Acne (Keel Muhase) in Pakistan: What Actually Causes It and What Actually Treats It

Acne is treated as a cosmetic nuisance and lived as something considerably heavier. A study of female undergraduate medical students across three randomly selected institutes in Rawalpindi and Islamabad, published in Cureus, found clinically assessed acne vulgaris in 14.47% of students screened — and among those affected, 66.7% said they felt embarrassed and self-conscious, while 60% reported their social and leisure activities were affected.

A separate cross-sectional study at Rawalpindi Medical University reported something very different: of 349 students, 244 (69.9%) reported acne, and 50.4% of those self-medicated for it. The two figures are not really in conflict — the first counted diagnosed acne of clinical significance, the second counted anyone who says they get spots. Both are worth knowing: real acne is common, self-treating it is more common still, and the self-treatment is often the part that causes lasting damage.

At a glance

• 14.47% clinically assessed prevalence among female medical students in Rawalpindi/Islamabad (Cureus, 2019)
• 69.9% self-reported acne in a separate Rawalpindi student sample; 50.4% of them self-medicated
• Among those with acne, 66.7% reported embarrassment and 60% reported social impact
• Both figures come from student populations — they are not national prevalence estimates
• Acne is hormonal and inflammatory, not a hygiene failure; scrubbing harder makes it worse

Keel muhase kyun hote hain?

Keel muhase (acne) tab hote hain jab jild ke masaam (pores) tel aur mari hui jild se band ho jate hain, un mein bacteria barhte hain, aur sujan ho jati hai. Iska taalluq hormones se hai — isi liye teenage aur PCOS mein zyada hote hain.

Do bari ghalat-fehmi: pehla, ke gandagi se hote hain — is liye log din mein kai baar zor se chehra ragarte hain, jis se jild aur kharab hoti hai. Dusra, ke koi "whitening" ya beauty cream inka hal hai. Pakistan mein aam milne wali bay-naam whitening creams mein aksar taqatwar steroid shamil hota hai: shuru mein chehra saaf lagta hai, phir cream chhorne par muhase pehle se zyada shadeed ho kar wapas aate hain, jild patli ho jati hai aur surkh nishan reh jate hain. Yeh cheez dermatologists rozana dekhte hain.

Sahi ilaj thora sust hota hai lekin asal hota hai: chehre par lagane wali medical dawai 6–8 haftay tak mustaqil mizaji se istemal karen, phir natija dekhen — aur daag banne se pehle ilaj shuru karen, baad mein nahi.

Symptoms and types

• Blackheads and whiteheads — blocked pores without much inflammation (keel)
• Red papules and pustules — the inflamed spots most people mean by acne (daane)
• Nodules and cysts — deep, painful lumps that are the ones most likely to scar
• Post-inflammatory marks — brown or red patches left behind, common in South Asian skin and often mistaken for permanent scars when they will in fact fade
• True scars — pitted or raised, which do not fade on their own

Chest, back and shoulders are affected as often as the face, and are frequently left untreated because they are less visible.

Causes and aggravating factors

• Hormonal change — puberty, menstrual cycles, and androgens generally
• Polycystic ovary syndrome, where acne often arrives with irregular periods and excess hair growth — see our guide to PCOS
• Family history
• Topical steroid misuse, including unlabelled whitening and "fairness" creams
• Heavy oil-based cosmetics and hair oils along the hairline
• Friction — helmet straps, tight collars, prolonged mask wear, constantly touching the face
• Certain medications, including some steroids and anti-epileptics
• Picking and squeezing, which converts a spot that would have faded into a scar that will not

Diet plays a smaller role than folklore suggests. The evidence for high-glycaemic diets and possibly skimmed milk is modest; for oily food and chocolate specifically, it is weak. Blaming samosas is easier than treating acne, but it is not the same thing.

Treatment

• Mild acne — a topical retinoid (adapalene) at night, benzoyl peroxide, or salicylic acid; a gentle cleanser twice daily, not more
• Moderate acne — topical treatment combined with a course of oral antibiotics, prescribed for a defined period rather than indefinitely, and always alongside a topical agent to limit resistance
• Hormonal acne in women — combined oral contraceptives or anti-androgen therapy, where appropriate, prescribed and monitored by a doctor
• Severe or scarring acne — oral isotretinoin, which is highly effective but requires medical supervision, blood-test monitoring and strict pregnancy precautions; it is not a medicine to buy on a friend's recommendation
• Sunscreen daily — several acne treatments increase sun sensitivity, and sun exposure darkens post-inflammatory marks
• Scar treatment — chemical peels, microneedling and lasers, but only once active acne is controlled

A dermatologist (skin specialist) is worth seeing early if spots are deep and painful, if marks are accumulating, or if three months of over-the-counter treatment has changed nothing.

When to see a doctor

• Painful nodules or cysts, or any acne that is already leaving scars
• Acne with irregular periods, excess facial or body hair, or unexplained weight gain — worth assessing for PCOS
• Sudden severe acne in an adult, particularly if starting a new medication or cream
• Acne that has flared badly after stopping a whitening or steroid cream
• Significant effect on mood, confidence, sleep or social life — a legitimate reason to treat, not a vanity

Frequently asked questions

Kya whitening cream se muhase theek hote hain?

Nahi — aur aksar ulta nuqsan hota hai. Bay-naam creams mein steroid ya mercury ho sakta hai; shuru ka faida waqti hota hai aur cream chhorne par muhase aur shadeed ho kar lautte hain. Dermatologist ki tajweez karda dawai istemal karen.

Does acne mean my face isn't clean?

No. Acne starts inside the follicle, with oil and skin cells, not with surface dirt. Washing more than twice a day, or scrubbing, tends to irritate the skin and worsen it.

How long before treatment works?

Six to eight weeks of consistent use before judging a treatment, and often three months for the full effect. Most treatment "failures" are courses abandoned in week three.

Will the dark marks left behind go away?

Post-inflammatory pigmentation usually fades over months, faster with daily sunscreen and without picking. True pitted scars need procedural treatment, which is why controlling active acne early matters.

Sources

• "Prevalence and Psychological Impact of Acne Vulgaris in Female Undergraduate Medical Students of Rawalpindi and Islamabad, Pakistan," Cureus (PMC)
• "Assessment of Knowledge, Attitude, and Practices Regarding Self-medication for Acne Among Medical Students" (PMC)

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