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How To Treat Moderate Acne Vulgaris

This week I'll be continuing my series on the types of acne and treatment options for each. If you haven't already taken my acne quiz, get to it so you can figure out which type you have. We already went over the treatment options for mild acne vulgaris, so now it's time to move on to moderate acne vulgaris.

Quick refresher before we get started: moderate acne vulgaris consists of papules and pustules. Papules are slightly elevated, solid lesions that have a "sandpaper" feel when you rub your hand over the area. A pustule is the more inflamed version of a papule. They are dome-shaped, fragile lesions containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. Lovely! Now that we know what we're dealing with, see what you can do about it when you


  • High Concentration Benzoyl Peroxide: You can get up to a 10% concentration of benzoyl peroxide without a prescription, but if your acne still won't budge, it might be time to step it up with a prescription. Yep, time to see the doc. She will be able to prescribe you a higher concentration, and more importantly, evaluate your acne one-on-one and determine the right course of treatment for you. If you do get a prescription for a higher dose of benzoyl peroxide, use it sparingly and only every other day at the most, as it can be very, very drying. Be sure and moisturize and use a high SPF every day, as it will also increase your sensitivity to the sun.
  • Topical Prescription Antibiotics: Topical antibiotics wipe out acne-causing bacteria on your skin, and can be effective for those of you afflicted with non-inflamed papules. The most commonly prescribed are Clindamycin and Erythromycin, which come in either a gel or a cream form, and are applied twice daily. The good thing about topical antibiotics is that the side effects are minimal, they don't cause much drying or irritation, and can potentially clear up moderate cases of acne in about 8-12 weeks.
  • Oral Prescription Antibiotics: Oral antibiotics kill acne-causing bacteria deeper within your pores than topical ones. So if your acne hasn't responded to topical treatments, you might need to try an oral one. The most commonly prescribed are Tetracycline and Doxycycline. There are generally more side effects for anything you take orally, so be sure and discuss what they are with your doctor, since they vary between each prescription. You can bet on at least increased sensitivity to the sun, and maybe some nausea and headaches.

As with any prescriptions, make sure you discuss any potential side effects with your dermatologist before starting a treatment plan. Don't be scared to ask questions — you are paying for your doctor's time so you should make sure you get the most out of it. And trust me, physicians have heard everything under the sun, so don't hold back! Also make absolutely sure you tell your dermatologist what other drugs you're taking — legal, illegal, over the counter, prescription, whatever. Nobody's going to arrest you, and your doctor needs to know so you don't have a potentially dangerous drug interaction. Let me know if any of you have tried any of these treatments, and what you thought!


