-term antibiotics is thought to be linked to MRSA. It may be better to use a higher dose of antibiotics for a shorter period to really attack the bacteria and sort the acute problem out. This may have a better outcome in controlling cysts and damage but a short sharp course of antibiotics may well cause less risk of bacteria developing resistance. Birth control pills are beneficial for women whose acne is caused by a hormonal imbalance but also they may just reduce the hormones which the skin is sensitized to and so only work in a small percentage of sufferers.

Isotretinoin is a vitamin A derivative taken orally that slows down the excessive new skin production. By reducing the thickness of the skin and slowing down cell production means there will be less dead skin cells to block the ducts. However thinner skin with lower levels of skin essential fatty acids means moisture loss will accelerate and the skin will fight back and become even oilier or where ducts already blocked become dry and cracked and sore  For an immediate result, the dermatologist may inject corticosteroids directly into the cyst or nodule on your nose to reduce its size and pain for a rapid reduction in inflammation but this should be considered a last resort and is only partially successful if for no other reason that it is difficult to do practically.

However, there are side-effects associated with these medicines. Aknicare – medically research and successfully proven to treat acne – is an effective alternative to many prescription medicines. Aknicare targets the four key symptoms of acne and the underlying cause without using antibiotics. Aknicare is also now available on prescription.  It replaces essential fatty acids and stops the bacteria feeding on the oil by giving them something they prefer to feed on (preferential substrate for science bods). The by-product of this new ‘food’ kills them, so they kill themselves and have no idea how, so it is almost impossible for them to become resistant to this. Not only that, the oil is protected now and this controls inflammation as less inflammatory by-products of oil breakdown are produced. The lack of nutrients from the oil prevents new bacterial growth too. How clever is this product?


Cysts and nodules often leave behind scars after they have healed which is why it is important to target the underlying cause of acne to prevent scarring. If the nodule or cyst has caused a pit on your nose, the dermatologist may inject the scar with a synthetic filling or collagen so that the skin fills out. Injections of tissue fillers are temporary and need to be repeated periodically. For a deeply indented scar, the dermatologist may decide to cut it out and stitch the skin back together to a uniform level. However, much better is to look at a TCA Cross treatment and maybe use a dermal roller in conjunction with this. Aknicare can help reduce the risk of scarring by addressing the causes of scarring quickly.

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