If a person has deep, painful acne, nodules, or cysts, they should consult a dermatologist.
They suffer from persistent or late-onset acne: Adults who have never had acne before may develop late-onset acne.
Acne is one of the most common skin conditions in the world, affecting people of all ages, backgrounds, and lifestyles. While most individuals experience mild breakouts during adolescence, some people struggle with more severe, painful forms of acne that can persist into adulthood. For these individuals, acne isn’t just a cosmetic concern — it’s often a source of emotional stress, discomfort, and even long-term scarring.
When acne becomes deep, painful, or persistent, it may indicate the presence of nodules or cysts — the most severe types of acne lesions. These forms of acne often require professional treatment from a dermatologist, as over-the-counter products are rarely effective in resolving them completely. Additionally, some adults experience late-onset acne, developing breakouts later in life even if they never had acne during their teenage years. Understanding why this happens and how to manage it effectively is crucial for maintaining healthy skin and self-confidence.
What Are Nodules and Cysts?
To understand severe acne, it’s important to know the difference between the common types of pimples and the more serious forms.
- Whiteheads and blackheads (comedones) occur when pores become clogged with oil, dead skin, and bacteria.
- Papules and pustules are inflamed bumps that form when bacteria and oil cause irritation and swelling.
However, when inflammation occurs deep within the skin, nodules and cysts can develop:
- Nodules are hard, painful lumps that form beneath the surface of the skin. They don’t usually contain pus, but they can last for weeks or even months.
- Cysts, on the other hand, are softer, pus-filled lesions that also form deep in the skin. They are often painful to touch and can leave significant scars if not treated properly.
Both nodules and cysts are considered severe acne and require medical treatment. Attempting to pop or squeeze them can push bacteria deeper into the skin, increasing inflammation and the risk of permanent scarring.
Why Deep Acne Develops
Severe acne is often the result of a combination of genetic, hormonal, and lifestyle factors. Here are some of the most common causes:
- Hormonal Imbalances:
Hormones play a major role in acne development. Androgens — hormones that increase oil production — can trigger or worsen acne. This is why many teenagers experience acne during puberty and why adults may develop breakouts during hormonal changes, such as menstruation, pregnancy, or menopause. - Genetics:
If a person’s parents or siblings struggled with severe acne, there’s a higher chance they will too. Genetic predisposition can affect how the skin reacts to inflammation, oil production, and bacteria. - Excess Oil Production:
When sebaceous (oil) glands produce too much sebum, it can clog pores and create the perfect environment for acne-causing bacteria to thrive. - Bacteria (Cutibacterium acnes):
This type of bacteria lives naturally on the skin, but when trapped in blocked pores, it multiplies and triggers inflammation. - Stress and Lifestyle Factors:
High stress levels can influence hormone production, while diets high in refined sugars, dairy, or processed foods may also contribute to breakouts in some people. - Incorrect Skin Care:
Using harsh products or not cleansing the skin properly can disrupt the skin barrier, leading to irritation and more severe acne over time.
The Importance of Seeing a Dermatologist
If you have deep, painful acne, nodules, or cysts, consulting a dermatologist is crucial. Unlike mild acne, severe acne does not typically respond to drugstore creams or home remedies. A dermatologist can determine the root cause of your acne and recommend a personalized treatment plan.
Professional treatment options may include:
- Prescription Topicals:
Stronger creams or gels containing ingredients like retinoids, benzoyl peroxide, or antibiotics that help unclog pores and reduce bacteria. - Oral Medications:
Antibiotics may be prescribed to reduce inflammation and bacterial growth. In more severe cases, isotretinoin (commonly known as Accutane) may be used to control oil production and prevent new cysts from forming. - Hormonal Treatments:
For women, birth control pills or anti-androgen medications (like spironolactone) can help regulate hormones that contribute to acne. - Cortisone Injections:
Dermatologists may inject a small amount of cortisone directly into painful cysts to quickly reduce inflammation and pain. - Professional Procedures:
Treatments like chemical peels, laser therapy, or microneedling may help reduce acne scars and improve overall skin texture once active acne is under control.
By getting expert guidance, you not only address current breakouts but also prevent future scarring and recurring flare-ups.
What Is Late-Onset or Adult Acne?
While acne is often associated with teenage years, many adults are surprised to find themselves struggling with breakouts in their 30s, 40s, or even 50s. This is known as late-onset acne or adult acne. It can be especially frustrating for individuals who never experienced acne during adolescence.
Adult acne commonly appears on the lower face, chin, and jawline, and is often related to hormonal fluctuations. For women, breakouts may worsen before menstruation, during pregnancy, or after discontinuing birth control pills. Stress, certain medications, and even cosmetic products can also trigger or aggravate adult acne.
Causes of Late-Onset Acne
The underlying causes of adult acne often overlap with those of teenage acne but can also include factors specific to adulthood:
- Hormonal Changes:
Fluctuations in estrogen and progesterone levels can cause the sebaceous glands to produce more oil, leading to clogged pores and breakouts. - Stress:
Chronic stress increases the production of cortisol, a hormone that can stimulate oil production and inflammation. - Diet and Lifestyle:
Diets high in refined carbohydrates and dairy products have been linked to increased acne risk in some studies. - Cosmetic Products:
Heavy or oily makeup can clog pores if not properly removed. Always look for “non-comedogenic” labels on products. - Underlying Medical Conditions:
Conditions like polycystic ovary syndrome (PCOS) can contribute to persistent acne in women due to hormonal imbalance.
Managing and Preventing Severe or Adult Acne
Even though deep, painful acne can be challenging to treat, there are several effective strategies to manage and prevent it:
- Establish a Gentle Skincare Routine:
Cleanse your skin twice daily using a mild, non-comedogenic cleanser. Avoid harsh scrubs or over-cleansing, which can irritate the skin and worsen acne. - Avoid Touching or Picking at Pimples:
Picking can push bacteria deeper into the skin, leading to scarring or infection. - Use Oil-Free and Non-Comedogenic Products:
Whether it’s moisturizer, sunscreen, or makeup, make sure your products are designed not to clog pores. - Stay Hydrated and Maintain a Balanced Diet:
A diet rich in fruits, vegetables, whole grains, and lean proteins supports skin health. Limiting sugar and processed foods can also help. - Manage Stress:
Activities like meditation, exercise, and proper sleep can significantly reduce stress-related breakouts. - Follow Your Dermatologist’s Advice:
Acne treatment often takes time — sometimes several months — to show full results. Patience and consistency are key.
Emotional Impact and Self-Confidence
Severe or persistent acne can affect more than just the skin — it can take a toll on self-esteem and emotional well-being. Many individuals with deep acne feel self-conscious, anxious, or even depressed about their appearance. It’s important to remember that acne is a medical condition, not a reflection of personal hygiene or lifestyle failure. Seeking professional help isn’t just about improving your skin — it’s also about restoring confidence and quality of life.
Final Thoughts
If you’re dealing with deep, painful acne, nodules, cysts, or persistent adult acne, don’t hesitate to consult a dermatologist. Severe acne often requires medical attention and professional care. With the right treatment plan, patience, and consistent skin care, clearer and healthier skin is absolutely achievable.
Remember: acne doesn’t define you, and with proper help, you can take control of your skin and your confidence.