What actually causes acne, and what does not

Two beliefs about acne do most of the damage, and they point in the same wrong direction.

“It’s because my face is dirty.” So people wash four times a day, scrub, and use harsh cleansers, all of which damage the skin barrier and make acne worse.

“It’s because of oily and fried food.” So they change their diet, see no improvement, and conclude nothing works.

Neither belief is right. Here is what actually produces a pimple.

This is information, not medical advice. Deep painful nodules, cysts, or acne that is scarring need a dermatologist, scarring is permanent and treatment prevents it.

The four things that make a pimple

Acne is a disorder of the hair follicle and its oil gland, and four processes combine. Understanding them explains why the effective treatments work and the popular ones do not.

1. Increased oil (sebum) production. Driven largely by androgens, which is why acne starts at puberty in both sexes, and why hormonal conditions affect it.

2. Abnormal shedding of cells inside the follicle. The cells lining the follicle fail to shed normally and stick together, blocking the opening. This is the step most people have never heard of, and it is the one most effective treatments target.

That blockage is the comedone, a whitehead when closed, a blackhead when open.

3. A bacterium: Cutibacterium acnes (formerly Propionibacterium acnes). It lives on everyone’s skin normally. In a blocked, oil-filled follicle it multiplies.

4. Inflammation. The immune response to all of the above. This is what turns a painless blackhead into a red, painful pimple.

And a crucial point: the inflammation is now understood to be present early, not just at the end, acne is an inflammatory condition from the start, which is part of why anti-inflammatory treatments work.

So what the popular beliefs get wrong

“Dirty skin.”

Blackheads are black because the trapped keratin oxidises on exposure to air, not because they are dirt. You cannot wash them out, and scrubbing drives inflammation.

Washing more than twice a day makes acne worse, by stripping the barrier, triggering irritation, and in some people increasing oil production in response to dryness.

“Oily and fried food.”

This is the most firmly held belief in India and the evidence does not support it. Eating oil does not put oil in your skin. Sebum is produced by the gland under hormonal control, not delivered from the plate.

There is a genuine dietary story, and it is a different one, covered below, and it is about sugar and dairy, not oil.

“Popping it helps.”

Squeezing pushes contents deeper into the dermis, increases inflammation, and is a direct route to post-inflammatory marks and permanent scars. The mark that lasts six months was often created by the squeeze, not the pimple.

“Toothpaste on a pimple.”

It contains irritants that can cause a chemical burn and post-inflammatory pigmentation, which in Indian skin is particularly likely to persist. It does not treat acne.

“It’ll go away on its own after the teens.”

Often, but not always. Adult acne is common, particularly in women, and acne that scars does not undo itself.

What genuinely makes it worse

Hormonal factors:

• Puberty and the androgen rise
• Menstrual cycle, premenstrual flares are real and common
• PCOS, and this matters. Acne along the jawline and lower face, with irregular periods, unwanted facial hair or hair thinning, warrants investigation
• Stopping hormonal contraception
• Anabolic steroids, a significant and under-discussed cause of sudden severe acne on the back and chest in young men at the gym
• Pregnancy, either way

Medications:

• Oral and topical corticosteroids
• Anabolic steroids
• Lithium
• Some anti-epileptics
• Some B12 and B6 at high doses, a recognised trigger in some people
• Hormonal treatments

Products and habits:

• Comedogenic products, heavy oils and creams. Coconut oil on the face is a common Indian trigger and genuinely does block follicles in acne-prone skin
• Hair oil migrating onto the forehead, a classic cause of forehead acne in India. The pattern is diagnostic: acne confined to the forehead and hairline
• Heavy foundation and concealer, not removed properly
• Thick sunscreens in oily skin, though sunscreen itself is necessary, and gel or fluid formulations solve this
• Friction and pressure, helmet straps, masks, phone against the cheek, resting the chin on a hand. This produces acne in a specific pattern matching the contact area
• Scrubbing and harsh cleansers
• Picking

Environment:

• Humidity and sweat, especially sweat left to dry on the skin
• Pollution
• Oil exposure at work, kitchens, workshops

Genetics, substantially. A family history of significant acne is one of the strongest predictors.

The diet question, answered honestly

The evidence here is moderate, not strong, and it does not implicate what people assume.

Reasonable evidence for a link:

High glycaemic load diets. Refined carbohydrate and sugar raise insulin and IGF-1, which stimulate sebum production and androgen activity. Several studies have found improvement with lower glycaemic load diets.

This is relevant to Indian diets, maida, white rice in quantity, sugary drinks and bakery items.

Dairy, particularly skimmed milk. An association has been reported in multiple studies, more consistently for milk than for cheese or curd, and more for skimmed than whole. The mechanism is thought to involve hormones and IGF-1. The evidence is observational, so causation is not established.

