Most teenagers have at least a handful of pimples, but only a few develop the severe type of acne known as nodulocystic acne, according to the American Academy of Dermatology. In nodulocystic acne, large, hard bumps form under the skin's surface, and these bumps often leave scars. There are several causes of nodulocystic acne, including hormonal shifts and bacterial infection.
Overstimulated Sebaceous Glands
Nodulocystic acne can result when the body's male hormones, known as androgens, overstimulate the skin's sebaceous glands, according to the Cleveland Clinic. These glands, located below the skin's surface, rely on signals from androgen hormones to tell them when to produce oil. When there's too much androgen hormone in the body, the sebaceous glands become overstimulated and produce too much oil. This oil then clogs pores and causes acne, which can become severe. Women who have hormonally driven nodulocystic acne might see flares immediately before their menstrual cycles. Several treatments, including laser therapy and, for women, oral contraceptives, can slow down oil production in the sebaceous glands.
Dead Skin Cells
Your skin sheds dead skin cells every day. But in people prone to nodulocystic acne, the skin almost always sheds too many cells each day, according to the AAD. These dead skin cells irritate the delicate hair follicles on the skin's surface, and they can combine with skin oil to form a pasty, whitish substance that blocks pore entrances. Once a pore is blocked, a painful nodule or a cyst can form behind it and an infection can develop. Tretinoin, a prescription medication best known as Retin-A, can help clear your pores and keep them clear by controlling dead skin cell shedding.
Bacterial Infection
Nodulocystic acne rarely appears without bacterial infection, according to the AAD. When your pores are blocked, the oil behind the blockage becomes a breeding ground for a type of bacteria known as Propionibacterium acnes, or P. acnes for short. P. acnes, normally a slow-growing organism, can reproduce quickly in oily skin, causing cysts and nodules to form and deep-seated infection to take root. Several different types of oral antibiotics can fight P. acnes infection, and your dermatologist can recommend the best one for you.
Picking at Lesions
It's possible to make existing acne lesions worse by picking at them or manipulating them, according to the Cleveland Clinic. Picking at pimples and squeezing them can cause infection to set in, possibly leading to a cyst or nodule. If you have nodulocystic acne, do not attempt to squeeze your lesions. Squeezing them or otherwise manipulating them can spread the infection and make the lesions last for months. Instead, your dermatologist can offer you injections that might give some quick relief from the pain of nodulocystic acne.
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