Nodular Acne

Dr Robert Ong of Medical Aesthetics.
Written By: Dr Robert Ong (MBBS, GDFP (Dermatology), Member - American Academy of Aesthetic Medicine)
Last updated: Aug 14, 2025

What Is Nodular Acne?

Close-up side profile view of young Singaporean man showing mild nodular acne on right cheek.
Close-up of inflamed skin on woman's cheek showing nodular acne lesions with redness and scarring.
Close-up side profile view of young Singaporean man showing mild nodular acne on right cheek.

Nodular acne is a severe form of inflammatory acne characterised by large, deep, and painful lesions that form under the skin and may persist for weeks or months. Unlike typical pimples, nodules do not develop a visible whitehead and often feel firm to the touch.

Nodular acne can be physically painful and emotionally distressing. The deep, inflamed lumps often last for weeks and may leave behind scars. When they appear on visible areas like the face, they can affect your confidence and how you feel about your appearance, especially when breakouts are frequent or hard to manage.

Prompt and appropriate treatment is essential to minimise inflammation, reduce the risk of scarring, and protect your skin’s long-term condition. At Medical Aesthetics, we offer treatments for nodular acne and post-acne scarring to support clearer, healthier skin.

What Causes Nodular Acne?

Inflamed acne lesions on woman's cheek demonstrating common symptoms of nodular acne breakouts.

Nodular acne typically develops when hair follicles become clogged with excess oil and dead skin cells, creating an environment where Cutibacterium acnes (a common skin bacterium) can multiply.

This bacterial activity triggers a strong inflammatory response deep within the skin, leading to painful nodules that may persist for weeks.

Common underlying causes within the body include:

  • Hormonal changes – Increased androgen levels can overstimulate oil glands, leading to more severe breakouts.
  • Excess oil production – Overactive sebaceous glands can clog pores and contribute to deeper inflammation.
  • Bacterial overgrowth – When C. acnes bacteria thrive in blocked follicles, they can trigger the body’s inflammatory response.
  • Genetic predisposition – A family history of severe acne may raise your likelihood of developing nodular acne.

External factors that can worsen or trigger nodular acne include:

  • Use of comedogenic products, including certain makeup or skincare items that clog pores.
  • High humidity, which increases skin oiliness.
  • Prolonged friction or pressure on the skin can irritate acne-prone areas and contribute to inflammation.

These factors often overlap, contributing to the severity and persistence of nodular acne.

What Are the Symptoms of Nodular Acne?

Close-up of painful subdermal acne nodule illustrating nodular acne symptom on person's chin.
Severe nodular acne on woman's jawline showing hormonal triggered acne lesions in oily skin.
Close-up of painful subdermal acne nodule illustrating nodular acne symptom on person's chin.

Nodular acne is characterised by deep, inflamed lumps beneath the skin that are typically skin-coloured or red, painful to the touch, and do not form a whitehead. These nodules most commonly develop on the face, chest, back, and shoulders.

They often persist for several weeks or longer. In some cases, multiple nodules can develop in close proximity, leading to more widespread inflammation, increased tenderness, and a greater risk of permanent skin damage.

If you’re experiencing deep, painful lumps that persist or leave marks, early treatment can help reduce the risk of lasting skin damage. Schedule a consultation with us to have your skin assessed and explore suitable treatment options.
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Illustration comparing types of acne including blackheads whiteheads papules pustules cysts nodules.

Nodular vs Cystic Acne

Nodular and cystic acne are both severe forms of inflammatory acne that develop deep beneath the skin, but they differ in texture, content, and how they present.

Nodular Acne Cystic Acne
Forms as firm, painful lumps under the skin. Appears as soft, swollen lumps filled with pus.
Lesions feel solid and may persist for weeks or longer. Cysts may rupture, worsening inflammation and increasing the risk of scarring.
Does not contain pus. Contains pus and is more tender than nodules.
Often leads to scarring if untreated. Also has a high risk of scarring, especially if lesions rupture.

In some cases, both types occur together in nodulocystic acne, which is considered one of the most severe and persistent acne forms. Because of their depth and severity, both nodules and cysts are more likely to result in permanent skin damage without appropriate medical care.

