Updated June 16, 2014.
Written or reviewed by a board-certified physician. See About.com’s Medical Review Board.
Moderate acne breakouts are more stubborn than mild acne, so those over-the-counter acne washes and spot treatments probably aren’t doing much good. Moderate acne is that sort of breakout-middle-ground – not mild but not severe either.
If your breakouts are stubbornly hanging around despite OTC treatment, if your blemishes are typically inflamed, or if you just have persistent bumps and blackheads, you might have moderate acne. (Check out What Is Moderate Acne? for a detailed run-down of moderate acne symptoms.)
But don’t think that you can’t get your skin under control; you can. You might just need a different approach (and a different treatment). And there are plenty of treatment options that are really effective.
Moderate acne typically doesn’t improve with over-the-counter medications. But there is one exception:
Benzoyl peroxide is hands-down the most effective OTC acne treatment there is (prescription benzoyl peroxide treatments are also available.) It helps to reduce blackheads and pore blockages, but it really shines as an inflamed breakout treatment. If you’re breaking out, you may want to try an OTC benzoyl peroxide product first. Give it 10-12 weeks to work. But if you’re not happy with the results after several weeks, it’s time to move on.
It’s likely that you’ll need a prescription medication to get your moderate acne cleared up. With so many good prescription acne treatments available, it doesn’t make sense to stick with OTC products for just so-so results. You’ll be a lot happier with the results of a prescription medication, and your physician will probably start you off with a topical treatment first.
Topical retinoids are some of the most commonly used topical acne treatments today. They can be used by both teens and adults. Topical retinoids are also prescribed as anti-aging treatments, so they pull double duty for adults with acne. Topical retinoids work by speeding up cell turnover and unclogging pores, so long-term they work to reduce breakouts. They can also help make pores look smaller.
Another type of prescription acne medications are topical antibiotics. These are especially good for inflammatory breakouts. Topical antibiotics work by reducing the amount of acne-causing bacteria (bacteria called propioni acnes) found on the skin. Topical antibiotics are usually prescribed along with another acne medication. There is some worry that bacteria are becoming more resistant to antibiotics, and that they are becoming less effective than they used to be.
Combination medications have two acne-fighting ingredients in one medication. Dermatologists have long prescribed several topical acne medications to be used at once, because treating acne this way is much more effective. Combo treatments basically take this idea and make it much more convenient. Just one quick application and you’re done. Combination treatment medications include:
If topical medications aren’t giving you the results you want, oral medications can be the next step in your treatment. They might even be the first step, depending on your situation. (It doesn’t have to be an either/or prospect, anyway. Your dermatologist might prescribe both an oral and topical medication. Again, it just depends on your situation and your skin.)
Oral antibiotics work like topical antibiotics – they reduce the amount of bacteria that contribute to acne breakouts. Oral antibiotics are usually prescribed for moderate acne breakouts that are inflamed. They just aren’t effective for comedonal acne. Again, bacterial resistance is a growing problem with antibiotic over-use, so it’s important that you take them exactly as directed.
Oral contraceptives (birth control pills)
Obviously, these aren’t an option for the guys. But birth control pills are the go-to treatment for adult women who suffer from those “hormonal” breakouts every month. Teen girls can also get relief from acne by going on birth control pills. So, how do birth control pills help clear up acne? They stabilize hormonal fluctuations. Acne development is closely linked to androgen hormones. Keep those hormones under control, and acne clears up.
Another hormone regulator is spironolactone. This treatment is only appropriate for adult women with acne. It’s not specifically an acne treatment, as it’s used to treat problems such as high blood pressure and fluid retention. But for many women it’s really effective in keeping the skin clear. To be effective, though, it needs to be used long-term.
Isotretinoin (the medication better known as Accutane) isn’t the first treatment choice for moderate acne, but it can be an option when other treatments have failed. Unlike many acne medications, you don’t need to use it indefinitely for the skin to stay clear. The decision to take isotretinoin should be discussed thoroughly with your dermatologist. Not everyone is a candidate for isotretinoin treatment.
Don’t hesitate to make an appointment with a dermatologist. Moderate acne can be treated, and your skin can improve.