Join The Conversation
ameliaj ameliaj 9 years
Our skin is an indicator of the bodies health. Before jumping to OTC quick fixes it would be a good idea to take a look at what's going on in your life to find out where some contributing factors are coming from. Acne is basically caused by these things: clogged pores, bacteria, cosmetics and products, and triggers such as hormones, stress, and foods. There are many differing opinions on whether or not food plays a role in acne but take it from personal experience IT DOES. My teacher had Grade IV Acne, which is the most severe, and had tried every OTC product and had spent a fortune going to get facials and peels. She eventually went to a herbalist/dietician who suggested that she stop eating dairy to see if that made an improvement. After 30 days her skin was almost clear, turns out she was allergic to dairy. I am not saying that everybody with acne should stop eating dairy but I know that for most people their acne would be less severe if they cut out foods known to irratate the skin. p.s. If you're wondering they include: Salt, MSG, Kelp, Cheese, Processed/Packaged Foods, and of course fast food. Also somebody else had mentioned using a scrub on their skin. That is a HUGE no-no. Acne is an inflammation of the skin, you wouldn't rub a cut or open wound with salt would you? It's important to exfoliate but if you have acne it's better to use a chemical or liquid form and steer clear from "scrubs"
burke_chi burke_chi 9 years
not recommended to take antibiotics orally b/c w/ prolonged use they become ineffective against other strains of bacteria - meaning if you get sick with a bacterial infection, you're facked.
JaimeLeah526 JaimeLeah526 9 years
I have found that I am really bad at topical application and just end up forgetting. For me I'd rather go the oral route and take it with my vitamin. It's a lot easier for me and I find it works better, I think my pimples start really deep in the pore.
ciaositos ciaositos 9 years
Also, a word of caution to anyone considering OTC benzoyl peroxide - it can bleach fabrics!
ami_z ami_z 9 years
Obviously, I'm late to the discussion, but I wanted include an anecdotal word of caution about oral antibiotics. I have had mild/moderate acne for years, and had it largely controlled through products (including Differin) when I started taking Doxycycline as a malaria prevention drug while abroad for 3 months. My skin was fantastic! However, when I got back and stopped the drugs I had the most horrific reaction! I broke out in truly painful cystic acne for months. It took going back on the Doxy and slowly weaning myself off of it for my skin to look remotely normal. I only mention this because I wish I knew this before I went on the drugs (even though I used them for a non-acne reason). Just an FYI.
Arielrb38 Arielrb38 9 years
I've had mild to moderate acne for a little over ten years, and I've tried almost everything under the sun. As for OTC stuff, I recently started using Neutrogena Pore Reducing/ Minimizing Cleanser and Toner with a department store moisturizer at night, and it has cleared my skin amazingly well. The exfolient in the Neutrogena is much smaller than in the St. Ives Medicated Apricot Scrub, which is nice (I would always end up with little particles in the corners of my eyes). I am also allergic to bezoyl perozide. If I really need to I can use a teeny bit on just one spot on my face, providing it's not near my eyes. Forget about it for a facewash though, I wake up in the morning and my eyes are really swollen and irritated (think pink-eye). On another note, I know a lot of people may poke at pimples and squeeze them occasionally. It is important to be able to identify the difference between skin maintenance behavior and symptoms of Body Dysmorphic Disorder. Anorexia gets all of the attention as being a part of Body Dysmorphic Disorder, but occasionally the disorder will show itself in the form of picking at skin, and poking at zits and pimples. When a person suffers from Dysmorphic Disorder she is often not fully in control of the picking behavior, it's more like a compulsion than anything else. I've only seen it talked about once or twice on the internet, but since the forum was open to the skin lesions, zits, and such I wanted to throw it out there, just so if someone is reading this and wondering, she knows that she's not alone out there.
bailaoragaditana bailaoragaditana 9 years
Ick. I used a lot of benzoyl peroxide when I was younger, but it tortured my skin - it really made things worse, I think, by drying everything out. Nowadays, I use tea tree oil, which I've found to be much more effective. Fortunately, I've never had to turn to prescription drugs...
Kristinh1012 Kristinh1012 9 years
I use St. Ives Appricot scrub, they have several different types depending on what you need, and that stuff is amazing. It will clear your skin very quickly if you use it twice a day.
ASpoonfulofSugar ASpoonfulofSugar 9 years
I have to be really careful with what I use because my skin is pretty sensitive to some of the ingredients in acne-fighting products, i.e., I break out MORE! Frustrated, I have made my own little routine. I wash with Desert Essence Thoroughly Clean face wash (which is all-natural), Boots No7 Restore & Renew to get rid of redness and help healing, and 100% tea tree oil on any blemish to dry it up. I'm not saying my skin is perfect, but I am definitely afraid of prescriptions, especially since one I had in high school made my skin much worse (as did Murad later in life), and most OTC brands also do terrible things to my skin. The products above have definitely helped clear up my moderate acne, and I only break out with papules and pustules very rarely.
