Acne (jerawat): causes, what spots in different places mean, and treatments that work
Acne is one of the most common skin conditions in Malaysia, affecting about two in three teenagers and many adults. Most acne responds well to the right treatment, but it takes time, and some spots that look like acne need different care. Here is what causes it, what different locations can mean, which treatments the evidence supports, and when to see a doctor.
Key points
- Acne is caused by oily skin, blocked pores, skin bacteria and inflammation, often driven by hormones. It isn’t caused by dirt, and scrubbing makes it worse.
- Itchy, uniform bumps on the back and chest are often “fungal acne” (Malassezia folliculitis), which is common in hot, humid weather and needs antifungal treatment.
- A rash of small bumps around the mouth may be perioral dermatitis, often triggered by steroid creams, not acne.
- Benzoyl peroxide, topical retinoids and azelaic acid work, but take 8 to 12 weeks. Doctors can add antibiotics, hormonal treatment or isotretinoin.
- Avoid unregistered creams: NPRA has cancelled products containing hidden steroids, tretinoin and mercury.
What causes acne?
Acne starts in the hair follicles (pores). Four things work together:
- The skin makes too much oil (sebum), often driven by hormones during puberty, periods, pregnancy or conditions such as polycystic ovary syndrome (PCOS)
- Dead skin cells block the pores, forming blackheads and whiteheads
- Bacteria that normally live on the skin (Cutibacterium acnes) multiply in the blocked pore
- Inflammation turns blocked pores into red spots, pus-filled spots, and deeper nodules or cysts
Malaysia’s 2022 acne guidelines report acne in about two-thirds of teenagers aged 13 to 17. It usually improves after the teenage years, but adult acne is common, especially in women.
What makes it worse: stress, picking or squeezing spots, oily cosmetics and hair products, and possibly high-sugar diets and large amounts of milk (the evidence is limited). Acne isn’t caused by dirty skin. The evidence on chocolate is mixed.
Spots in different places: what they can mean
| Where | What it may be |
|---|---|
| Forehead, hairline, eyebrows | Acne, often aggravated by oily hair, fringes and hair products. Spots from hair products can take 4 to 6 weeks to clear after stopping the product. |
| Around the mouth, lips and nose | Often perioral dermatitis: small red bumps that spare the skin right next to the lip. It is commonly triggered by steroid creams, or inhaled and nasal steroids, and can flare when they are stopped. It needs different treatment from acne. |
| Jawline and chin in adult women | Often linked to hormones. Acne with irregular periods or excess hair can be a sign of PCOS. |
| Upper back and chest | Acne, or “fungal acne” (Malassezia folliculitis): small, uniform, itchy bumps without blackheads, common in hot, humid weather and in young men. It is treated with antifungal washes or tablets, not acne creams. |
| Buttocks | Usually folliculitis (inflamed hair follicles) from sweat, friction and tight clothing, rather than true acne |
“Face mapping”, the idea that spots in certain areas reflect problems with particular organs, has no scientific basis.
Acne treatments that work
These treatments are recommended in Malaysian and international guidelines:
- Benzoyl peroxide: kills acne bacteria and reduces inflammation. Available from pharmacies. It can bleach fabrics and cause dryness, so start with a low strength.
- Topical retinoids (adapalene, tretinoin): unblock pores and prevent new spots. They cause dryness at first, make the skin sensitive to sun, and must not be used in pregnancy.
- Azelaic acid: treats spots and helps fade dark marks left by acne.
- Salicylic acid: sold over the counter, with modest benefit for mild acne.
- Topical antibiotics (clindamycin): prescribed, and always used with benzoyl peroxide or a retinoid, never alone, to prevent resistance.
- Oral antibiotics (such as doxycycline): for moderate acne, usually for no more than 3 to 4 months, alongside a cream.
- Hormonal treatment: the combined contraceptive pill or spironolactone can help women with hormone-related acne.
- Isotretinoin tablets: very effective for severe, scarring or persistent acne. In Malaysia, guidelines say it should be prescribed by dermatologists. It causes serious birth defects, so women must use contraception during treatment and for a month afterwards, and doctors monitor blood tests and mood.
Be patient: most treatments take 8 to 12 weeks to work. Use them on the whole area, not just on spots, and keep going after the skin clears to prevent relapse.
Do acne patches work?
