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Moderate Acne

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Moderate acne is the stage of acne vulgaris between mild and severe acne. It is the turning point in the progression of acne. When properly treated at this stage, extensive and permanent damage to skin can be prevented. Find out how to stop moderate acne from progressing to severe acne.

Acne vulgaris is a common skin disease that first appears during puberty. Although it has no cure, acne can be well controlled until it clears off. For most people, acne resolves during their twenties. However, some people do experience acne well into their adulthood.

While there are many ways to classify acne, the simplest classification is by severity. Therefore, moderate acne is the stage of acne progression between mild acne and severe acne.

Because moderate acne lies between mild and severe acne, it is the phase of the skin disease where treatment must be intensified. When properly treated, moderate acne can be arrested before it causes the permanent scarring experienced with severe acne.

The transition from mild to moderate acne may not be clear cut but careful attention and consultation with a dermatologist can confirm moderate acne.

Moderate acne can affect teenagers and adults alike.

Causes of Moderate Acne

Moderate acne is caused by all the factors that cause mild acne.

Since it is a progression of mild acne, moderate acne can result from diet, stress, increased production of growth hormones and extensive colonization of the skin by acne-causing bacteria.

Moderate acne can also be hereditary. In some families, the severity of acne breakout is an inherited trait. Therefore, the presentations of moderate acne may affect multiple members of the family.

Psychological stress, and emotional stress in particular, may also worsen a case of mild acne and turn it quickly into moderate acne.

During stress, the composition of the sebum produced by the sebaceous glands changes. Studies have found that stress causes an increase in free fatty acids in sebum. These free fatty acids are directly responsible for the increase in inflammatory acne lesions experienced during moderate acne.

Diet can also cause moderate acne. The foods that have been identified to worsen acne include milk and dairy products as well as foods with high glycemic loads such as sugary drinks and snacks.

Eating more of these foods can easily turn a mild case of acne into moderate acne.

Acne breaks out during puberty mainly because of the hormonal changes that is sweeping through the body. To fuel this growth phase, adolescents are flooded with hormones such as androgens and insulin-like growth factor-1 (IGF-1).

Although androgens such as testosterone and its analogs (especially DHT or dihydrotestosterone) are male sex hormones, they are also released in females (but in smaller amounts).

Testosterone, DHT and IGF-1 change the nature of the sebaceous follicles. They cause the enlargement of the sebaceous glands and they stimulate excessive production of sebum.

Therefore, increased hormonal levels can quickly turn mild acne into moderate acne by causing an increase in the secretion of sebum. When excess sebum is produced, it mixes with dead skin cells and bacteria to clog the skin pores as it rises to the surface.

The excess sebum that gets to the skin surface is the ideal growth environment for acne-causing bacteria. This increases the population of these bacteria that grows on the skin.

Acne-causing bacteria such as Propionibacterium acnes release toxins on the skin.

To prevent the damage caused to the dermis by these toxins, the body recruits the cells of the immune system for repairs. These cells then cause the skin inflammation that arises during moderate acne. Because the bacteria are continuously aggravating the dermis, they set off an abnormal cycle of inflammation that can turn moderate acne into severe acne if left untreated.

Features of Moderate Acne

Moderate acne is a progression of mild acne; therefore, acne lesions appear in greater numbers and in more varieties. In moderate acne, these lesions can cover between ¼ and ¾ of the face and any other body part affected.

While mild acne is mostly restricted to the face, moderate acne can spread to the neck, upper part of the chest and the back.

There are a lot of comedones at this stage of acne. These include whiteheads and blackheads.

However, it is inflammatory acne lesions such as papules and pustules that define moderate acne. These lesions appear as red, inflamed bumps on the skin. Some of them will even get larger and more painful to form a few acne nodules.

Furthermore, dark spots appear in increasing numbers during moderate acne and the first signs of acne scars start to show too.

