Painful Acne Under the Skin in Teenagers: What Parents Should Know

Painful lumps deep under the skin are usually acne nodules or cysts. They sit deeper than ordinary spots and carry a higher risk of permanent scarring, so they should not be squeezed or picked. If your teenager has deep, sore lumps that keep coming back, or any early scarring, it is worth getting their acne assessed by a doctor.

Parents often describe these as "blind pimples" or spots that never come to a head. They can last for weeks, and they are not a sign that your teenager is doing anything wrong. Here is what they are, what to avoid at home and when to get help.

What are acne nodules and cysts?

The HSE describes nodules as large, hard lumps that build up under the skin and can be painful, and cysts as large pus-filled lumps that look like boils. Both are forms of inflammatory acne. They form when a blocked pore becomes inflamed deep in the skin rather than near the surface.

Nodules feel firm and tender, are often skin-coloured or red, and do not come to a head.
Cysts are softer, deeper and can look like a boil.
They often appear alongside blackheads, whiteheads and smaller red spots, on the face, back or chest.

A doctor will also check that a lump is acne and not something else, such as a boil or folliculitis.

Why do deep spots matter more?

Deep inflammation can damage the surrounding skin before the spot settles. The HSE notes that people with nodules or cysts are at more risk of permanent scarring, and advises talking to a GP if there are many spots or large, sore lumps. Waiting for each lump to go down does not deal with the process that is creating the next one.

What should a teenager avoid?

Do not squeeze, pierce or pick a deep lump. This pushes inflammation deeper and raises the risk of infection and scarring.
Do not layer several acids, drying lotions or home remedies on the same spot. They do not reach the deep part of the lump and can irritate the surface.
Do not scrub. A gentle cleanser twice a day is enough.

A cool compress can ease discomfort for a short time, but it does not treat the acne.

When should a teenager see a doctor?

They have deep, painful lumps or cyst-like spots, especially if these keep coming back
Spots are leaving marks, dents or raised scars
Acne is spreading to the back or chest
Pharmacy products have not helped after two to three months of regular use
Acne is affecting their mood, confidence, sleep or school life

Get same-day medical advice if acne suddenly becomes much worse with fever, joint pain or feeling generally unwell.

What does an assessment look at?

An assessment looks at the whole picture, not just the worst spot: the number, depth and spread of spots, any marks or scarring, acne on the body, what has been tried so far, family history and how acne is affecting your teenager. The plan depends on overall severity.

At ClearDerm I see teenagers aged 14 and over by video consultation. For anyone under 18, a parent or guardian gives consent and needs to be present for the consultation.

Frequently asked questions

Can ice make a deep spot go away?

A cool compress may ease the pain for a while, but it does not treat the underlying acne or stop new lumps forming.

Should we use a needle to release it?

No. Piercing or squeezing a deep lump increases inflammation, infection risk and the chance of a scar.

Does one deep spot mean severe acne?

Not necessarily. Severity depends on the whole pattern. Deep spots that keep coming back, or any scarring, are a good reason for an assessment.

Can painful acne be assessed online?

Often, yes. Photos, a careful history and a video consultation are enough to assess most acne. If anything needs to be seen in person, I will say so and explain the next step.

Is it my teenager's fault?

No. Deep acne is not caused by poor hygiene or diet. It comes from how their skin responds to normal hormones, oil production and inflammation, and it often runs in families.

If your teenager has painful lumps or early scarring, the Teen Acne Consultation explains how I assess teenage acne and what to expect.

Sources

Reviewed by Dr Tara Treacy, GP with a special interest in dermatology (IMC 411337). Last reviewed: 2 November 2026. General information only; it does not replace an individual medical assessment.