Grade 3 or Papulopustular Acne
Moderate Acne: Grade 3 or Papulopustular Acne

Moderate acne is a transition state between the non-inflammatory and inflammatory pimples. Skin colored bumps (papules) and comedones predominate in moderate acne, also called grade 2 acne. A moderate amount of pustules (pus filled bumps) is also seen in some patients.

Is it Necessary to Treat Moderate Acne?

The aim of treating acne is to reduce and clear the unsightly bumps thus preventing scarring. Being non-inflammatory acne, expert advice should be sought and treatment started in moderate acne without delay. Remember early, appropriate treatment drastically reduces the chances of acne scar formation.

How is Moderate Acne Treated?

Treatment of moderate acne involves general measures and specific measures. General measures are similar to all other types of acne and involve advice on avoiding the acne triggers, skin care and observing healthy dietary and life styles.

Specific measures in the treatment of moderate acne involve use of topical antiacne medications.

  1. Topical retinoids are the first line of therapy for moderate acne where comedones predominate. Treatment is started with tretinoin or isotretinoin applied sparingly at night. Adapalene or tazarotene are alternative retinoids that may be used.
  2. For papule and pustule predominant moderate acne, a topical antibacterial solution is also added. Clindamycin and erythromycin are the usual topicals used in acne. Azelaic acid is a useful alternative, especially in the healing stages, when mild pigmentary changes are prominent.
  3. If the number of pustules are more, and there is sign of deeper inflammation, an oral antibiotic like doxycycline or azithromycin.
  4. In those with pustule predominant moderate acne, benzoyl peroxide is the second line of treatment, along with either topical retinoids or antibiotics.
  5. Retinoids and benzoyl peroxide are applied at night only, as these can sensitize your skin to sunlight, especially the retinoids.

Some may experience a flare up in the first 2-3 weeks of starting the topical treatment. This is a good sign and there is no need to stop medication, though concentration and frequency may be reduced till the inflammatory blowout is controlled.

 How Long Should Moderate Acne be Treated?

Duration of treatment of acne varies from individual to individual and the type, severity and extent of the zits. In general, treatment should be continued till 6-8 weeks after the acne bumps subside completely and there is no fresh outbreak. A maintenance application with topical retinoids should continue weekly twice or thrice for a few months to years, depending upon previous history of recurrences and the life style of the acne sufferer. Regular treatment will have to be re-instituted, should there be any recurrence.

Treatment of moderate acne involves avoidance of acne triggers , a combination treatment with topical anti-acne medications and following tips on how to prevent acne recurrences.

Published by Dr Hanish Babu, MD on 28th May, 2018

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD


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