nodulocystic

Nodulocystic is a descriptive term used in medicine to refer to lesions that combine nodules and cysts. In dermatology, it is most commonly applied to nodulocystic acne, a severe form of acne vulgaris characterized by deep, inflamed nodules and fluid-filled cysts that frequently lead to scarring.

Clinical features include painful, large nodules and cysts on the face, chest, or back. Lesions may rupture and discharge material, and several lesions can merge into larger inflamed areas. The condition tends to be persistent and resistant to basic topical therapies, with a higher risk of lasting scarring compared with milder forms of acne.

Pathophysiology involves excess sebum production, abnormal keratinization of hair follicles, and inflammation driven by bacteria such as Cutibacterium acnes. Hormonal influences, particularly androgens, and genetic predisposition contribute to disease severity.

Diagnosis is usually clinical, based on inspection and patient history. Nodulocystic acne is classified as a severe form of acne vulgaris in many grading systems. Differential diagnoses may include other deep-seated dermatologic conditions such as hidradenitis suppurativa or deep bacterial abscesses, but imaging is rarely necessary.

Management requires a multi-modal approach. Isotretinoin is the most effective long-term systemic therapy for nodulocystic acne. Other systemic options include antibiotics with anti-inflammatory effects (e.g., doxycycline or minocycline) and, in appropriate patients, hormonal therapies such as combined oral contraceptives or spironolactone. Topical agents (retinoids, benzoyl peroxide) are used as adjuncts. For individual stubborn nodules, intralesional corticosteroid injections may provide relief. Squeezing or unroofing lesions is generally discouraged due to scarring risk. Early, guided treatment improves outcomes and reduces the likelihood of permanent scarring.

See also: acne, cyst, nodular lesions.