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Traitement nodule sous la peau

Under-skin nodule: what are the treatment options?

Perceived as skin protrusions, subcutaneous nodules generally require treatment for removal. Indeed, while some may disappear spontaneously, this is not always the case, especially if they are due to nodular acne. In the latter case, the benefit of quick removal is twofold: it improves the patient's quality of life who may suffer from the conspicuous nature of the nodules and prevents scarring. Let's explore together the various options for eliminating nodules.

Summary
Published October 24, 2024, updated on October 24, 2024, by Pauline, Head of Scientific Communication — 7 min read
Nodes

Option No.1 for nodules: topical treatments.

Nodules can initially be managed with topical treatments, including:

  • Corticosteroids.

    In the event of inflammatory nodules, some dermatologists prescribe corticosteroid creams to reduce the inflammation and swelling of the nodules. These anti-inflammatories work by binding to specific cellular receptors, thereby inhibiting the production of pro-inflammatory cytokines and prostaglandins, which are mediators of inflammation. Corticosteroids can also slow the migration of immune cells and stabilize the membranes of lysosomes, which limits the release of enzymes that degrade tissues. Like all medications, corticosteroids can cause side effects, such as skin atrophy or pigmentation disorders, hence the importance of closely following the recommendations of one's dermatologist.

  • Topical Retinoids.

    Derived from vitamin A, retinoids are a molecular class frequently used to combat acne, including nodular acne. By binding to specific nuclear receptors of retinoids RAR and RXR, they modulate the expression of genes related to cell growth. Thus, retinoids help to normalize the desquamation of epidermal cells and assist in unclogging hair follicles, thereby reducing the formation of new nodules. They also have anti-inflammatory properties. Although one often wishes to quickly eliminate nodules, applying an excessive amount of retinoid-based cream to the skin provides no additional benefit. On the contrary, it increases the risk of local irritation.

  • Topical Antibiotics.

    Used for their antibacterial and anti-inflammatory properties, antibiotics such as clindamycin or erythromycin are effective in reducing bacterial populations at the nodule level. For instance, clindamycin works by inhibiting the synthesis of certain proteins essential to bacterial metabolism, thereby limiting the proliferation of these microorganisms responsible for inflammation. This type of treatment has the advantage of carrying a low risk of side effects.

Option No. 2 in case of a nodule: oral treatments.

It is also possible to treat inflammatory nodules with oral medications.

  • Oral antibiotics.

    Oral antibiotics, such as doxycycline or minocycline, are commonly prescribed to treat nodules of infectious origin or those accompanied by significant inflammation. These drugs primarily work by inhibiting the proliferation of pathogens that colonize the sebaceous glands and promote inflammation, such as Cutibacterium acnes. Antibiotics inhibit the synthesis of bacterial proteins by binding to ribosomal subunits, thereby preventing the multiplication of microorganisms. It is quite common for oral antibiotics to be prescribed in conjunction with topical retinoids.

  • Isotretinoin.

    A derivative of Vitamin A, isotretinoin is a gold standard oral treatment for severe acne and persistent inflammatory nodules. Its mechanism of action is multifaceted. This molecule directly affects the sebaceous glands by reducing their size and activity and normalizes the keratinization process, thus reducing the risk of hair follicle obstruction. Moreover, isotretinoin decreases the expression of pro-inflammatory cytokines, thereby helping to calm inflammation at the nodule level. Despite its proven efficacy, isotretinoin requires special attention due to its potential side effects, including skin and eye dryness, musculoskeletal disorders, and teratogenic risks in women. Regular medical follow-ups and monthly blood tests are therefore required throughout the treatment.

Option No. 3 in case of a nodule: aesthetic medicine and surgical treatments.

Finally, certain aesthetic medicine and surgical techniques allow for the rapid removal of nodules.

  • Surgical excision.

    Surgical excision is a traditional method for removing large inflammatory nodules or those suspected to be malignant. This technique involves the complete removal of the lesion using a scalpel or a surgical knife, followed by suturing and the application of healing care to promote rapid recovery. When the nodule is suspected to be cancerous, a histopathological analysis is performed. Surgical excision is typically performed on an outpatient basis and requires at least minimal local anesthesia.

  • Cryotherapy.

    Cryotherapy is a minimally invasive technique used to eliminate relatively shallow nodules. It involves the application of liquid nitrogen to the nodules, which lowers the temperature of the skin tissues. Their rapid cooling leads to the formation of ice crystals inside and around the cells, causing the rupture of cellular membranes and their destruction. Cryotherapy also stimulates cellular regeneration, leading to a gradual repair of tissues and the disappearance of the nodule. It should be noted that, in some cases, multiple cryotherapy sessions may be necessary.

  • The CO2 laser.

    Recognized for its high precision, the CO2 laser is particularly recommended for localized or recurring nodules. It uses an infrared light beam, emitting at a wavelength of 10.6 µm absorbed by the water contained in the cells of the nodule, which causes their immediate vaporization. The CO2 laser offers a relatively short healing time but can cause temporary redness and crusting in the days following the session. Moreover, it is important to limit sun exposure after the treatment and to use daily sun protection, in order to prevent the risks of hyperpigmentation.

Some nodules may be indicators of malignant tumors. At the slightest doubt, do not hesitate to consult a dermatologist if you notice the presence of a lump under your skin.

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