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How to treat moderate to severe acne.

This is how to get your moderate/severe acne under control.
Not sure what kind of acne you have and how best to treat it? Read this first.
Read on for a thorough(!) guide.
This is going to be slightly different to my post about Minimal to Mild acne because when you have Moderate to Severe acne, the most effective products available to you will be the ones prescribed by doctors or dermatologists. There are a couple of over-the-counter options available for you to try before seeing a doctor and i’ll list those below. I’ll also offer a few tips and suggestions for those using Accutane right at the end.
Remember that with any stonger anti-acne routine, your skin may get a little worse before it gets better. This is called ‘purging’ and occurs when your acne treatment pushes out all the acne embedded deep within your skin. This process should last a maximum of 2 weeks. If you’re experiencing increased breakouts any longer than that you should ditch whatever you’re using and try something else.
As with any routine, i’ll start with the framework in Skincare 101.
AM
Cleanse
Treat
Moisturise

PM
Cleanse
Treat
Moisturise

WEEKLY (optional)
Mask/Scrub/Spot Treatment

Now we’re going to go through each category and find products to fit each of the above slots.
On to recommendations!
Cleansers

Since you’ll be using some rather harsh treatments for your face, it’s good to start off with a gentle cleanser.
From left to right…
  • Cetaphil/CeraVe Cleanser – See a dermatologist about acne and these are the cleansers they’re likely to recommend right off the bat – and for good reason! They clean skin thoroughly without aggravating acne or making it worse.
  • Acne.org Cleanser – Again, this is another gentle yet thorough cleanser – can’t really go wrong with it!
  • Neutrogena Oil-Free Acne Wash – This really gets your face clean, great if you wear sunscreen during the day and need a quick way to get it off at night. Problem is that it’s also quite drying so I’d only recommend this if you have oily skin.
  • Mario Badescu Acne Cleanser – Soothing, non drying and it contains an acne treatment that’ll get rid of mild clogs as you wash. It’s not going to cure your acne but it’ll leave your skin really clean. I like this one.
  • DDF Blemish Foaming Cleanser – This is a great foaming cleanser. Wash your face for at least a minute to get the full benefits from this AHA/BHA combo cleanser – it’ll help to calm down blemishes as well as brighten up your complexion.
  • St Ives Green Tea Cleanser – A great drugstore treatment cleanser, nice gentle formula and a bit of salicylic acid in there to help to calm down blemishes.


Treatments

Next up, treatments. This is where you’ll be doing most of your acne-fighting. Treatments  provide your skin with a concentrated shot of acne-fighting goodness – with as little fillers and useless stuff as possible. There are three main types of treatments you can use to fight acne, BHAs, Benzoyl Peroxide and Retinoids. The fourth is Accutane which we’ll come to a little later.
BHAs (Beta Hydroxy Acids) are gentle on the skin but pack a very powerful acne-fighting punch at higher concentrations – they also have the added benefit of soothing razor burn and preventing ingrown hairs! These are great to use during the day when you can’t use your stronger acne treatments due to sun sensitivity.
Since you have moderate or severe acne, it’s wise to incorporate a retinoid or Benzoyl Peroxide product at night and a BHA product during the day. Benzoyl Peroxide destroys the acne bacteria and is well known for its acne fighting abilities. Retinoids are a stronger option and (save for one product that i’ll mention) can only be obtained with a prescription from a doctor or dermatologist. In terms of efficacy, both are very effective in treating acne. There are lots of different Benzoyl Peroxide and retinoid products out there, it’s up to you and perhaphs your doctor to find the one that works best for you.
If you want to try and handle your acne by yourself and without the help of a dermatologist, I recommend starting by using either the Acne.org benxoyl peroxide product or Avene Diacneal retinoid as your treatment. Try it out for a few weeks to see if it works and if it does, great! If it doesn’t, switch over to retinoids if you tried the benzoyl peroxide product and vice versa. If this still doesn’t work for you, it’s time to go to a dermatologist.

On to recommendations!
BHA Products – to use during the day underneath your moisturiser.

