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Moderate to Severe Acne: A Treatment Guide

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Acne, the most common skin disorder in the U.S., has an impact that goes more than skin deep. It affects 40 to 50 million Americans and is associated with anxiety, depression, and higher unemployment rates. However, moderate to severe acne can be controlled and managed with the proper treatment.

Whether this is your first time dealing with acne or skin problems, or you've had flare-ups in the past, you will want to work closely with your dermatologist or doctor to come up with a treatment plan to get your acne under control. Know that you have options for creating a healthy skin care regimen that works for you.

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What Causes Acne?

Acne is a skin disease that's often misunderstood. Some people believe that it's contagious or is caused by dirt; both of these allegations are untrue. There are a number of factors, like stress, that can contribute to acne. Hormonal changes can contribute to acne, so women may be more susceptible during pregnancy and menopause.

If people don't understand what's causing of acne, they won't understand treatment, says John E. Wolf Jr., MD, professor and chairman of the department of dermatology at Baylor College of Medicine in Houston.

He likes to use a simple diagram to illustrate the process. First, oil glands produce oil. Then pores get plugged up with a combination of oil, bacteria, and dead skin cells. This results in acne.

"The critical part of treating all forms of acne -- mild, moderate and severe -- is to eliminate microcomedones, the obstruction before you can actually see a whitehead or blackhead," he says.

Determine Your Treatment Plan

The severity of acne is determined by the scope and type of lesions. Moderate acne is characterized by inflammatory (papules, pustules, nodules) and noninflammatory (comedones) lesions. Severe acne consists of numerous or extensive papules and pustules, as well as many nodules/cysts.  

Moderate to severe acne, which often warrants a more aggressive treatment than mild acne, is usually approached with a combination of topical treatments and oral antibiotics.   

Wolf explains that he prescribes two medications, "one to unplug the pore and one to kill the bacteria."

Your doctor may put you on a two to greater than six-month course of oral antibiotics, such as doxycycline, minocycline, tetracycline, or erythromycin. Antibiotics in the tetracycline class are frequently used because they have both antibacterial and anti-inflammatory properties. The use of benzoyl peroxide with topical or oral antibiotics decreases the emergence of antibiotic-resistant bacteria.   

Topical retinoids may be used to supplement this treatment. You can see an initial flare-up at the two to three-week mark, says D'Anne Kleinsmith, MD, a dermatologist in private practice in West Bloomfield, Mich., and a spokeswoman for the American Academy of Dermatology. This flare-up is generally attributed to the opening up of pores and drainage of sebaceous contents.

It's important that you follow instructions for prescribed medications carefully. For example, tetracycline should be taken before meals and without milk for full efficacy. Tell your doctor about other medications you are taking because certain medications can aggravate acne and interact with prescribed drugs.

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