Concern hub · Acne
Acne & acne scars in brown skin.
How acne works, what the latest guidelines recommend, why brown skin is left with dark marks, and how scars are treated safely, explained by a dermatology doctor.
Reviewed by Dr. Khadija Farid, FCPS Dermatology Resident 9 references Last reviewed: 23 October 2026
Antibiotics
Never alone and never for long: they are paired with benzoyl peroxide to limit resistance.1
What acne is
Acne starts in the hair follicle: excess oil, sticky skin cells that block the pore, the skin bacterium Cutibacterium acnes, and inflammation. Hormones, especially androgens, drive oil production, which is why acne often starts at puberty and can flare around periods.
Comedones
Blackheads and whiteheads: blocked pores without much inflammation.
Papules & pustules
Red bumps and pus spots: inflamed, and the main cause of dark marks in brown skin.
Nodules & cysts
Deep, painful lumps that are most likely to scar. These need a doctor promptly.
Things that commonly make acne worse
- Picking and squeezing, which deepens inflammation and scarring.
- Heavy, oily cosmetics, hair oils and some sunscreens on acne-prone areas.
- Some medicines, including steroid creams and tablets.
- Hormonal changes, including polycystic ovary syndrome (PCOS).
- The evidence on diet is mixed; ask your doctor before cutting out whole food groups.1
Dark marks, red marks or scars?
In brown skin the mark left behind often bothers people more than the spot itself. Knowing which one you have decides the treatment.4
Brown marks
Post-inflammatory hyperpigmentation: flat and brown. It fades over months, faster with sun protection and treatments such as topical retinoids.4
Red or purple marks
Post-inflammatory erythema: flat redness from small blood vessels. It usually fades slowly on its own.
True scars
Changes in texture: ice-pick, boxcar and rolling scars, or raised and keloid scars. These do not fade with creams alone.5
How acne is treated
The treatment ladder
Treatment is matched to severity, and almost every plan combines more than one approach.1
Step 1 · Everyone
Daily care
Gentle cleanser, non-comedogenic moisturiser and daily sunscreen. No picking, scrubbing or home remedies.
Step 2 · Mild to moderate
Topical treatment
Benzoyl peroxide and a topical retinoid such as adapalene are the foundation. Azelaic acid and salicylic acid are useful options; a topical antibiotic is only used together with benzoyl peroxide.13 A newer option, clascoterone cream, blocks hormone signals in the skin itself without the whole-body effects of hormonal tablets.79
Step 3 · Moderate
Tablets
A short course of an antibiotic such as doxycycline, always with topical treatment. For women, hormonal options such as some contraceptive pills or spironolactone may help.1
Evidence at a glance
What works, and how sure are we?
Ratings draw on the 2024 American Academy of Dermatology guideline and large meta-analyses. See our editorial standards.
| Treatment | What it does | Evidence | Notes |
|---|---|---|---|
| Benzoyl peroxide | Kills acne bacteria; prevents resistance | Strong | Can bleach fabric; start with lower strengths1 |
| Topical retinoids (adapalene, tretinoin) | Unblock pores; reduce inflammation | Strong | Also help dark marks in brown skin; avoid in pregnancy14 |
| Topical antibiotics | Reduce bacteria and inflammation | Strong | Only with benzoyl peroxide, never alone13 |
| Oral doxycycline | Anti-inflammatory and antibacterial | Strong | Short courses, combined with topicals1 |
| Oral isotretinoin | Shrinks oil glands; long-term remission | Strong | Specialist only; pregnancy must be avoided12 |
| Azelaic acid | Antibacterial; calms inflammation and marks | Moderate | Gentle; helpful when dark marks are a concern1 |
| Salicylic acid | Unclogs pores | Moderate | Mild; useful for blackheads1 |
| Combined oral contraceptive | Lowers androgen effects | Moderate | For suitable women, after medical review1 |
| Spironolactone | Blocks androgen effects | Moderate | Prescription; not used in pregnancy1 |
| Clascoterone 1% cream (newer) | First topical androgen-receptor blocker: reduces hormone-driven oil and inflammation in the skin | Moderate | Twice daily, from age 12; works in males and females; mostly mild redness. Not studied in pregnancy; availability in Pakistan may be limited789 |
Acne scars
Treating scars safely in brown skin
Scar treatment starts only once active acne is controlled. Results come from a series of sessions, and combining methods usually works better than any single one.5
- Focal chemical treatments for narrow ice-pick scars.
- Fillers for some rolling scars.
- Preparation and aftercare: in skin types IV–VI, irritating acids are avoided straight after resurfacing to reduce pigmentation risk.6
A simple acne routine
Morning
- Gentle cleanser (a benzoyl peroxide wash if advised)
- Light, non-comedogenic moisturiser
- Broad-spectrum sunscreen, SPF 30 or higher
Evening
- Gentle cleanser
- Your treatment, such as adapalene, a pea-sized amount for the whole face
- Moisturiser
Retinoids can sting and peel for the first few weeks. Start every other night and build up. Most treatments take 8–12 weeks to show their full effect.