Nodular Acne Treatment Options

Treatment for nodular acne often involves prescription medications and professional dermatological procedures. Over-the-counter treatments generally offer limited improvement for deep, inflamed lesions.

Treatment Description Commonly Used For
Oral Antibiotics Prescription medications that help control C. acnes bacterial overgrowth and reduce inflammation in the skin. Initial treatment for moderate to severe inflammatory or nodular acne.
Topical Retinoids Vitamin A–derived creams or gels that help prevent clogged pores and promote skin turnover. They also reduce inflammation over time. Often prescribed with oral antibiotics for moderate nodular acne or as maintenance therapy.
Hormonal Therapy Medications such as oral contraceptives and anti-androgens like spironolactone, which reduce androgen activity to help lower sebum production and minimise breakouts. Women with hormonally influenced or cyclical nodular acne.
Intralesional Corticosteroid Injections Involves injecting corticosteroids directly into nodules to quickly reduce inflammation, swelling, and pain. Individual, painful or persistent nodules. Helps prevent scarring if treated early.
Oral Isotretinoin A systemic retinoid that reduces oil production, normalises skin cell shedding, and lowers inflammation and bacterial levels. Requires regular monitoring. Severe, treatment-resistant, or scarring nodular and nodulocystic acne.

Each treatment is recommended based on the individual’s acne severity, skin type, medical history, and response to past therapies. Long-term management often requires a combination approach under medical supervision.

Are There Any Procedures That Can Support Treatment?

Professional skin procedures can complement medical therapy for nodular acne by helping reduce active inflammation, prevent scarring, and support long-term skin recovery. These are typically used alongside prescription treatments and should be performed by qualified professionals.

Common options include:

  • Chemical peels – Use exfoliating solutions, such as salicylic or glycolic acid, to help unclog pores, reduce post-acne pigmentation, and improve skin texture over time.
  • Laser therapy – Medical-grade laser treatments can help target inflammation, reduce oil production, and minimise acne-related scarring.

Can Nodular Acne Cause Scarring?

Visible acne scarring on man's cheek showing atrophic scars as result of untreated nodular acne.

Nodular acne can result in permanent scarring, particularly when left untreated or if lesions are picked, squeezed, or otherwise disturbed. Types of acne scars include:

  • Atrophic scars – Indented marks caused by loss of collagen during healing. These may appear as ice-pick, boxcar, or rolling scars.
  • Hypertrophic or keloid scars – Raised, firm scars that can form when excess collagen is produced in response to prolonged inflammation.

In addition to scarring, nodular acne may also lead to post-inflammatory hyperpigmentation (PIH), especially in individuals with darker skin tones.

For those with existing scars, procedures such as laser resurfacing, or subcision may be recommended, depending on the type and severity of the scarring.

Nodular Acne Treatment: Before and After Photos

Owing to the regulations of The Ministry of Health (MOH), we are unable to publish before and after photos on our website. However, you may view these photos during your consultation with our doctor to understand more about the treatment you seek.

Why Choose Dr Robert Ong's Nodular Acne Treatment in Singapore?

The Medical Aesthetics Track Record

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Patients Consulted Since 2002

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Years of Experience

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Google Reviews

Experienced & Friendly Doctor

Dr Robert Ong listens attentively to your concerns and patiently discusses with you the appropriate treatment options, based on over 20 years of medical and aesthetics experience.

Affordable Treatments

We are priced competitively and affordably. We also have a variety of treatment options depending on your budget and requirements.

Safe & Effective Results

Our treatment options are safe, effective and promotes natural healing for your skin. We strive to keep your experience a comfortable one and will minimize any pain or discomfort, if any.

Nodular Acne Treatment Cost

At Medical Aesthetics, we offer treatment for nodular acne, other acne types, and acne scars. Pricing varies based on the treatment provided.

Treatment Price*
Consultation From $38.15 to $70.85
Oral Antibiotics From $2.40 / tablet
Retinoid From $21.80
Antibiotic Gel From $38.15
Cortisone Acne Injection From $109
Chemical Peel From $114.45
Fractional CO₂ Laser From $436
Laser Soft Peel From $436

*Prices are NETT and inclusive of GST.
All patients are required to undergo a consultation with our doctor to assess his or her suitability for the relevant treatment(s).

