Acne
Also called: acne vulgaris, pimples, spots, blackheads and whiteheads
Acne is a common skin condition where blocked pores cause blackheads, whiteheads, red spots and sometimes deep painful lumps, mostly on the face, chest and back. It is very treatable with creams, gels and sometimes tablets, but treatment takes weeks to work.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Acne happens when the tiny openings in the skin (pores) get blocked. Each pore leads to a hair root and an oil gland. When oil and dead skin cells form a plug, it shows as a whitehead or a blackhead. If germs trapped in the plug cause swelling, red spots and pus-filled spots appear, and deeper lumps (nodules or cysts) can form.
Acne is most common in teenagers and young adults, but it can start later and can last into middle age. Babies can also get it. It often runs in families. The face is affected most, followed by the shoulders, chest and back. Doctors talk about mild, moderate and severe acne, mainly by counting the red spots and deep lumps.
Acne can hurt a person's confidence and mood, even when it looks mild to others. Good treatments exist. Most people start with a cream or gel, and some also need tablets for a few months. Treatment often takes 6 to 8 weeks to start working, and doctors usually review it at 12 weeks. Scars are more likely the more severe the acne is and the longer it lasts, so it is worth treating early.
In Pakistan
In a study of 163 young adults with acne at three hospitals in Karachi and Lahore, half had moderate acne and about 58 in 100 said acne affected their quality of life moderately or severely; the authors noted that even mild acne can be very distressing.
Symptoms
- Blackheads (dark-topped plugs) and whiteheads (white-topped plugs) in the pores
- Small red bumps (papules) that may feel sore
- Spots with yellow or white pus in the centre (pustules)
- Large, painful lumps under the skin (nodules or cysts) in more severe acne
- Oily skin
- Spots on the face, and often on the shoulders, chest and back
- Redness, crusting and dark marks left after spots heal
- Scars (pits or raised marks) where deep spots have healed
Causes and risk factors
Causes
- Oil and dead skin cells block the pores and form plugs
- Germs that live on the skin grow inside the blocked pore and trigger swelling and redness
- Hormone changes, such as at puberty, around periods, in pregnancy or from stress, increase oil production
- Some medicines, such as steroids, testosterone, some hormone medicines and the epilepsy medicine phenytoin, can bring it on
- Medical conditions that raise male-type hormones, such as polycystic ovary syndrome (PCOS)
What makes it more likely
- Being a teenager or young adult
- A family history of acne
- Greasy or oil-based skin creams, make-up, sunscreens and hair products
- Heavy sweating and hot, humid weather
- Often touching, rubbing or leaning on the skin, or tight hats and headbands
- Progestogen-only contraception, which may make acne worse in some women
- Using anabolic steroids (muscle-building hormones)
- Polycystic ovary syndrome in women
Complications
The most lasting problem is scarring. The risk of scars goes up the more severe the acne is and the longer it goes on, and picking or squeezing spots makes scars more likely. Healed spots can also leave dark or uneven patches of skin that may last for months. Acne of any severity can cause real distress, low confidence, anxiety and depression, so feelings matter as much as the skin. Medicines for acne have their own side effects, for example dry or irritated skin from creams, and antibiotic resistance when antibiotic tablets are used for too long.
When to see a doctor
- A sudden, very severe flare of acne (a rare form called acne fulminans): this needs same-day review by a hospital skin team
- Low mood, anxiety, thoughts of self-harm or suicide, especially while taking isotretinoin: stop the medicine and get urgent help
- Becoming pregnant, or planning pregnancy, while using isotretinoin, a topical retinoid or a tetracycline antibiotic: speak to your doctor straight away
- Large painful lumps or cysts, or acne that is starting to leave scars
- Acne that has not improved after two full courses of treatment
- Acne in a baby that has not cleared after 3 months
Are you a PMDC-registered doctor who treats Acne? List your profile free.
Diagnosis
A doctor can usually diagnose acne just by looking at the skin. Tests are rarely needed. The doctor checks the type of spots (blackheads, whiteheads, red spots, pus spots or deep lumps), where they are, and whether there are scars or dark marks. They judge how severe the acne is, mainly by counting red spots and deep lumps, and ask how the acne is affecting mood and daily life.
The doctor also asks about medicines, including steroids and muscle-building hormones, and in women about periods, extra hair growth and contraception, because conditions such as polycystic ovary syndrome can cause acne. If a hormone problem or a medicine may be playing a part, the doctor may refer you to a specialist, such as a hormone doctor. A swab may sometimes be taken if large pus spots do not settle, to check for another infection. Some treatments, such as isotretinoin, need close monitoring, including regular blood tests and strict pregnancy prevention.