ragedyfairy ragedyfairy 9 years
The Diane pill only cleared my backne. Now, I'm using 5% benzoyl peroxide(morning), Retin-a micro(night), and Doxycycline. It took about 5 months, but now I only get one major pimple (and that's only during my period). I might try birht control again to deal with that issue... I hate taking antibiotics, but I know it's keeping a lot of major pimples from developing. If you're worried about yeast infections try taking acidophilus pills and eating yogurt everday:-) @advo:For scaring I would try a chemical peel. I've also heard good things about Bio-Oil.
k_izzle k_izzle 9 years
BeautyXRush BeautyXRush 9 years
oh, and I too was taking Yaz.
BeautyXRush BeautyXRush 9 years
My hormones were out of whack a year ago, so my skin was freaking out. My dermatologist gave me Differin gel. It cleared my face in 2 weeks, now its near perfect. I think everyone should try it if they are at all having problems with their skin.
Liselola Liselola 9 years
I had much acne on my back and a lighter variant in my face. My dermatologist prescribed me Tetralysal when I was 15 but it didn't help at all and those pills were very nasty! Differin made my back acne a little better but my face became very very dry with like little white flakes coming from my skin. When I went back to the doctor he prescribed Diane35 which is an anticonception pill. This pill helped but not really well, my back acne didn't disappear completely and I continued to suffer from break-outs in my face. Unfortunately I began to suffer from migraine and Diane35 is a big no-no for migraine patients, so I stopped taking it. When I was 17 I got the Yasmin anticonception pill and that really worked for me! My back is completely clear now (hello tank tops ! =) but I do have breakouts in my face when I get my period. I treat these with Clinique Spot Treatment Gel which works fine!
facin8me facin8me 9 years
carhornsinapril, it's true that recent research indicates that there is no significant reduction of oral contraceptives during doxy treatment- but this side effect continues to be listed on the indication sheet and doctors continue to recommend a secondary barrier method during doxy treatment, which I take to mean "better safe than sorry."
advo advo 9 years
I was on Tetra for a while. It's not that it didn't help - but it really did dry my skin out. Plus it makes the skin very sensitive to the sun or something, it's not recommended to be used with lots of sun anyways. Great article Bella, but how about some post-acne tips? Right now, I'm not so trouble by my acne anymore - it's more the scars. Perhaps because I needn't pay for doctor visitations because the doctors here, also dermatologists, aren't very forthcoming.
carhornsinapril carhornsinapril 9 years
lemuse20, i was told to take my doxy in the middle of a meal to prevent nausea, and that's helped me a lot. perhaps you can ask your doc about doing that?
carhornsinapril carhornsinapril 9 years
"And oral antibiotics for your skin are a big no-no!! You should not be on oral antibiotics for a prolonged amount of time- it'll make your birth control (if you're on it) less effective and open the door to yeast infection city." facin8me, this isn't entirely factual. some types, like doxycyclin, will not interfere with hormonal BC -- i was assured of this by both my gynecologist and dermatologist! it's a different type than what you take say, when you're sick. i've been on three different types of doxy in the last year and have never had a problem with yeast infections, though i always get them whenever i'm sick & prescribed a z-pack.
lemuse20 lemuse20 9 years
I'm scared to take antibiotics now because someone told me it messes with your immune system. I took Doxycycline, I didn't see too much of a difference, and I hated how it made me nauseas, and that I had to take it either 2 hours before or after eating, to prevent nausea, yet I still got it. Retina micro works really well, it get rid of scar marks and makes your skin really soft... but kinda red.
bellaressa bellaressa 9 years
benzoyl peroxide makes my pimples turn dark.
mischo-beauty mischo-beauty 9 years
Double cleansing morning & night will help!
liltandweave liltandweave 9 years
I have nasty reactions to bezoyl peroxide. My skin gets all itchy and my eyes puff up, so sadly it is not a treatment option for me.
nobodymuch nobodymuch 9 years
One thing to clarify: more is NOT better with benzoyl peroxide. Higher concentrations only cause more side effects, they don't work better. Most dermatologists prescribe 2.5-5% rather than 10% as some drugstore products contain. The lower concentration in a better vehicle works at least as well, that's basically what proactiv and similar products are. Look for gel based formulas, etc not the highest concentration.
bea831 bea831 9 years
Duac gel is also good. it's a combination of benzoyl peroxide and clindamycin :)
bea831 bea831 9 years
I took Tetralysal, it's great stuff. it stopped me from having big breakouts, etc. you just have to take it for around 2 weeks but you can see the effects just after a week. it really works!
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