What acne is
Acne is a common skin condition that causes blackheads, whiteheads, red pimples and sometimes deep, painful lumps. It appears mostly on the face, forehead, chest, shoulders and upper back, where the skin has the most oil glands. Almost all teenagers get some acne, and many adults, especially women, continue to have it into their twenties, thirties and beyond.
Acne is not caused by dirty skin and it is not contagious. It can, however, affect confidence and mood, and severe acne can leave scars and dark marks that last. Treating it early is the best way to protect your skin.
What causes pimples
Each hair follicle has a small oil gland. During puberty, hormones called androgens make these glands produce more oil. The oil mixes with dead skin cells and blocks the opening of the follicle, forming a blackhead or whitehead. Bacteria that normally live on the skin then grow inside the blocked follicle and cause red, swollen pimples.
- Hormone changes in teenage years, around periods and in pregnancy
- Polycystic ovary syndrome (PCOS) in women
- Heavy, oily creams, hair oils that run onto the forehead and some make-up
- Some medicines, such as steroids
- Squeezing and picking pimples
- Family history of acne
Types and severity
Doctors grade acne to decide on treatment. Mild acne has mainly blackheads and whiteheads with a few small pimples. Moderate acne has more red pimples and pus-filled spots. Severe acne has deep, painful lumps and cysts under the skin, which are most likely to leave scars.
In people with darker Indian skin tones, even mild pimples often leave dark brown patches after they heal. These marks usually fade slowly over months, but true scars that are pitted or raised are permanent without procedures. This is one more reason to treat acne early.
Treatment options for acne and pimples
Mild acne is usually treated with creams or gels applied to the whole affected area, not just on spots. Common choices are benzoyl peroxide, retinoids such as adapalene, and azelaic acid. They take six to eight weeks to show results, and mild dryness or redness at the start is common. Using them regularly matters more than using a lot.
For moderate to severe acne, a doctor may add antibiotic creams or tablets, hormonal treatment for women, or isotretinoin for severe or scarring acne. Antibiotics and isotretinoin are given only on a doctor's prescription. Isotretinoin and retinoids must not be used in pregnancy, as they can harm the baby.
Daily skin care
Good habits help treatments work better and reduce irritation and dryness. Choose products labelled non-comedogenic or oil-free, and introduce one new product at a time so you can tell what suits your skin. Be patient and gentle; harsh routines usually make acne and dark marks worse, not better.
- Wash your face twice a day with a mild cleanser and lukewarm water
- Do not scrub hard or use harsh soaps; they worsen irritation
- Never squeeze, pick or pop pimples
- Use a light, oil-free moisturiser and sunscreen every day
- Keep hair oil away from the forehead and wash pillowcases often
- Eat a balanced diet; some people notice that sugary foods or milk worsen acne
Myths to avoid
Applying toothpaste, lemon, garlic or undiluted home mixtures can burn the skin and leave darker marks. Steroid creams, sometimes sold as fairness or quick-fix creams, can cause acne and thin, damaged skin, so never use them on your face unless a doctor has prescribed them. Acne is also not a sign of poor hygiene or a sexual problem.
Another common myth is that acne must simply be waited out until it goes away with age. In reality, leaving moderate or severe acne untreated for years is the main reason people are left with permanent scars. Blood purifier tonics and strict diets are not proven treatments, so rely on tested medicines advised by a doctor.
When to see a doctor for acne and pimples
See a doctor or dermatologist if acne is painful, deep or leaving scars, if it has not improved after two to three months of regular over-the-counter treatment, or if it affects your mood. Women with acne plus irregular periods or excess facial hair should be checked for PCOS. A doctor or pharmacist can help you choose the right products and treatment.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Benzoyl peroxide gel or washKills acne-causing bacteria and helps unblock pores.Follow the label or your pharmacist's advice; it can bleach clothes and towels.
- Topical retinoids such as adapaleneUnblock pores and prevent new blackheads and pimples.Avoid in pregnancy; use sunscreen as the skin may become sensitive.
- Topical antibiotics such as clindamycinReduce bacteria and redness in inflamed pimples.Only on a doctor's prescription, and usually combined with benzoyl peroxide by the doctor to prevent resistance.
- Oral antibiotics such as doxycyclineTreat moderate to severe inflamed acne from within.Only on a doctor's prescription; not for pregnant women or young children.
- IsotretinoinStrongly reduces oil production for severe or scarring acne.Only on a dermatologist's prescription with monitoring; must never be taken in pregnancy.
See a doctor urgently if
- See a doctor soon if you have deep, painful lumps or cysts that leave scars.
- See a doctor soon if acne makes you feel very low, anxious or withdrawn.
- See a doctor soon if acne comes with irregular periods, weight gain or excess hair growth.
- See a doctor urgently if you get a sudden severe rash, swelling or blistering after starting any acne medicine.
- See a doctor if acne suddenly starts in adulthood or after starting a new medicine.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.