Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 12/07/2020
No pimples are fun. It’s not like a small, white one is any better than a deep, pulsing red one — you’ll never be happy to see either. But hard, deep pimples can do more damage.
Living with acne is hard — physically and emotionally. And the possibility that your acne could leave you with lasting scars is a frightening thought. But hard acne lesions are a serious matter, and treating them sooner rather than later could save you heartache years down the road.
You know what acne is. We all do. It’s the pimples that come when you’re about to have your period, or the breakouts that occur when you’re under stress. For some, acne never really goes away, and dealing with pimples is a lifelong challenge.
Acne is broadly caused by: bacteria (P. acnes), inflammation, dead skin cells that clog pores. It can be triggered by hormones and people may be genetically predisposed to have it. Things like stress, smoking, UV radiation, obesity, cosmetics, medications, and some hormonal diseases can also play a role in acne development.
When a pore or hair follicle becomes clogged with dead skin cells, sebum or oil can be trapped beneath the surface. Add in bacteria, and you have the recipe for inflammatory acne.
Although acne is commonly thought of as a teenager’s condition, it’s not unusual for adults to battle acne. As a matter of fact, one estimate suggests as many as 76 percent of acne patients are female, and they have an average age of about thirty-six.
There are several different kinds of acne lesions including whiteheads and blackheads (or closed and open comedones), papules, pustules, nodules and cysts. Generally, if you have a big, hard pimple that develops deep in the skin, it’s a nodule.
Nodules, pustules, cysts and papules are considered inflammatory acne. They’re larger and more damaging than non-inflammatory acne. Nodular acne, characterized by hard nodules, can lead to scarring.
If your acne is characterized by nodules and cysts, it’s likely considered “severe.” The American Academy of Dermatology says people with acne nodules and cysts should seek the help of a dermatologist to treat their severe acne and lessen the risk of serious scarring.
As the American Academy of Dermatology suggests, treating nodular acne requires a healthcare professional’s guidance, as the risks are higher when your pimples can leave scars.
A dermatologist will likely suggest a few different approaches to treat your hard pimples.
First, a systemic treatment, like oral antibiotics or an oral retinoid such as isotretinoin. Both of these options are recommended for severe acne. Isotreinoin fights excess sebum, reduces bacteria colonization, and helps proper shedding of dead skin cells. Antibiotics such as tetracyclines work to inhibit bacteria and inflammation.
Your healthcare provider may also suggest topical treatments such as benzoyl peroxide, topical retinoids, or salicylic acid. If your acne flare-ups coincide with your menstrual cycle, they may recommend trying oral contraceptives to regulate those hormonal fluctuations and therefore the acne they cause.
While following the advice of a healthcare professional, you can also take steps to minimize breakouts. Mitigating stress, regulating your weight, and getting enough sleep are a good start. If you smoke, acne is yet another reason for you to quit — smoking can aggravate acne.
In regards to your daily skin care regimen: wash your face twice daily with a mild cleanser. Washing more than twice a day or scrubbing your skin too vigorously will not help and can actually worsen your acne.
Always shop for cosmetic products that are noncomedogenic. This means they won’t clog pores and will be less likely to worsen your acne or trigger a breakout.