From left to right…
  • Paula’s Choice 2% BHA Liquid – I recommend this stuff so often I feel like Paula’s Choice should be paying me a monthly wage. Unfortunately they aren’t but i’m still going to plug this amazing stuff. This is a highly effective treatment for pimples and blackheads and I use it myself to keep them well away. The great thing about this is that it’s a liquid so it’s not heavy at all – just apply it with your hands or a cotton pad and you’re good to go. There’s also a slightly moisturising Lotion version if you have dry skin and 1% options if you have sensitive skin.
  • Mario Badescu Anti-Acne Serum – It’s simple and a milder option that’s great if you have sensitive skin.
  • Skinceuticals Blemish Control Gel – A highly effective, milder option – this is very slightly moisturising too, perfect if your treatments leave your skin a bit dry and flaky.
  • Stridex/Clearasil/Neutrogena – All these brands make really good BHA products. Stridex makes acne clearing pads (in a red box) with a 2% BHA solution that you just swipe on and Clearasil Ultra also makes a similar product. As for Neutrogena, they have toners in their Acne ranges that’re all great for the price.
Benzoyl Peroxide/Retinoids – to use at night.

Most of the time I like to give you as many options as possible but there’s only one product in each category (barring, of course, retinoids you can get from your doctor) that I can wholeheartedly recommend to you guys.
  • Acne.org  2.5% Benzoyl Peroxide – This is pretty much the gold standard when it comes to topical benzoyl peroxide treatments. This acne.org product is a light, clear gel with  2.5% benzoyl peroxide and nothing else that could potentially make your acne worse. There are lots of products out there with a higher concentration of benzoyl peroxide (lots of drugstore brands come to mind) but I think concentrations that high are very damaging to skin and not that much different in terms of how effective they are. So yeah, if you have mild acne – give this stuff a shot. I recommend using this only at night and using a BHA product during the day since this stuff makes skin more sensitive to sunlight. If your acne isn’t too bad, you may only need to use this 3 or 4 times a week and then use a regular moisturiser on the other days.
  • Avene Diacneal – The only retinoid product you can buy without prescription that’s worth buying – that’s thanks to a special form of retinol used at a good concentration. The addition of 6% glycolic acid helps the retinol to penetrate deeper and also helps to fade acne scars. This is a personal favourite of mine and I have a full review here. This is a nice retinoid product but still nowhere near the strength you’ll find in the retinoids available through prescription. Just ask your doctor or dermatologist about them for more information!
Moisturisers

After treating your skin comes moisturising! Acne treatments tend to be pretty harsh on the skin which can lead to some pretty unattractive flaky patches on your skin. Even if your skin is oily, it’s good to use a light moisturiser just to balance out your oil production. When you’re using your benzoyl peroxide or retinoid product at night, it’s a good idea to wait about half an hour to an hour before moisturising so that the treatment has time to really sink into your skin.
Sunscreen
Firstly, you should be using a moisturiser with sun protection in it during the day. This helps because products like Benzoyl Peroxide and Retinoids make your skin more sensitive to burning in the sun. Besides, sun exposure will cause your acne scars to become darker – the only way to fade them is by using a sunscreen. I highly recommend these ones if you’re acne prone:
From left to right…
  • Olay Complete Sensitive SPF15 – This is a well-loved moisuturiser amongst those with acne. Not the best sun protection but it’s still decent and best of all it shouldn’t break you out.
  • DDF Ultra-Lite Oil-Free Moisturizing Dew – This is a great moisturiser with SPF, again it doesn’t have amazing ingredients but it’s an excellent option if you have acne prone skin. It moisturises but it’s lightweight and very comforting on the skin.
  • Elta MD UV Clear – Great sun protection and it’s specifically formulated for people with acne. It’s light and it contains the acne-fighting ingredient Niacinamide in a large enough concentration to be effective.
  • Japanese sunscreens – Japanese sunscreens in general tend not to aggravate acne prone skin, probably because they’re very very light and don’t contain a tonne of chemical filters. Despite that they offer fantastic sun protection and a finish that’ll stay matte all day. Click here for my top 5 recommendations and information on how to buy them. If you can’t order online, try the Shiseido Sun Protection Lotion which is available in-store internationally.
  • Another option that I haven’t pictured is the Peter Thomas Roth Mineral Sunscreen SPF30 – This is a powdered sunscreen that you simply brush onto your skin over your regular moisturiser. The sun protection isn’t great at all (since you need to apply a crapload to get the labelled SPF) but it’s a fantastic option for those whose skin just doesn’t agree with sun protection. Also great to carry around and powder away shine whilst bumping up your sun protection.