Summary of the Lesions of Moderate Acne

Whiteheads – Whiteheads are also called closed comedones or pimples. They are formed from completely blocked pores that trap in a mixture of sebum, dead skin cells and bacteria. Whiteheads appear as white specks on the skin and they can be easily popped.

Blackheads – Blackheads are also known as open comedones. They are formed from the partial blockage of pores which are filled with sebum, dead skin cells and bacteria.

Because blackheads are partially blocked, the sebum inside the pores oxidizes in air and turns hard and black. The contents of the pores are also given their dark color by the skin pigment, melanin, which mixes with them.  Blackheads are more stable than whiteheads and they are more difficult to eliminate.

Papules – Papules are inflamed, red, tender, small bumps on the skin. They have no heads and should not be popped. These inflammatory acne lesions can easily turn into the more severe nodules if aggravated.

Pustules – Pustules are similar to papules except they are filled with pus and they have whitish or yellowish head with red borders. They are commonly referred to as zits and can be carefully popped.

Topical Products for Moderate Acne

Moderate acne requires aggressive treatment to stop its quick progression to severe acne. It usually requires treatment with more than one anti-acne agent and that is why combination products are used at this stage.

There are over-the-counter (OTC) topical acne products that combine different anti-acne active ingredients, and there are also natural topical products that combine effective herbal extracts to treat moderate acne.

Some of the topical agents used in treating moderate acne are discussed below.

Benzoyl peroxideBenzoyl peroxide is a common ingredient of OTC acne products. As a peroxide, it is quick to break down the acne-causing bacteria on the skin as well as exfoliate the skin itself to remove dead skin cells. It is an effective first-line treatment.

Topical antibiotics – Topical antibiotics include clindamycin and erythromycin solutions. They are useful for killing off the acne-causing bacteria on the skin.

However, antibiotic resistance may develop to these antibiotics. To reduce the risk of treatment failure due to such resistance, topical antibiotics are commonly combined with other topical agents such as benzoyl peroxide.

Topical retinoids – Retinoids are synthetic vitamin A analogs and make a family of powerful anti-acne medications. Topical retinoids such as Adapalene are routinely used to treat moderate acne. They do not produce the serious systemic side effects associated with oral retinoids.

Here are a few skincare advices to use along in order to improve the efficacies of these topical agents.

  • Only use mild cleansers to wash your skin and wipe with clean, gentle, soft wash cloths. These are to prevent your skincare products from directly irritating your skin and acne lesions
  • Avoid picking or popping the acne lesions on your skin. Doing this will only aggravate these lesions and cause secondary infections and scarring.
  • Use an oil-free moisturizer if your OTC acne cream or lotion causes skin dryness. Also use sunscreens especially if the active ingredients in your topical acne products are noted to increase the sensitivity of the skin to sunlight.

Oral Medications for Moderate Acne

There are 4 types of oral medications indicated for treating moderate acne.

First, there are oral antibiotics. These are usually tetracycline antibiotics although erythromycin is also a common choice. Tetracycline antibiotics are broad-spectrum antibiotics that can kill off acne-causing bacteria as long as the bacteria are not resistant to their antibacterial activities.

Secondly, there are oral contraceptives specifically those containing estrogens and progestins.

Anti-androgens such as spironolactone can also be used to treat moderate acne. Oral contraceptives and anti-androgens work by reducing the amount of androgens secreted in the body or by blocking the effect of these androgens on the sebaceous glands.

These agents are generally very effective. However, when they fail, isotretinoin or Accutane may be prescribed. Accutane causes some very serious side effects and should only be used under the supervision and care of a dermatologist.

Lastly, there are oral, natural acne remedies such as Actimine.

These natural remedies pack proven anti-acne supplements such as vitamins, minerals, herbal extracts and other nature-sourced active ingredients. By using a combination of different anti-acne remedies, they provide a broader spectrum of activity and are capable of treating moderate acne by different mechanisms.

Besides the synergistic effect produced by active ingredients of acne supplements such as Actimine, these natural products produce far less side effects than conventional medications and they are a lot of people who have successfully treated moderate acne with them.





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