Overview 

Nodular acne is a type of inflammatory acne that appears as hard lumps or nodules deep under the skin, manifesting as red bumps on the skin.¹ Primarily, it affects the face, chest, or back. These nodules are very painful and can last for weeks or even months.¹ The bacteria Cutibacterium acnes become trapped under the skin and cause infection.¹ Unless treated, acne can cause permanent scarring, which at times can be very severe. Some natural methods and some remedies can help treat nodular acne.

The National Health Library states that acne and its later outcomes can have a severe impact on emotions, daily activities, social interactions, study/work, and relationships, in that order. Nodular acne could be painful and demoralising to a person’s self-esteem due to its unsightly appearance. Assurance, counselling, and early interventions for the disease are necessary in cases of nodular acne to lessen the psychological impact of the disease and allow for better outcomes.²

Causes of nodular acne

There are numerous causes for nodular acne, and some of them are as follows: 

Hormonal imbalance: Young people who are going through adolescent development are more likely to have an acne breakout as hormone levels change. Increased levels of androgens can cause oil in the skin to thicken, leading to clogged pores. In teenagers and young adults, it is more common, and even in pregnant people assigned female at birth (AFAB), menstruating or going through menopause can also get nodular acne.¹

Genetic predisposition: More likely to develop nodular acne if it runs in a family¹

Diet and lifestyle factors

Environmental triggers: Some lotions, creams and makeup can clog pores and lead to acne nodules

Stress and its impact on skin health: Increased anxiety and stress can cause the body to produce more sebum as cortisol levels rise.¹

Lifestyle modifications for nodular acne

Dietary adjustments

Reducing the intake of high GI (Glycemic index) foods and eating more low GI foods may have benefits for the skin. High GI foods are those which increase the level of blood sugar instantly, and examples of High GI foods are:

• Fast foods
• Chocolates
• Sweets
• Sugary and baked goods
• All packed and processed food 
• Sweetened cereals
• Refined carbohydrates, e.g. white bread  

  Eating low GI foods also has benefits such as stabilising blood sugar. 

• Non-starchy foods
• Whole grains and cereals
• Beans and legumes
• Nuts and seeds
• Fruits such as apples, berries, and plums. 
• Many protein and fat sources do not have a GI score because they have little to no effect on blood sugar. Incorporating olive oil, eggs, chicken, and fish into the diet can keep blood sugar levels stable and provide important nutrients for skin health.

Omega-3 fatty acids

Fatty acids like omega-3, omega-6, and omega-9 can affect inflammation levels in the body. For instance, a diet rich in omega-3 fatty acids may reduce inflammation. While research has not definitively proven a direct connection between omega-3 consumption and acne, omega-3 may decrease insulin-like growth factor 1, which impacts androgen levels in the body. People can get more omega-3 from:

• Oily fish, such as wild salmon and mackerel
• Fish oil supplements or algae oil
• Nuts and seeds, such as flaxseeds and walnuts

Antioxidants

Antioxidants keep the skin generally healthy and even ensure good health. They slow down the process of ageing. Some of the research indicates that people with acne are more likely to be low in certain antioxidants, such as selenium. It doesn’t seem that low in antioxidants has a direct link with acne. However,  antioxidants have other important health benefits. It is a better idea to eat foods that contain them.

Foods to include: 

• Brazil nuts, fish, seafood, beef, turkey, and organ meats, which contain selenium
• red grapes, mulberries, and peanuts, which contain resveratrol
• other foods high in antioxidants, such as blueberries, leafy greens, red cabbage, and green tea

Foods to avoid

Several studies have implicated modern Western diets in increasing acne risk. That could be due to the number of high-glycemic-index foods they often contain. The glycemic index measures how quickly foods increase blood sugar levels in the body. High GI would be expected to form part of modern Western diets, which raises blood sugar levels enormously and could be related to acne in countries like the United States, but not in others.

For example, a 2016 review cited a few studies that looked into the acne prevalence of Indigenous people living in northern Canada, the Kitava Islands, and rural villages in Brazil, South Africa, and Kenya. These studies reported a low prevalence of acne in these locations, with traditional low GI diets of participants as the reason. According to a study in Canada, once participants start consuming high GI foods, such as soda, dairy, and refined carbohydrates, processed foods increase the rates of acne among those participants.