How to Prevent Nodular Acne?

While not all cases of nodular acne can be prevented, adopting a consistent skincare routine and addressing known triggers may help reduce the frequency and severity of breakouts. Prevention tips include:

  • Use non-comedogenic skincare and cosmetic products.
  • Keep your skin clean, particularly after sweating.
  • Avoid touching or picking at acne lesions.
  • Avoid excessive scrubbing or harsh cleansers that may irritate the skin.
  • Manage stress, which may influence hormone levels.

Where Can I Find Nodular Acne Treatment in Singapore?

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Frequently Asked Questions

Nodular acne is usually treated with prescription medications such as oral antibiotics, retinoids, or isotretinoin, while acne scars may require dermatological procedures like laser resurfacing or microneedling. Treatment depends on the severity of active acne and the type of scarring present. It is advisable to consult a doctor to determine the most appropriate treatment approach for your skin.

A pimple is a small, superficial lesion caused by clogged pores, while a nodule is a deeper, inflamed lump that forms under the skin and typically lasts longer. Nodules do not form visible pus and often feel firm or painful, making them more likely to cause scarring than standard pimples. Consulting a doctor can help identify your acne type and guide treatment.

Salicylic acid may help prevent clogged pores and reduce surface inflammation, but it is usually insufficient for treating nodular acne, which forms deep within the skin. While salicylic acid is suitable for mild acne and individual pimples, nodular acne generally requires medical treatment. It is advisable to consult a doctor for personalised treatment recommendations.

Lack of sleep may indirectly worsen nodular acne by disrupting hormone levels, increasing stress, and impairing skin repair. While poor sleep is not a direct cause, it can contribute to more frequent or severe breakouts in acne-prone individuals. Maintaining regular sleep habits may support skin health, but persistent nodular acne should be assessed by a medical professional.

Healing nodular acne becomes less painful, flatter, and gradually less red, although full resolution may take several weeks. Nodules do not form heads and shrink slowly from within the skin. If inflammation subsides and tenderness decreases without new nodules forming, it often indicates improvement. Consulting a doctor can help confirm progress and guide next steps.

Yes, nodules can go away, but they typically take weeks or longer to resolve and may leave scars if untreated. Unlike surface acne, nodules are deep and persistent, often requiring prescription treatment for complete resolution. Consulting a doctor can help determine if intervention is necessary to promote healing and reduce the risk of scarring.

Applying ice to nodular acne may temporarily reduce swelling and discomfort by constricting blood vessels, but it does not treat the root causes of inflammation. While cold compresses can soothe the skin and reduce redness, nodular acne typically requires medical treatment to address the deep infection and prevent scarring. Consulting a doctor can help determine if additional interventions are needed to manage your acne effectively.

A pimple may develop into a hard lump if inflammation extends deeper into the skin, forming a nodule. This can occur when blocked pores trap bacteria and oil, triggering a strong immune response. Unlike surface pimples, nodules do not release pus and often take longer to heal. Consulting a doctor can help confirm the cause and recommend appropriate treatment for deep, persistent lesions.

A nodule typically appears as a firm, raised, and painful lump beneath the skin without a visible head or pus. It may be skin-toned or red and often lasts for weeks. Nodules are most common on the face, chest, and back, and can result in scarring if left untreated. Consulting a doctor can help confirm the diagnosis and guide suitable treatment options.

There is no universally best face wash for nodular acne, but non-comedogenic cleansers containing salicylic acid or benzoyl peroxide may help reduce surface oil and bacteria. While a suitable cleanser supports acne care, nodular acne typically requires prescription treatment. Consulting a doctor can help determine whether your current skincare routine complements your medical treatment plan.

Niacinamide may help improve nodular acne by reducing inflammation, regulating sebum production, and strengthening the skin barrier. While it can be a helpful addition to acne-prone skincare routines, it is not a standalone treatment for deep, persistent lesions. Consulting a doctor can help determine if niacinamide is appropriate as part of your overall acne management plan.

Sudden nodular acne may result from hormonal fluctuations, increased oil production, stress, or use of comedogenic products. Environmental factors and genetic predisposition may also contribute. If you experience a sudden onset of deep, painful acne, consulting a doctor can help identify potential triggers and initiate timely treatment to minimise complications.