Hydrocolloid acne patches absorb fluid from a spot and, just as importantly, stop you touching and picking it. They can help a single surfaced whitehead heal, but the research is small, and they don’t treat deep cysts or prevent new acne.
What not to do
- Don’t pick or squeeze spots. It spreads inflammation and causes scars and dark marks.
- Don’t scrub, or use toothpaste, lemon or alcohol on spots. Wash twice a day with a gentle cleanser.
- Don’t use steroid creams on the face. They can worsen acne and cause perioral dermatitis.
- Avoid unregistered “acne” or “whitening” creams. The National Pharmaceutical Regulatory Agency (NPRA) has repeatedly cancelled cosmetics found to contain hidden steroids, tretinoin, hydroquinone and mercury, which can thin and damage the skin and harm the kidneys and nerves. Check products on the NPRA website.
Dark marks and scars
Dark marks after acne (post-inflammatory hyperpigmentation) are very common in Asian skin, affecting up to 87% of acne patients in some studies, and can last more than a year. Treating acne early, sun protection, and azelaic acid or retinoids help them fade. Acne scars affect many people with acne.
Once acne is controlled, scars can be improved with treatments such as chemical peels, laser resurfacing and microneedling at a doctor-led aesthetic clinic. See our guide to laser treatments and checking a clinic.
When to see a doctor
- Painful, deep nodules or cysts, or acne that is leaving scars or dark marks
- No improvement after 2 to 3 months of pharmacy treatment
- Acne affecting your confidence, mood or daily life
- Sudden adult acne with irregular periods or excess hair, which may be PCOS
- Itchy bumps on the back and chest that don’t respond to acne treatment
- Acne during pregnancy, as some treatments aren’t safe
Seek help urgently for acne that suddenly becomes painful and ulcerated with fever, or if acne is making you feel hopeless or think about harming yourself.
Where to get acne treated
A GP can diagnose acne and its look-alikes, prescribe creams and tablets, and refer you to a dermatologist for severe acne. For acne scars, choose a doctor-led aesthetic clinic. Our directory lists GP and aesthetic clinics across Kuala Lumpur, Selangor and other states.
Browse the clinic directoryFrequently asked questions
How do I get rid of acne? (Cara hilangkan jerawat)
Wash twice daily with a gentle cleanser, don’t pick spots, and use an evidence-based treatment such as benzoyl peroxide, a topical retinoid or azelaic acid for at least 8 to 12 weeks. See a doctor if it doesn’t improve or leaves scars.
Why do I get acne on my eyebrows and forehead? (Jerawat di kening)
Often from oily skin, oily hair, fringes, and hair or skin products that block pores. Spots caused by hair products can take 4 to 6 weeks to clear after stopping the product.
Why do I get spots around my lips? (Jerawat di bibir)
Small red bumps around the mouth may be perioral dermatitis rather than acne, often triggered by steroid creams or inhalers. See a doctor, as acne creams can make it worse.
Why do I get acne on my bottom? (Jerawat di punggung)
Spots on the buttocks are usually folliculitis, inflammation of hair follicles from sweat, friction and tight clothing, rather than acne. Loose cotton clothing and gentle washing help.
Do acne patches work? (Patch jerawat)
They help single surfaced whiteheads heal and stop you picking, but evidence is limited and they don’t treat deep cysts or prevent new spots.
What is fungal acne?
Malassezia folliculitis causes small, uniform, itchy bumps on the back and chest, common in hot, humid climates. It is caused by yeast, not acne bacteria, and is treated with antifungals.
Sources
- Ministry of Health — Clinical Practice Guidelines: Management of Acne Vulgaris, 2nd edition (2022)
- Reynolds et al. — Guidelines of care for the management of acne vulgaris (American Academy of Dermatology, 2024)
- NHS — Acne (Sep 2026)
- American Academy of Dermatology — Adult acne
- American Academy of Dermatology — Hair products and acne
- American Academy of Dermatology — Acne scars: diagnosis and treatment
- DermNet — Malassezia folliculitis
- DermNet — Periorificial dermatitis
- British Association of Dermatologists — Acne patient information leaflet
- NPRA — Press release on cancelled cosmetic products (Nov 2025)
- The Star — Health Ministry bans cosmetic products containing scheduled poisons (2 Apr 2026)