Myths that make acne worse
“Toothpaste and lemon dry out spots”
They irritate the skin, and in brown skin irritation means more dark marks.
“Acne means dirty skin”
Acne is driven by hormones, oil and inflammation. Over-washing and scrubbing make it worse.
A warning for Pakistan
Steroid creams sold as “acne” or “fairness” creams can cause steroid acne and long-term skin damage. Antibiotic tablets bought without a prescription, or taken for months, add to antibiotic resistance and often stop working. Acne treatment should be guided by a doctor.
See a dermatologist if
- You have deep, painful nodules or cysts.
- Acne is leaving scars or dark marks.
- It is affecting your mood or confidence.
- Adult acne comes with irregular periods, excess hair growth or weight changes, which may suggest PCOS.
- Over-the-counter treatment has not helped after 2–3 months.
Frequently asked questions
Acne: your questions answered
What is clascoterone, the new acne cream?
Clascoterone 1% cream is the first topical androgen-receptor blocker for acne. In two large trials it cleared or almost cleared acne in about 18 to 20% of people at 12 weeks, versus 7 to 9% with a placebo cream, with mostly mild redness. It is applied twice daily from age 12 and has not been studied in pregnancy.
What is the best treatment for acne?
For most people, a combination works best: benzoyl peroxide with a topical retinoid such as adapalene, adding an antibiotic or hormonal treatment when needed. Severe or scarring acne may need isotretinoin from a specialist.
How long does acne treatment take to work?
Most treatments take 8 to 12 weeks to show their full effect. Retinoids can cause some dryness and peeling in the first weeks, which usually settles.
How do I get rid of dark marks after acne?
Flat brown marks fade over months. Daily sunscreen, treating active acne early, and ingredients such as topical retinoids and azelaic acid speed this up. Avoid picking, which deepens marks.
Can acne scars be removed?
Textured scars do not fade with creams, but they can be improved with procedures such as microneedling, subcision and fractional lasers, usually in a series and often combined.
Is isotretinoin safe?
Isotretinoin is the most effective acne treatment and is safe when prescribed and monitored by a specialist. It causes birth defects, so pregnancy must be strictly avoided during treatment.
Should I take antibiotics for acne?
Antibiotics are used for short courses and always together with benzoyl peroxide or other topical treatment, to limit antibiotic resistance. They should not be bought and taken without a prescription.
Does diet cause acne?
The evidence is mixed. Some studies link high-sugar foods and dairy with acne in some people, but cutting out whole food groups is not recommended without medical advice.
References
- Reynolds RV, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30. doi:10.1016/j.jaad.2023.12.017
- Huang CY, et al. Comparative efficacy of pharmacological treatments for acne vulgaris: a network meta-analysis of 221 randomized controlled trials. Ann Fam Med. 2023;21(4):358–369. doi:10.1370/afm.2995
- Kakpovbia EE, et al. Efficacy of topical treatments for mild-to-moderate acne: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2025;39(4):775–784. doi:10.1111/jdv.20154
- Callender VD, et al. Effects of topical retinoids on acne and post-inflammatory hyperpigmentation in patients with skin of color. Am J Clin Dermatol. 2022;23(1):69–81. doi:10.1007/s40257-021-00643-2
- Ou Y, et al. Laser, microneedling, and combination therapies for moderate to severe acne atrophic scars: a systematic review and network meta-analysis. Aesthetic Plast Surg. 2026;50(17):7308–7334. doi:10.1007/s00266-026-06165-8
- Draelos ZD, et al. International consensus on anti-aging dermocosmetics and skin care for clinical practice. J Drugs Dermatol. 2024;23(1):1337–1343. doi:10.36849/JDD.7798
- Hebert A, et al. Efficacy and safety of topical clascoterone cream, 1%, for treatment in patients with facial acne: two phase 3 randomized clinical trials. JAMA Dermatol. 2020;156(6):621–630. doi:10.1001/jamadermatol.2020.0465
- Eichenfield LF, et al. Integrated short-term and long-term efficacy of topical clascoterone cream 1% in patients aged 12 years or older with acne vulgaris. J Drugs Dermatol. 2024;23(1):1278–1283. doi:10.36849/JDD.7719
- Shergill M, Ali MU, Abu-Hilal M. Comparison of the efficacy of clascoterone, trifarotene, and tazarotene for the treatment of acne: a systematic literature review and meta-analysis. Dermatol Ther (Heidelb). 2024;14(5):1093–1102. doi:10.1007/s13555-024-01175-3
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