Acne: Spot reduction

Clear skin will no longer remain a wistful memory. Follow these simple guidelines to manage and treat acne

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Synonymous with pimples, acne is one of the most common skin problems. Considering it normal and leaving it untreated may result in scarring and pigmentation. Acne affects not just the skin, but a person’s self-esteem too. Hence, treatment is essential.

What is it?

Acne is a chronic inflammatory disorder of the pilo-sebaceous unit, which affects face, chest, back, upper arms, shoulders and ears. It runs a self-limiting course and occurs more frequently in males owing to the androgen activity. In females, a premenstrual exacerbation occurs probably due to a rise in the progesterone levels. Predisposition to acne may sometimes be genetic.

Acne formation

Our skin has minute glands called sebaceous glands, which open into the hair follicle and secrete an oily substance called sebum. When the male sex hormones—present in both males and females—are on the rise, they activate the glands to increase in size, which in turn, leads to increase in the secretion of sebum.

Secondly, the cells stick together, plugging the opening of the hair follicle, resulting in ‘white heads’. When the pigment melanin, present in white heads, is exposed to air it forms black heads. Acne is also formed when there is an increase in the level of ‘propionibacterium acne’ bacterium. When the follicle gets clogged, its wall ruptures. This leads to formation of severe acne.

The culprits

Factors affecting acne:

  • Hormonal imbalance.
  • Genetic predisposition.
  • Use of cosmetics such as creams, oil-based moisturisers, foundations.
  • Application of heavy oil or gel on the scalp leads to pimples on the back and forehead.
  • Working in chemical or oil industries and coming in contact with hydrocarbons, heavy oils, cutting oil, wax, grease and coal tar derivatives.
  • Working in hot and humid climate.
  • Drugs such as oral contraceptives, steroids, anti-tuberculosis.
  • Squeezing or picking at a pre-existing lesion will lead to secondary infection, increased pigmentation and scarring.
  • Stress.

Topically speaking

The medical line of treatment for acne comprises topical and systemic therapy. Surgery used as an adjunct gives better results. Persistent acne associated with hirsutism [excessive and increased hair growth] or alopecia [loss of hair] calls for hormonal evaluation to rule out endocrine disorders.

  • Blackheads can be treated with topical creams that contain adapalene or benzoyl peroxide.
  • In case of blackheads, whiteheads and pustules, a cream or gel that contains clarithromycin works best when applied once or twice a day. It can also be combined with adapalene to prevent pigmentation and scars.
  • Antibiotic creams like erythromycin or clindamycin are also used. Peeling agents like tretinoin, alpha-hydroxy acids, salicylic acid, resorcinol may also be used. Comedone [acne blemish] extraction [clean ups] done fortnightly by a trained professional leads to faster resolution of lesions.
  • In case of pustules and whiteheads, one needs to take systemic antibiotics for at least 6 – 8 weeks. It is contraindicated in pregnancy and lactation.
  • For severe acne, topical creams and systemic antibiotics show good results when taken for 8 – 12 weeks.

Daily soaps for acne

For acne-prone skin, cleansers are available in the form of soaps, face and foam washes. They remove unwanted dirt, contaminants, and bacteria, and also eliminate dead surface cells, endogenous sebum and sweat. In doing so, these products generally make it easier for topical acne creams to be absorbed. When opting for an acne cleanser, look for the terms ‘oil-free’, ‘non-irritating’ and ‘non-comedogenic’ [non-pimple aggravating]. You must wash your face only twice a day and be kind to your skin while washing as excess washing can cause irritation.

Salicylic acid-based face wash or foams: Salicylic acid is a beta-hydroxy acid derived from willow bark. It is as an antiseptic and antifungal agent. Since it is lipid soluble, it has the ability to penetrate into the pore, clean it and slough off the dead cells, making it effective for reducing blackheads and whiteheads. They are recommended for those acne-prone with oily skin.

Tip: Do not use it if you are undergoing chemical peels treatment.

Benzoyl peroxide-based face wash: Benzoyl peroxide kills pimple-causing bacteria and reduces inflammation. It also dries out skin by reducing the oil on your skin’s surface. So sometimes, it may cause flaking, irritation and redness. It is recommended for extremely oily skin and severe acne.

Tip: Do not use if your skin is dry or sensitive.

Soaps containing sulphur: Sulphur keeps bacteria in check and works wonders on whiteheads, blackheads and pimples. It is milder than face washes containing benzoyl peroxide. These are recommended for oily skin with blackheads and whiteheads.

Tip: Do not use in winter and if the skin is flaking.

Soaps containing triclosan: These have antibacterial and anti-inflammatory properties.

Tea tree oil containing face washes: These act as natural anti-bacterial agents. They are soothing and leave a moisturising film on the skin. They are recommended for sensitive acne-prone skin.

Cetyl alcohol-based cleansing lotions: Many a times, anti-acne drugs or creams cause dryness of the skin. In such cases, it is advised to avoid the use of anti-acne soaps and face washes as they could rip off the skin’s barrier layer. Cetyl alcohol cleansing lotions come handy in such cases, as they do not strip the skin of natural protective oils or emollients or disturb the skin’s natural pH balance. Recommended for those with extremely sensitive skin.

Ugly reminders

If acne is not treated on time, you develop scars, which is what causes the psychological trauma. Acne scars may be in the form of:

  • Macules. These are small dark skin discolorations and are flat.
  • Depressed fibrotic scar and ice-pick scars. These are large, depressed valleys on the surface of the skin. They are usually jagged.
  • Soft scars. These are gentle, scar-like depressions, usually small, and either circular or linear.
  • Raised scars called hypertrophic scars.

These scars can be healed with treatments like microdermabrasion, chemical peels, dermaroller, and other surgical methods. However, consult your dermatologist before undergoing any treatment.

Proper care, treatment and hygiene go a long way in managing and even eradicating acne.

Tips to tackle acne

  • Wash your face with an anti-bacterial soap at least 3-4 times a day.
  • Increase the intake of citrus fruits such as oranges, grapes, lime and lemon and other food stuff which are high in vitamin C and zinc.
  • Drink plenty of water.
  • Avoid the use of oily cosmetics, cleansing milk and gels.
  • Avoid facials.
  • Acne is not normal, get it treated.
  • Be patient and give medicines some time to act. You may have to take medicines for 8 – 12 weeks.

Magnifying lens over an exclamation markSpot an error in this article? A typo maybe? Or an incorrect source? Let us know!

Jaishree Sharad
Dr Jaishree Sharad is medical director and consultant cosmetic dermatologist at a skin cosmetology clinic, Mumbai. She is also the Vice-President of the Cosmetic Dermatology Society of India[CSI].


  1. I have all those small pimples in my face,i tried nixoderm but did not work to my satisfaction.they said the application of coconut oil would only aggravate the condition.what can i use naturally and eat naturally to clear up my face including the scars that will possibly erupt from the pimples within 7 days.plssssss.

  2. Hey Biju,
    I seem to be losing a lot of hair from the follicles… what should I do?
    Also, I do colour my hair using hair dye.


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