Moisturisers
You need to have a regular moisturiser to use at night over your treatment to ensure your skin doesn’t dry out. If you’re using Benzoyl Peroxide or Retinoids, go for a simple moisturiser as a treatment one will just overload your skin with acne medication and probably make the problem a lot worse.
Acne treatments work better with no moisturisers applied over them but this can be far too harsh for most skin types. A good mid-point is to only moisturise the dry patches on your face and leave the other bits alone. As with anything related to skin, trial and error is your best friend. Try not using moisturiser, using it all over and using it only on dry bits to figure out what works best for you.
Here are my top picks, a few of which feature in my ‘Simple moisturisers for acne-prone skin’ post.

From left to right…

  • Cetaphil/CeraVe/Acne.Org Moisturiser – These are all quite light and well known for being acne-friendly. Not much to say apart from the fact that they shouldn’t break you out and they’ll leave your skin feeling nice and smooth.
  • La Roche Posay Toleraine – This is a great moisturiser if you have  drier skin, La Roche Posay is known for its very gentle skin-friendly products. One of the most recommended product lines by dermatologists here in Europe and available at most drugstores.
  • Korres Yoghurt – The Korres Yoghurt Cream is an intreresting moisturiser. It looks creamy but it’s actually quite light and refreshing. This is particularly good if you feel as though your skin feels dry even though it looks oily. Love this one.
  • Clinique DD Line – The entire Clinique Dramatically Different line of moisturisers are great staples for acne-prone skin. Best thing is that they have different formulas for different skin types; a cream for dry skin, a gel for oily skin and a lotion for those in between!
  • Jojoba Oil – If you have oily skin, moisturising with an oil may be the last thing you want to do but Jojoba Oil in particular is an amazingly effective moisturiser for any skin type. Just splash a  few drops into your hand (or into another moisturiser if you have dry skin) and massage into your face. The oil absorbs instantly and leaves your skin feeling fresh, moisturised and not oily at all. This has become a cult fave amongst acne sufferers and you can grab a bottle at any health store.
  • CeraVe PMI reviewed this product here and I still stand by my claims that this is a fantastic light moisturiser for acne prone skin. Especially good if your skin tends to look a little bit red thanks to your retinoid.
So that’s more or less the products you’re going to need. Next up are some treatments you can use weekly just to boost your routine a bit.

Weekly Treatments

Every week you can use a face mask to help calm down and dry out your acne. You can apply these all over your face or simply apply the mask to the areas with acne. My two favourites are the DDF Sulfur Therapeautic Mask and the Queen Helene Mint Julep Mask.
It’s also a good idea to exfoliate your skin once a week to prevent the build up of dead skin cells, especially the dry flakes a retinoid or benzoyl peroxide can create. Good scrubs are plentiful, just avoid anything that contains grains of walnut shell or other ‘natural’ products – they can be tough on the skin.
Since you’re using harsh products like retinoids and benzoyl peroxide, you might want to try something that isn’t too grainy – look for face scrubs made for sensitive skin. My favourite scrubs for this purpose are the Dermalogica Daily Microfoliant (this one’s very gentle), the Clinique 7 Day Scrub (again gentle, only use this once a week though!), the Shiseido face brush (used gently) and finally a good old washcloth (as long as you keep it clean and dry between uses).

If you have a particularly large spot pop up and you want to heal it as quickly as possible, it’s a good idea to apply a spot treatment product at night. Read this post for my recommendations.

_____________________________________________
So that’s it! A complete guide to building your own skincare routine for moderate to severe acne.
Once you’ve chosen what you think would work best for you out of the categories above, you can then slot them back into the routine I posted right at the beginning.
Here’s one that i’ve made from chosing products listed above.
AM
Cleanse – Cetaphil Cleanser
Treat – Paula’s Choice 2% BHA Liquid
Moisturise – Elta MD UV Clear
PM
Cleanse – Cetaphil Cleanser
Treat – Precription Retinoid (for example, Tazorac)
Moisturise – Cetaphil Lotion

Simple, right? For most people, this is where you finish. However, there’s more for people that have severe acne so read on if you do!

_____________________________________________
Now for some, all of these products may decrease the acne slightly but won’t get rid of the majority. If you’ve tried benzoyl peroxide and retinoids (both the ones you can buy in shops and doctor-prescribed ones) to no effect, there are a couple more options for you.
Other Options (Antibiotics and Accutane Tips).

