Can Acne Cause Swollen Lymph Nodes Behind Ear?

Severe forms of acne can cause inflammation and swelling in the lymph nodes in the neck and behind the ear. Learn the basics of acne and lymph nodes, and how this swelling may occur. 

The Basics Of Acne

Acne is a type of skin condition that is characterized by both inflammatory and non-inflammatory lesions on the skin. It can appear on most commonly the face, but also the rest of the body.

It is primarily considered an inflammatory disorder caused by a type of bacteria known as Cutibacterium acnes (C. acnes). This condition presents itself in many different populations, especially in young adolescents. 

During puberty, the body goes through many changes. One change includes an increase in the androgen hormones. This leads to an increase in sebum production (1).  In addition, changes in the epidermis as you grow older causes retention of this sebum. Sebum is one of the contributors of acne formation. As puberty hits, an increase in cell growth and sebum production causes rupturing of the hair follicles. Once these follicles become plugged with sebum, other dead skin cells, and C. acnes bacteria, this leads to inflammatory lesions (1).

Acne Causes

There are a variety of causes of acne that range from hormonal changes, lifestyle choices, diet, and medication (1). Diet, in particular, has been shown to be correlated with the severity of acne. Certain high glycemic foods (foods that spike your blood sugar levels quickly) have been shown to worsen acne. These include sugary foods like chocolate or pastries. 

Acne is also due to stress. When stressed, the body releases cortisol which can stimulate inflammation and acne formation. 

Certain skincare products may also cause an increase in acne. Oily, high-comedogenic skincare products may exacerbate acne. These may include coconut oil, oils high in oleic acid content, shea butter and other waxy substances, harsh cleansers and alcohol-containing toners. 

Acne Treatments

There are numerous acne treatments that can be implemented to improve acne. These include both topical and oral treatments. 

Topical treatments include antibiotics like Clindamycin, as well as over the counter products like benzoyl peroxide, salicylic acid, and other acids like alpha hydroxy acids. Sulfur is another topical treatment that has been used for acne. In addition, retinoids like tretinoin and adapalene are also acne treatments.

Oral treatments include antibiotics like doxycycline, minocycline, and tetracycline. Birth control pills may also regulate hormones and promote a decrease in acne. Accutane is another oral treatment used for more severe acne, or in cases in which the acne is resistant to other treatments. 

Some may use supplements such as zinc and vitamin A to reduce inflammation in the skin and to improve the look of acne and redness. 

Severe Acne

One type of severe acne includes acne conglobata. This is a type of acne that is characterized by large cysts that are persistent, take a long time to heal, and may present itself all over the face and body. Since it is a very resistant and persistent type of acne, isotretinoin (Accutane) is a common last ditch effort of oral treatment used to improve the acne lesions. Unfortunately, the use of isotretinoin in some patients may result in swollen lymph nodes.

The Basics Of Lymph Nodes

Lymph nodes are part of the body’s lymphatic system. This system connects vessels that move fluid throughout the body (2). The lymph nodes work to filter out debris and cells at the end of their life cycle. This helps to regulate immune responses. 

As mentioned previously, C. acnes bacteria is a contributing factor to the formation of acne lesions. Once this bacteria begins to proliferate in the presence of sebum and plugs the hair follicle, an inflammatory response ensues. Inflammation in response to the bacteria, as well as cell debris can cause swollen lymph nodes (2). Other symptoms include pain and impaired function of the lymph nodes

Acne Fulminans and Swollen Lymph Nodes

As mentioned earlier, isotretinoin for the treatment of severe acne can cause swollen lymph nodes in a select number of patients. This can lead to a condition called acne fulminans. 

This is a severe form of acne that is triggered by isotretinoin treatment. It can also be caused by high testosterone levels. These elevated levels can cause an increase in sebum production as well as an increase in C. acnes bacteria. An increase in bacteria leads to a greater immunologic response that results in acne fulminans. Oftentimes, this response results in the inflammation of joints, which leads to pain in the joints and swelling. Nodules may form on the neck, and swollen lymph nodes are present at the base of the neck, throughout the neck and even behind the ears.

Lymph nodes have been shown to be inflamed due to skin inflammation from other skin conditions as well, such as rosacea or UV damage. When exposed to inflammation, the lymph nodes become inflamed with fluid such as inflammatory cells and other cell infiltrates.

Treatment

The most effective treatment for acne fulminans involves steroid therapy; this is a better form of therapy than antibiotics. If not treated as soon as possible, patients may end up in the hospital for weeks with severe lesions on the body. 

References

  1. https://www.ncbi.nlm.nih.gov/books/NBK459173/
  2. https://www.frontiersin.org/articles/10.3389/fimmu.2019.00308/full

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