Treatment
- Start with gentle skin care: wash morning and evening with a mild, non-soap cleanser and use only non-greasy products
- For most acne, use a treatment applied to the skin for the full course your doctor or pharmacist advises, usually a combination gel or cream that contains benzoyl peroxide, a retinoid or an antibiotic. Start slowly to avoid irritation
- For moderate to severe acne, your doctor may add an antibiotic tablet (usually a tetracycline) to a cream that does not contain an antibiotic
- Review with your doctor at the planned check-up. If the acne has cleared, the tablet can often be stopped while the skin treatment continues; antibiotic tablets are kept as short as possible
- Women who need contraception, or who have PCOS, may be offered a combined contraceptive pill
- If acne is severe, scarring, causing distress or not responding, your doctor may refer you to a skin specialist for isotretinoin
- Ask for help early if acne affects your mood; support or referral to mental health services may be offered
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Benzoyl peroxide combinations (applied to the skin) | First choice for most acne; combined with a retinoid or an antibiotic in one gel. Benzoyl peroxide alone is an option if other treatments are not suitable. Can bleach clothes and towels | Adapalene + Benzoyl peroxide (2 brands), Clindamycin + Benzoyl peroxide (1 brand), Benzoyl peroxide (12 brands) |
| Tetracycline antibiotics (tablets) | Added to a skin treatment for moderate to severe acne, for a limited time only, then reviewed. Never used alone or with an antibiotic cream. Not for use in pregnancy, breastfeeding or under 12 years | Doxycycline (80 brands), Tetracycline (2 brands) |
| Other antibiotics (tablets) | Used instead of a tetracycline if it cannot be taken or causes side effects; your doctor decides | Erythromycin (11 brands), Trimethoprim (7 brands) |
| Hormonal treatments for women | A combined contraceptive pill can help acne in women who also want contraception or have PCOS; spironolactone (a male-hormone blocker) is sometimes used by specialists. Your doctor checks they are safe for you | Levonorgestrel + Ethinyl estradiol (2 brands), Spironolactone (11 brands) |
| Oral retinoid (isotretinoin) | For severe acne that has not responded to antibiotic tablets and skin treatment, or acne causing scars. Started by a specialist. It can seriously harm an unborn baby, so a strict pregnancy prevention programme is needed, and mood is checked during treatment | Isotretinoin (20 brands) |
| Other skin treatments | Salicylic acid is a milder option in some over-the-counter products | Salicylic Acid |
Also used (not yet in our price list): Tretinoin with clindamycin gel (a first-choice combination), Azelaic acid cream or gel, Lymecycline (a tetracycline antibiotic), Co-cyprindiol (cyproterone acetate with ethinylestradiol), mainly for women with PCOS, Clascoterone cream
Self-care and prevention
Self-care
- Wash your face morning and evening with a mild, non-soap cleanser that is not alkaline; do not scrub
- Choose oil-free, non-comedogenic (does not block pores) moisturisers, sunscreens and make-up, and remove make-up before bed
- Do not pick, squeeze or scratch spots, as this raises the risk of scars and infection
- Wash your hair regularly if it is oily and keep it off your face
- Keep using your treatment every day for the full course; most treatments take weeks before you see a change
- If a cream stings or dries your skin, use it every other day or wash it off after a short time at first, and talk to your pharmacist
- Avoid tight hats and headbands and try not to touch or lean on your face
Prevention
- Use only oil-free, non-comedogenic skin and hair products
- Keep a gentle daily washing routine, including after sweating or exercise
- Avoid picking spots to prevent scars
- Start treatment early and keep going with maintenance treatment if your acne keeps coming back
Common questions
Does eating chocolate or oily food cause acne?
Chocolate, nuts and greasy foods have not been shown to cause acne. A link with sugary foods or dairy is still debated, and there is not enough evidence to recommend a special diet for acne. A healthy, balanced diet is sensible for everyone.
How long does acne treatment take to work?
Most treatments take several weeks before the skin starts to improve, and doctors usually review progress after a few months. Spots can seem worse or the skin can feel dry at first. Keep going unless your doctor or pharmacist tells you to stop.
Why should I not use an antibiotic cream on its own?
Using an antibiotic alone, or an antibiotic cream together with antibiotic tablets, helps germs become resistant. Guidelines advise pairing antibiotics with benzoyl peroxide or another non-antibiotic treatment and keeping courses as short as possible.
Is it safe to use acne treatments in pregnancy?
Some are not. Retinoid creams, tetracycline antibiotics and isotretinoin must not be used in pregnancy or when planning a pregnancy, because they can harm the baby. If you are pregnant, breastfeeding or planning a pregnancy, let your doctor choose a suitable treatment.
Will my acne scars go away?
Dark marks often fade with time, but true scars can be lasting. Treating acne early and not picking spots lowers the risk. If severe scars remain a year after the acne has cleared, a skin specialist can talk about options such as laser or chemical peels.
Sources
- NICE. Recommendations - Acne vulgaris: management (NICE guideline NG198) (n.d.).
- NICE. Acne vulgaris: management (information for the public) (2021).
- American Academy of Dermatology (Journal of the American Academy of Dermatology). Guidelines of care for the management of acne vulgaris (2024).
- NHS Scotland Right Decision Service (approved by the Scottish Dermatological Society). Acne | Right Decisions (2023).
- MedlinePlus. Acne: MedlinePlus Medical Encyclopedia (2025).
- Pakistan Journal of Medical Sciences (Naveed et al.). Impact of acne on quality of life in young Pakistani adults and its relationship with severity: A multicenter study (2021).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Polycystic ovary syndrome (PCOS)DepressionAnxiety disordersEczema (atopic dermatitis)