Acne (మొటిమలు) affects most people at some point between the ages of 12 and 25, and a significant number of adults — particularly women in their twenties and thirties. It is a medical condition of the hair follicle and oil gland, not a cosmetic problem or a sign of poor hygiene.
Why acne happens
Four things happen together in an acne-prone follicle:
- The oil gland produces more sebum, usually under hormonal influence
- Dead cells block the follicle opening, forming a comedone
- Cutibacterium acnes multiplies in the blocked follicle
- The surrounding skin becomes inflamed — this is what causes redness, pain and scarring
Which of these dominates decides the treatment. That is why acne cannot be treated sensibly without someone actually looking at the skin.
Types we distinguish
- Comedonal acne — blackheads and whiteheads, little inflammation
- Papulopustular acne — red bumps and pus-filled spots
- Nodulocystic acne — deep, painful nodules; the type that scars
- Hormonal acne — jawline and lower-face distribution, often in adult women, sometimes with irregular periods or excess hair growth that needs investigating
- Steroid-induced acne — caused by the cream that was supposed to treat it
A word about steroid and “fairness” creams
Combination creams containing a potent steroid are sold across counters in Andhra Pradesh without prescription, and they are one of the most common reasons acne gets worse. They calm redness for a few days, then produce steroid-induced acne, facial flushing, visible blood vessels and thinned skin — and the skin flares badly when the cream is stopped.
If you are using any such cream, bring the tube with you. Stopping it suddenly on your own can cause a severe rebound. It needs to be withdrawn in a planned way.
How we diagnose it
A consultation involves examining the distribution and type of lesions, asking about duration, previous treatments and any creams currently in use. For adult women with jawline acne, irregular periods, excess facial hair or hair thinning, we investigate for an underlying hormonal cause such as PCOS rather than only treating the skin.
Treatment options
Treatment is matched to the type and severity. Most patients need a combination rather than a single medicine:
- Topical retinoids (adapalene, tretinoin) — the backbone of almost every acne plan; they unblock follicles and prevent new lesions
- Benzoyl peroxide — reduces bacteria and limits antibiotic resistance
- Topical or oral antibiotics — for inflammatory acne, used for a defined period, never indefinitely
- Hormonal treatment — for selected adult women, where appropriate
- Isotretinoin — for severe, scarring or treatment-resistant acne. Highly effective, but requires monitoring and must be avoided in pregnancy; this is discussed in detail before starting
Treating acne scars
Scars are treated only once active acne is controlled — otherwise new lesions undo the work. The approach depends on scar type:
- Chemical peels — for pigmentation and shallow, superficial scarring
- Microneedling — stimulates collagen in rolling and boxcar scars
- Subcision — releases tethered, depressed scars from below
- TCA CROSS — for narrow, deep ice-pick scars
- Fractional laser resurfacing — for more extensive textural scarring
Scars can usually be improved substantially, but honestly — rarely erased entirely. Several sessions spaced weeks apart are normal. Treating active acne early is by far the most effective scar treatment there is.
A realistic timeline
Expect visible improvement in 6 to 8 weeks and a full course of 3 to 6 months. Acne commonly looks slightly worse in the first two or three weeks of retinoid treatment — this is expected and not a reason to stop.
The most common reason acne treatment “doesn't work” is stopping it at four weeks. The second most common is switching between creams recommended by different people every few weeks.
Common questions
Does oily food or chocolate cause pimples?
Much less than people expect. There is reasonable evidence that a high-sugar, high-glycaemic-index diet and, in some people, large quantities of milk can worsen acne. Oily food and chocolate on their own are not established causes.
Should I wash my face more often?
No. Washing more than twice a day, or scrubbing, irritates the skin barrier and usually makes acne worse. A gentle cleanser twice daily is sufficient.
Will it come back after treatment?
Acne can recur, particularly if there is a hormonal driver. Many patients continue a light maintenance topical treatment after the main course to prevent relapse. This is discussed at the end of your course.