Now, on to two other options. If your acne seems to be unresponsive to topical treatments (gels, lotions etc) then there are two other options you can take. Firstly is a course of antibiotics, an appointment with a doctor will sort that out for you. These can be highly effective for some, and not effective at all for others. There’s only one way to tell!
Secondly, if your acne is severe and unresponsive to any other treatment, you can ask your doctor or dermatologist about going on a course of Accutane. I discussed potential risks in this post and a quick google search will reveal the rest. Going on a course of Accutane is a decision not to be taken lightly but it’s fantastic success rate makes it something worth considering if your acne is really bad. If you’re on Accutane, you won’t really have to use any other acne fighting skincare but your doctor will clue you in to all of that. Here are some general tips for you if you’re taking Accutane:
  • Try to use a high SPF as it makes you sensitive to the sun.
  • Buy some eye drops, one common side effect is dry eyes.
  • You’re doing to have some insanely dry skin while you’re on Accutane, keep some Aquaphor in your car, your pockets, your bathroom, your bedroom…
  • Keep the rest of your skincare nice and simple. Use simple moisturisers and cleansers like the ones listed in this post.
_____________________________________________
Hope that was helpful, if you have had any successes or failures with products please leave a comment or send me an email and i’ll add it to a future post. Thanks for reading!

Useful Posts:
Acne scars – how to treat them.
How to treat minimal to mild acne.
Acne homepage.
 

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Comments (8)

  1. Rick Tuesday - 10 / 08 / 2010 Reply
    I've been looking into Avene Diacneal but it seems there is more than 1 version of it. I've seen a lotion one and a cream one, also one that has green/white packaging instead of the pic you have in your post. Which is the one you would recommend?
    • TommyGNL Friday - 22 / 04 / 2011 Reply
      I'm a male in my mid 30s, I had blotchy skin, enlarged pores, acne around my face. =) I sometimes have no acne, but lately it seems the breakouts have gotten worse and they are getting more frequent. I just wanted a clear face! After a month of washing with the Shielo Anti-Aging Scrub every night, my pores have gotten smaller and my overall skin appearance has improved. I would say, my skin appears less dull. I'm happy that my over all skin appearance has improved ... and I know that as I keep using his, it will get even better.
  2. Michael Williams Monday - 18 / 10 / 2010 Reply
    I cannot tell you how much I appreciate this.
  3. Charles Thursday - 09 / 12 / 2010 Reply
    Wonderfully informative post! How do you feel about other products in the Paula's Choice line such as her cleansers and acne treatment gel (2.5% BP)?
  4. Clora Gautsch Monday - 19 / 12 / 2011 Reply
    I have been using proactive for a long time here but it seems that i isnt workin at all. Does anyone know of something else that may be of help to my skin?

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  1. A complete guide to treating your acne: from ‘Minimal’ to ‘Severe’. | Male Grooming | Skincare Blog SCforM: Skin Care for Men - August 8, 2010

    […] Acne, How Tos | 08. Jun, 2010 by admin | 2 Comments This is my complete guide to acne treatment options in a series of 3 posts, this one will help you to identify what kind of acne you have and the other two (linked in this post) will suggest products and help you to build a routine for your type of acne. From minor breakouts to full-blown cystic acne, most people suffer from some form of acne at one point or another. Acne can be a pretty tough thing to deal with, especially when companies take advantage of this fact by throwing wave after wave of useless products out there to compete with the ones that actually work. The great thing is that acne, for the most part, is totally treatable. Now i’m going to preface this by saying that obviously all skin is different so the advice I post here may not be entirely applicable to you or the products may not work well for you. The aim of this guide is show you what to look for in your skincare if you’re trying to sort of your acne and I’ve thrown out a couple of suggestions along the way. As with all skincare, finding products that work is a pretty hit and miss process. All I can do is help you to hopefully score more hits with your purchases than misses! Let’s get started! Firstly, if you already know which type of acne you have you can skip this and go right into building a skin care routine for yourself. Click here if you have minimal to mild acne. Click here if you have moderate to severe acne. […]

  2. How to treat minimal to mild acne. | Male Grooming | Skincare Blog SCforM: Skin Care for Men - August 8, 2010

    […] add it to a future post. Thanks for reading! Useful Posts: Acne scars – how to treat them. How to treat moderate to severe acne. Acne […]

  3. Therapeautic mask | Alleycats - June 1, 2011

    […] How to treat moderate to severe acne. | Male Grooming | SkincareEvery week you can use a face mask to help calm down and dry out your acne. You can apply these all over your face or simply apply the mask to the areas with acne. My two favourites are the DDF Sulfur Therapeautic Mask and the Queen Helene Mint Julep Mask. […]

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How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.
How to treat moderate to severe acne.

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