Moderate Acne Treatments

If you have moderate acne, you will likely need help from your family doctor or a dermatologist (see Checklist – When to see a doctor). Your family doctor or a physician at a walk-in clinic can refer you to a dermatologist if necessary.

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Medical treatment for acne focuses on

  • healing existing spots and lessening the risk of scarring
  • preventing future acne spots and scarring

Treatments for moderate acne, which may be used in combination, include:

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Topical Treatments:

Topical (applied to the skin) prescription products are the most common medical treatment for moderate acne. The main active ingredients in topicals are:

  • retinoids
  • antibiotics
  • prescription strength benzoyl peroxide
  • combinations of the above agents
  • clascoterone 1%
  • dapsone 5%
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Treatment: Retinoids, synthetic by-products of vitamin A. Examples are tretinoin, adapalene, tazarotene.

How it works: normalizes the excess shedding of skin cells to prevent plugging of pores and limits oil produced, resulting in a reduction in blackheads, whiteheads and inflamed spots. Particularly helpful to even out skin tone.

Side Effects: Irritation, dryness and redness

Dos and Don’ts – (See 7 tips – How to apply prescription topical retinoids) Use a sunscreen and other sun protection as your skin may be more sensitive to the sun. Don’t use if pregnant or nursing.

Expect results: 2 – 3 months. There may be visible improvement at 6 weeks.

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Treatment: Benzoyl Peroxide in prescription strengths

How it works: Kills bacteria; has some ability to unclog pores.

Side effects: irritation, dry skin, flaking, possible bleaching of hair

Dos and Don’ts: Use a sunscreen. Be aware, may bleach clothes and bedding.

Expect optimal results: 2 – 3 months

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Treatment: Topical antibiotics. Examples: clindamycin

How it works: Destroys bacteria in pimples and cysts, reducing inflammation. Topical antibiotics are generally well tolerated but of limited effectiveness when used alone.

Side effects: irritation, dry skin, redness, In rare cases (clindamycin) diarrhea

Dos and Don’ts: Apply to affected areas twice daily.

Expect optimal results: 2 – 3 months

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Treatment: Combination topical treatments put 2 or more active ingredients into 1 product. These combinations offer better results and simpler treatment regimens. Examples of combination treatments are: retinoids + benzoyl peroxide; retinoids + antibiotics; antibiotics + benzoyl peroxide.

How it works: Targets multiple acne causes at the same time

Side Effects: see under retinoids, benzoyl peroxide, antibiotics

Dos and don’ts: see under retinoids, benzoyl peroxide, antibiotics

Expect results: 2 – 3 months. Some visible improvement may be seen by 2 weeks, although more significant improvement often takes 4 – 6 weeks.

Treatment: Clascoterone 1% is the first ever topical drug to reduce oil production in the skin – a new mechanism of action to treat acne. Overproduction of oil is a major contributor to the development of acne spots. Suitable for males and females age 12 and older with moderate to severe acne.

How it works: During puberty, oil glands within the skin stimulated by male hormones known as androgens, enlarge and become overactive, pumping out excess oil. This oily substance combines with dead skin cells to clog skin pores, certain skin bacteria may overgrow, and acne spots develop.

Clascoterone penetrates the skin to reach the androgen receptors of the oil glands. The drug then binds to androgen receptors and inhibits the production of oil.

Side effects: Most skin reactions are mild in nature. These include redness, dryness, itching, and burning.

Dos and Don’ts: Do not spot treat. Do not use if you are pregnant or plan to be or are breastfeeding. Avoid skincare products that dry the skin.

Expect results: Significant improvement after 12 weeks. Results from two clinical trials showed that after 12 weeks of treatment, patients with moderate to severe acne had a reduction in inflammatory lesions (pimples and red bumps) in the 1% clascoterone treatment groups of 44.8% and 47.0% (5). The reduction in non-inflammatory lesions (blackheads and whiteheads) was 30.7% and 29.3%.

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Treatment: Dapsone 5%, made from a chemical compound, was approved as an acne treatment in Canada in 2012. It is particularly suitable for those with sensitive skin or those who cannot tolerate other topical treatments. This treatment seems to be especially helpful in women.

How it works: Has anti-inflammatory and anti-bacterial properties

Side Effects: Can cause mild to moderate dryness, redness, burning

Dos and Don’ts: Do not apply at the same time with benzoyl peroxide containing medications as the combination can lead to temporary yellow/brown skin discoloration at application sites

Expect results: 8 – 12 weeks

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Birth control pills

Treatment: For women under the age of 35 whose acne is partly caused by a hormonal imbalance – signs include pre-menstrual acne flare ups, irregularities in periods and acne on the jawline or neck – certain birth control pills can help and offer a long term solution.

These pills can do double duty – help to control acne and provide birth control. Today’s birth control pills contain lower doses of hormones. Some ‘low dose’ estrogen pills and combination pills with estrogen and progestin can help. The ‘mini pill’ containing only progestin is likely to make acne worse. Discuss the choice of pill with your physician.

The main drawbacks are that it takes up to 6 months to see significant results (there should be visible improvement at 3 months) and there are well-known, potentially serious side effects associated with the use of birth control pills.

The birth control pill is generally prescribed in combination with other acne treatments such as topical (applied to the skin) therapies.

