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If you have been struggling with light to moderate acne for many years, it can be tempting to try out several facial treatments and skin products with acne-fighting ingredients that are proven to manage skin breakouts. However, if you have not seen improvements after a few years, there might be a chance that you are not taking the right products to treat your type of skin and acne. Whether you’re just starting out on an acne- treatment regimen for the first time or you’re a longtime user, knowing what specific ingredients do in your most products can be beneficial.

John J. Russel underlines the importance of recognizing the right type of acne that the patient is dealing with, thus taking the right anti-inflammatory products to eliminate skin breakouts (Am Fam Physician. 2000;61(2):357-365). The doctor has created a scheme, to report the four most common lesion types:

  1. Comedonal acne

It is caused by an excess of sebum production, combined with increased cells on the surface of the skin (epithelial cells), leading to the formation of microcomedones, which can progress to open comedones, commonly termed “blackheads,” or to closed comedones (“whiteheads”).

2. Inflammatory papule and pustule in acne

The combination of sebum and desquamated cells provides an environment that is suitable for the growth of Propionibacterium acnes, the principal organism in inflammatory acne lesions. The proliferation of P. acnes leads to the conversion of sebum to free fatty acids, which are irritating and stimulate the immune response, leading to the development of inflammatory lesions.

3. Nodular cystic acne

This is the most severe type of acne. For this skin condition, it is necessary a systematic therapy according to the patient’s situation

Now that the most common acne types have been explained, let’s talk about their specific treatments.


Topical therapy is the first care for mild to moderate acne. Retinoids and antimicrobials such as benzoyl peroxide and antibiotics are the pillars of topical acne therapy. The main side effect is local irritation. Gels, pledgets (medication-soaked pads), washes and solutions tend to be drying and are helpful for oily skin. Lotions, creams and pomades are beneficial for dry, easily irritated skin. Most topical preparations require at least six to eight weeks before an improvement is seen; they may be used for years as needed. (John Kraft and Anatoli Freiman, 2011).

This is a selection of the most common chemical ingredients found in skin care products to fight mild to moderate acne:

Azelaic Acid

This agent has antibacterial activity, and it appears to be as effective as benzoyl peroxide or tretinoin (Retin-A) in the treatment of mild to moderate acne inflammatory acne. Azelaic acid is available as a 20 percent cream (Azelex), which is applied twice daily to a clean, dry affected area. Because azelaic acid decreases pigmentation, it should be used with caution in patients with darker complexions.

Benzoyl Peroxide

This agent has bactericidal and comedolytic properties. It is the topical agent most effective against P. acnes. This agent comes in water-based or alcohol-based gels. The water-based formulations are less drying than the alcohol-based preparations. Benzoyl peroxide gels are applied once or twice daily. Skin irritation is the most common side effect of benzoyl peroxide.


Look to retinol to improve acne and scars caused by acne, along with your skin’s hydration levels. Retinol is derived from vitamin A and is found in many over-the-counter “anti-aging” skin care products. Tretinoin, which is the active ingredient in prescription Retin-A® and Renova® creams, is a stronger version of retinol. If your skin is too sensitive to use Retin-A, over-the-counter retinol is an excellent alternative.

“Vitamin A has a molecular structure that’s tiny enough to get into the lower layers of your skin, where it finds and boosts collagen and elastin, which is a protein that strengthens your skin’s flexibility” explains Dr. Bergfeld (

These are the first steps to recognizing your acne condition, thus taking action in the right direction. A professional consultation with your physician or with a dermatologist is recommended.