Cow’s milk

Consumption of cow’s milk may be associated with acne in some cases. However, studies conducted by Kucharska, Szmurło, and Sińska 2016 found a weak association between dairy consumption and acne. A 2018 review of 71,819 participants across 34 studies revealed a 16% increased likelihood of acne among milk consumers versus non-milk consumers. The American Academy of Dermatology currently finds no supporting evidence linking other dairy products, such as cheese or yoghurt, with acne.⁶

Chocolate

There has long been a fear that chocolate is a real acne aggressor, but little supports this idea, according to a 2016 review. Several studies have associated chocolate consumption with acne, but in many of these studies, there was a flaw in design, for example, some did not even specify the kind of chocolate consumed; therefore, sugar or milk could also play a role. In a 2018 study involving 33 young men, it was observed that 10 grams of dark chocolate consumed daily for four weeks brought changes to the skin that could make a person more prone to acne, particularly among young males. Others may experience that by reducing or avoiding cocoa intake, acne breakouts are reduced.⁷

Supplements

Zinc

Eating foods rich in zinc may be useful in preventing and treating acne. Includes pumpkin seeds, cashews, beef, turkey, quinoa, lentils and seafood.

Vitamin A and E

In a study published in the Journal of Cutaneous and Ocular Toxicology, researchers found that low levels of Vitamin A and E also seem to be linked to severe cases of acne.³ Professional assistance is required before taking vitamin supplements, as an overdose may cause toxicity. 

Probiotics

Including probiotic food may help in balancing gut bacteria and its impact on the skin

Lifestyle modifications

If the body is in constant stress, then it goes into fight or flight mode and releases the stress hormone cortisol. This hormone harms our immune system. 

By managing stress, you will promote better skin health and lower the risk of acne. Here are a few suggestions for stress management, like going for a long walk, doing yoga, and basic stretching exercises. Or even listening to music, talking to a friend, or taking a break from regular activities can also help relieve stress. 

Regular exercise 

There is some evidence that exercise may help or improve acne. For example, one recent study looked at the skin health of elite athletes who exercised more than eight hours per week. Researchers found that these athletes had less acne and other skin problems than recreational athletes who exercised for fewer hours.⁴

Adequate sleep

Quality of sleep also matters; the average adult must sleep 7 to 8 hours undisturbed. 

Sleepless nights can trigger acne. Sleep deprivation disrupts your hormones, leading to a chemical imbalance instead of one that usually works to prevent spots. Good quality of sleep can also lessen stress, further lowering the risk of spots. The body and skin heal while we are asleep. When sleep is compromised, the skin has less time to repair overnight.

Natural cleansing and skincare routine

Regular cleansing and skin care routine can help to keep the acne in control and improve personal hygiene. Some of the tips include:

• Washing the face twice daily and after working out may be helpful in the maintenance of acne. 
• Taking off the make-up before sleeping
• Using gentle skincare products and make-up, preferably non-comedogenic skincare products.
• Using a light, oil-free moisturiser 
• Avoid frequently touching your face
• Apply sunscreen whenever going out in the sun

Precautions and considerations

Natural home remedies include

• Apple cider Vinegar: Applying dilute vinegar on skin is believed to help lessen acne-causing bacteria on the skin. Apple cider vinegar is known to possess natural bacteria-killing agents⁵
• Olive oil: It is considered a gentle natural skin cleanser, and believed that it can remove excess oil, dead skin cells and bacteria, which in turn helps in reducing breakouts 
• Reducing stress: Stress can trigger or worsen acne breakouts. Try stress management practices like focused meditation, yoga, or exercise. Listening to music, going for a long walk, and meeting new people can help to reduce stress and potentially improve acne⁵

Conclusion

Nodular acne requires a complete and personalised treatment approach. With the combination of prescription medications, professional treatments and at-home care, nodular acne can be effectively managed by preventing breakouts, reducing scarring, and achieving healthier skin.