How these work:

These oral medications alter the hormonal balance in the body and reduce the level of male hormones called androgens, in particular testosterone. Testosterone, present in males and females, is a major culprit in acne because it stimulates the oil glands to enlarge and produce excess oil that combines with dead skin cells to clog the pores.

Side Effects:

There are many well-known side effects associated with birth control pills such as weight gain (by causing increased appetite), nausea and mood swings. Less common but serious side effects include blood clots, stroke, headaches, high blood pressure and depression. Read all drug safety information provided.

Dos and Don’ts – Not for smokers, those who get migraine headaches (especially with aura) or are obese, diabetic, epileptic, have a history of blood clots or strokes, have high blood pressure or are at risk for breast cancer.

Expect results: from 3 – 6 months.

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Other hormonal treatments:

Treatment: For females with severe or stubborn acne that is thought to be caused by a hormonal imbalance, several oral hormonal treatments are available. One of these treatments, spironolactone, is used to help women with adult acne.

Hormonal treatments each have unique and potentially serious side effects associated with their use. Whether these treatments are a suitable and safe option for you will be determined in consultation with your doctor or dermatologist.

How these work: These medications reduce levels of male hormones called androgens – in particular testosterone. This decreases oil gland activity and limits oil produced.

Side Effects: Unique to each. Read all drug safety information provided.

Results: from 3 – 6 months.

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Oral antibiotics

Treatment: A cornerstone of treatment for those with moderate to severe acne who are not getting improvement with topical (applied to the skin) treatments, or who have a lot of acne on many areas of the body, oral antibiotics such as tetracycline, doxycycline or trimethoprim will help clear up the skin. These are often used with topical treatments or hormonal therapy.

How these work: reduces bacteria and inflammation, redness etc.

Side effects: Stomach upset, nausea, allergic reactions. Read all drug safety information provided.

Dos and Don’ts: Complete the full course of medication, use sunscreen and other sun protection

Expect results: 2 – 3 months

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Light and laser treatments

Blue light, red light, LED light, intense pulsed light (IPL), lasers

Treatment: for mild, moderate and moderate to severe acne, these newer treatments offer an option that does not involve taking oral medications such as pills. Since only the top layer of the skin is affected, side effects are generally mild and temporary. There is preliminary evidence of good short-term results.

However, as with any recent treatment option, more studies are needed on the long term effectiveness and safety of these options. Researchers have questions around how long results last for these treatments, how these compare to conventional therapies and who these options will work best for. Study results continue to come in and add to what is known. Most studies have only evaluated treatment to 3 months.

Topicals may be prescribed along with these treatments.

How these work:

Light treatments work by reducing bacteria in acne spots and lessening inflammation. Bacteria produce chemicals called porphyrins which are sensitive to light. When exposed to light sources, such as blue or red light, these chemicals absorb the light and the bacteria are destroyed. Light treatments are also presumed to work through heat that can help to reduce acne bacteria.

For light treatments, a regimen of 2 treatments a week over 5 or 6 weeks is usual.

Laser treatments similarly work by reducing bacteria in some acne spots. You will likely need a several treatments. Effects are not long lasting.

Side effects: since these devices do not penetrate the skin deeply, side effectstend to beminimal and temporary, particularly for lighttreatments. Expect mildredness and swelling. Hyperpigmentation (patches of the skin get darker) can occur. There can be more serious side effects from lasers, such as burning and blistering due to deeper penetration into the skin with possible scarring of the skin.

Dos and don’ts: Some require avoiding sun exposure for several days.

Expect results: in a few weeks.

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Chemical peels, microdermabrasion, facials

Treatment: For some types of mild to moderate acne, these are in-office treatments that offer improvement by exfoliating the top layers of the skin. These compliment other treatments but do not work on the root causes of acne. Several sessions are usually required. Your skin type and colour will help determine treatment.

How these work: For chemical peels, a highly concentrated acid such as glycolic or salicylic, is applied to the skin and causes peeling. This helps exfoliate the skin and unclog pores.

For microdermabrasion, fine crystals brush against the top layer of the skin, helping to remove dead skin cells and oil.

Facials, often done in conjunction with comedo extraction, deeply cleanse and hydrate the skin which helps to unclog the pores.

Side effects: redness and peeling that may last a few days.

Dos and Don’ts: Use sunscreen and sun protection as your skin will be very sun sensitive.

Expect results: after a few days.

7 tips – How to apply prescription topicals containing retinoids

Retinoids or combination treatments with retinoids can irritate the skin. Correct use will maximise effectiveness and limit skin reactions.

  1. Use at night (generally). Cleanse your skin, pat dry. Wait 10 – 15 minutes before applying to lessen risk of irritation such as burning, stinging or itching.
  2. Apply a pea-sized amount of product to each main area of the face – 1 for nose and chin, 1 for each cheek, 1 for forehead etc.
  3. Gently massage all over the entire area, not just spots. Avoid eyes, mouth and nostrils.
  4. Use every other night to start. If well tolerated, increase to every night.
  5. Consider applying a moisturizer after the retinoid.
  6. If you develop any irritation or stinging, stop treatment for 1-3 days, cleanse and moisturize in the meantime, and then restart your topical medication applying it for 30 to 60 minutes for a few days before leaving it on for more prolonged time intervals.
  7. Make application part of your daily routine by placing medications where you can easily see them, using around the same time every day and setting up self-reminders on your phone.

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