Whey protein supplements have reported associations with acne flares in young men, worth knowing, since this group often starts whey and gym training at the same time.

Weak or no evidence:

Oily and fried food, no good evidence. Chocolate, studied, inconsistent, and if anything the sugar rather than the cocoa. Spicy food, no evidence. Nuts, no evidence.

The practical conclusion: if you want to try a dietary change, reduce sugar and refined carbohydrate, and consider reducing milk specifically for a couple of months to see. Do not cut oil, and do not eliminate entire food groups on the strength of weak evidence.

And give it twelve weeks. Acne responds slowly to anything, including diet.

What actually works

Matching the mechanisms above:

For the blocked follicle, retinoids. Topical adapalene, tretinoin. These are the most effective topical treatment for the root process, because they normalise follicular cell shedding. Adapalene is available without prescription in many places.

They cause irritation and purging in the first weeks, which is why people abandon them. Start every third night, use a small amount, moisturise, and build up. Retinoids require sunscreen. Not in pregnancy.

For bacteria and inflammation, benzoyl peroxide. Effective, inexpensive, and it does not produce bacterial resistance. Start at a low concentration. It bleaches fabric, so it is a night product on an old pillowcase.

Salicylic acid for oily skin and comedones.

Azelaic acid, useful, and particularly relevant for Indian skin because it also helps post-inflammatory pigmentation.

Topical antibiotics, used, but always with benzoyl peroxide to limit resistance, and not alone long-term.

Oral treatments from a doctor: antibiotics for a defined course, hormonal treatment including combined contraceptives and spironolactone for appropriate women, and isotretinoin for severe or scarring acne, which is highly effective, requires monitoring, and is strictly contraindicated in pregnancy.

And the two free ones: do not pick, and use sunscreen, because in Indian skin, the lasting problem is usually the mark rather than the pimple, and sun exposure darkens those marks considerably.

On neem, turmeric and the traditional approach

We manufacture in this category, so let us be accurate.

Neem has documented antibacterial and anti-inflammatory activity in laboratory work, and long traditional use in Indian skin care. Clinical trial evidence specifically for acne is limited. It is a reasonable ingredient with a plausible mechanism, not a demonstrated treatment.

Turmeric has a large preclinical anti-inflammatory literature, with the usual bioavailability caveat for oral curcumin.

Manjistha has traditional use for skin clarity, with little modern data.

What can honestly be said: traditional use in Ayurvedic skin formulations; cleansing; support for clearer-looking skin.

What cannot: treats acne, clears acne, removes pimples permanently, or treats scars. These are medicinal claims and we decline artwork that makes them.

And two warnings about traditional application:

Raw turmeric paste on the face stains, and in some people causes contact dermatitis. It is not a treatment for inflamed acne.

Lemon juice is a popular remedy and a bad idea, it is irritating, and it causes photosensitivity that leads to pigmentation in Indian skin.

Why pigmentation matters more here

Worth its own note, because it changes the priorities for Indian skin.

In darker skin types, acne leaves post-inflammatory hyperpigmentation far more readily, the dark marks that persist for months after the pimple has gone. For many Indian patients, those marks are the actual complaint, not the active acne.

Which has three practical consequences:

1. Treat acne early and properly, fewer inflamed lesions means fewer marks
2. Never pick, this is the single biggest controllable cause of marks
3. Use sunscreen daily, sun exposure darkens and prolongs existing marks, and this is the most neglected step

And a warning: the market is full of fairness and skin-lightening products aimed at this problem, some containing undeclared steroids, mercury or hydroquinone. Topical steroid misuse on the face is a serious and widespread problem in India, causing thinning, redness, visible blood vessels and steroid-induced acne, and it is very difficult to reverse. Any cream that works dramatically in days deserves suspicion.

The short version

1. Four mechanisms: more oil, blocked follicle, bacteria, inflammation. Treatments work by targeting these.
2. Acne is not dirt. Blackheads are oxidised keratin, not grime. Washing more than twice daily makes it worse.
3. Eating oil does not cause acne. The real dietary links are sugar and refined carbohydrate, and possibly milk, not fried food.
4. Popping causes the mark that lasts.
5. Hair oil on the forehead and coconut oil on the face are common Indian triggers with recognisable patterns.
6. Anabolic steroids and whey are worth asking about in young men with sudden back and chest acne.
7. Jawline acne with irregular periods warrants a PCOS discussion.
8. Topical retinoids address the root process; benzoyl peroxide handles bacteria and inflammation. Both need patience and sunscreen.
9. In Indian skin the lasting problem is the mark. Treat early, never pick, use sunscreen daily.
10. Beware creams that work in days, steroid misuse on the face is common and hard to reverse.

Product detail: Glowo 360 and the neem ingredient page. Related: a simple routine for acne-prone skin and when acne needs a dermatologist.