Mild, Moderate, or Severe Acne: Here’s What To Do
- Posted on: Feb 24 2020
Do you know what type of acne you have? We’re not talking “annoying cystic lump on my chin” vs. “that field of tiny bumps across my forehead.” While it comes in many shapes and sizes, sometimes literally, the most important thing to know about your acne isn’t what it looks like or where it shows up, but how severe it is.
That’s because all acne has one underlying cause: inflammation, your body’s immune response to oil production. To get the best treatment, you need to know if that response is mild, moderate or severe. It’s also why the first step in getting rid of it is to find a board certified, experienced dermatologist who can tell you what type of acne you have and what treatments are available.
“Acne can turn up on your face, chest or back, or sometimes all three,” says NDDA’s Board Certified Dermatologist, Dr. Melissa Rubenstein. “There’s no particular patient population or age group I see who struggle with acne more than another. It’s much more that people fall into groups according to how severe their acne is.”
There are many ways an experienced professional can discern what group you fall into, but there’s one overarching thing most people in all three have in common: the idea that it’s somehow their fault, and they need to fix it alone.
“Acne just happens. It’s a fact of life, and it requires intervention if you have it and you want to live without it,” says NDDA’s Board Certified Dermatologist, Dr. Rachel Gordon. “Many over the counter products that address specific ‘kinds’ of acne aren’t going to help you if they aren’t part of a cohesive plan.”
Bottom line: if your acne doesn’t seem “bad” enough to go to a dermatologist but you’re regularly shelling out cash on new products that promise a quick fix . . . or it’s so severe you’ve lost hope because nothing you try works . . . it’s time to educate yourself on what kind of acne you have and how it’s treated.
Severe Acne: What It Is
For severe acne, the amount of inflammation is what sets it apart from milder cases. Your skin in general looks “angry,” swollen with red bumps, lesions and nodules or cysts that can be painful to touch. Breakouts often feel like they are in deeper layers of the skin or may show up with lots of non-inflamed closed blackheads. Regardless of how the acne appears, it lasts weeks, does not respond to even the most vigilant over the counter skincare routines and can leave serious scarring.
“If you have severe acne, you have internal inflammation that needs to be treated with medication,” says NDDA bord certified dermatologist Dr. Corinne Erickson who also specializes in contact dermatitis.
Treatment Options for Severe Acne
“Severe acne can definitely be managed with the right medication and a good routine,” says Dr. Erickson. “Accutane is still the gold standard, but not everyone may want to go that route. In those cases, there are many other oral medications that can help us address that underlying inflammation.”
Accutane: How it Works
This is definitely the most aggressive and effective treatment for severe acne, and while it comes with side effects, it’s the closest thing to a cure or at least a longstanding break from acne because it can not only treat the inflammation, but can prevent it from coming back.
“Accutane almost retrains the body to prevent the cycle that severe acne sufferers are trapped in. In a good percentage of patients, it does stop acne and has the best chance to actually halt it long-term,” says Dr. Rubenstein. “Other medications are available and also work, they’re just more temporary.”
Keeping Skin Clear: The Long-term Plan
After the underlying medical problem is addressed with an oral medication, its essential that a patient has an ongoing routine tailored to their own skin type.
“With a topical regimen and addressing the underlying medical needs, you can absolutely maintain clear skin,” says NDDA’s newest board certified dermatologist Dr. Dickson, adding that an experienced physician will tailor that topical and medical treatment to each patient very differently.
“I take into account many different factors when I’m working to develop a plan with a patient. Not everyone can be treated with the same strategy. I take into account the age of the patient, how sensitive their skin is, their lifestyle, what kind of exposure they have to environmental factors like UV radiation, as well as how quickly they want things to get better and even what cost issues they might have that would necessitate a different, but equally effective approach.”
Moderate Acne: What It Is
If you struggle with moderate acne, you may not know it. This is the kind of acne that’s “always there,” but seems like more of a low-level annoyance than an actual problem that can be solved. Most moderate acne sufferers either accept that they have problem skin or spend lots of time, energy and money trying to get their skin under control –sometimes for years.
Moderate acne outbreaks tend to produce red, inflamed pustules or lots of obvious bumps, blackheads and blemishes that feel “deep.” Like severe acne, breakouts can also be painful, but not as inflamed or serious as severe acne. The litmus test here is how stubborn your acne is. If it doesn’t seem to respond to any kind of over the counter treatment, you’ve got a case of moderate acne on your hands.
Treatment Options for Moderate Acne
Just like severe acne, the first stop for moderate acne sufferers should be your dermatologist’s office – to assess the amount of inflammation you’re dealing with. “People should seek help from a dermatologist for moderate and even mild acne because simple regimens actually work, you only have to know what specific challenges you’re dealing with,” says Dr. Rubenstein.
She added that in many cases, the first step is a course of oral antibiotics or other short term medications to get the underlying cause of acne – the inflammation – under control, just like in severe cases.
If fluctuating hormones are contributing to the problem, a hormonal intervention, similar to the birth control pill may be necessary.
After that, says Dr. Rubenstein, moderate acne sufferers should focus on maintenance. “So many times, we think that just because our skin is clear, we’re free of acne, especially if it’s the first time you’ve experienced being acne-free,” she says. “That’s where people mess up. They stop following their treatment plan.”
The best maintenance involves some combination of washing your face twice a day, applying a topical treatment like an antibiotic or anti-inflammatory cream in the morning and for most people, applying a retinoid to keep pores open.
Moderate Acne: The Products
If you’re dealing with moderate acne, now is definitely the time to ditch that DIY skincare routine. “Using the right products as part of a good, appropriate skincare routine can definitely make the biggest difference,” says Dr. Dickson “What works for one person is not going to work for another. The biggest mistake I see is when people are trying to do too many things to their skin. Pare it down, use good quality products and get an outside assessment of what you should be doing.”
She added that washes with alpha hydroxy acids – salicylic, lactic and glycolic acids –can be a good starting point as well as antibacterial products that help decrease the amount or activity of a type of bacteria in the skin that is known to exacerbate acne.
Mild Acne: What It Is
If you’ve got mild acne, you may have some bumps or blackheads, but unlike the other two types of acne, they’re not widespread or inflamed. In fact, mild acne is usually classified by what you don’t see. You won’t get nodules or cysts because you don’t get the deep-seated blemishes that people with moderate or severe cases experience. And sometimes, you may not even recognize mild acne because it can show up as non-inflamed skin-colored bumpiness called comedonal acne.
Treatment Options for Mild Acne
Mild acne responds best to a rigorous skincare routine – something everyone should have. Many “three-step-systems” and other over the counter products for acne prone skin may work for mild cases. However, you may want to try some of the skin care lines offered by dermatology offices such as SkinCeuticals, which include higher quality formulations, says aesthetician Joni Thomas. (NDDA is a SkinCeuticals flagship).
Also, remember that when the over the counter products stop working, you have sensitive skin or suddenly your normal routine isn’t working to keep you clear, it’s time to see your dermatologist.
“Mild acne is more about maintaining the right routine and being consistent, than it is about intervention,” says Thomas. “Lots of times, patients come in and they haven’t done anything, but sometimes they’ve tried everything and they’re just not getting the results they want.”
That’s where prescription-grade products and treatments with an aesthetician can help the most. “Most physicians can get you higher quality, stronger products (than what’s available over the counter) and whether you’ve tried everything, or nothing, using the right regimen for your skin makes the biggest difference.
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