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Pimples (spots)

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Dermatologists who treat acne, rosacea, and sebaceous disorders

A clear guide to understanding what pimples (spots) are, what causes them, and when they stop being a minor problem.

Before reading: En skinpaths We distinguish between opinion and evidence. To write this content, we prioritized indexed medical sources and recommendations from scientific societies. At the end, you will find the complete bibliography for your reference.
Important: This article is for informational purposes only and does not replace medical advice. If you have any questions, persistent symptoms, or your condition worsens, consult a healthcare professional.

Summary in 60 seconds

  • Pimples are, in most cases, part of the acne spectrum.
  • They appear when the pore becomes clogged with sebum and skin cells, and then they can become inflamed.
  • Black spots (nails) are not dirt: the dark color is related to the exposure of the pore contents to air.
  • They don't all look the same: there are white spots, black spots, papules, pustules, nodules, and deeper lesions.
  • Puberty, genetics, certain cosmetics, friction, and some medications can contribute to them.
  • Stress can worsen outbreaks, and diet can influence some people, but it doesn't explain all cases.
  • Squeezing them often worsens inflammation and increases the risk of marks or scarring.
  • Serious treatments don't work in hours: they usually take several weeks.
  • If there is significant pain, nodules, scarring, a sudden outbreak in adults, or emotional impact, it is advisable to consult a specialist.

What is a biosimilar

In everyday language, “pimple” or “spot” is often used for various acne lesions. Dermatologically, it can refer to a closed comedo (whitehead), an open comedo (blackhead), or an already inflamed lesion, such as a pustule . The central idea is this: the pore becomes clogged, and from there it can remain a non-inflammatory lesion or progress to inflammation. NIAMS 2023 , Sutaria 2023.

It's also worth debunking a common myth: blackheads are not ingrained dirt. Their dark color is due to changes in the pore's contents upon contact with air, not to "poor cleansing." NIAMS 2023 , NHS 2026.

Why do they appear?

The best evidence describes four main mechanisms: excess sebum , follicle obstruction by skin cells , involvement of Cutibacterium acnes , and inflammation . These factors interact; therefore, the same person can have blackheads in some areas and painful lesions in others. Sutaria 2023 , Vasam 2023.

In practice, acne often appears or worsens due to hormonal changes—especially during puberty—family history, oily or occlusive products, repeated friction, and certain medications such as corticosteroids, lithium, or hormones. Stress does not cause acne from scratch in all cases, but it can worsen existing acne. NIAMS 2023 , AAD 2024.

Regarding diet, caution is advised: there is insufficient evidence to recommend a specific diet as a universal treatment for acne , although systematic reviews suggest that certain patterns, such as a high glycemic load, may influence some individuals. This does not mean that every breakout is explained by "eating poorly." NICE 2023 , Meixiong 2022.

What do they look like?

Pimples don't all look the same. They can appear as small whiteheads , blackheads , tender red bumps, white- or yellow-tipped lesions, or deeper, painful nodules. The deeper and more inflamed the lesion, the greater the risk of scarring. (NIAMS 2023 , Mayo Clinic 2024 )

They most commonly appear on the face , but also on the back, chest, and shoulders . When they predominate on the trunk, management with topical products alone can be more difficult due to the size of the affected area and the difficulty of application. NHS 2026 , NICE 2023.

When pain, nodules, scarring, or emotional impact appear, it ceases to be a minor problem.

In what diseases or conditions do they usually occur?

For general guidance and information purposes:

1) Very frequent

  • Comedonal acne vulgaris
  • Papulopustular acne of adolescence
  • Adult acneespecially in women

2) Frequent

  • Mechanical or occlusive acne (friction, helmet use, mask, straps, tight clothing)
  • Cosmetic acne or acne favored by oily products
  • Acne-like outbreaks due to medications (for example, corticosteroids, lithium, androgens)

3) Infrequent

  • Acne associated with hormonal disorders, such as some cases of hyperandrogenism
  • Severe forms, such as nodulocystic or conglobate acne
  • Acne fulminanswhich is rare and requires urgent attention

The most important idea is this: the most common cause of a pimple is acne vulgaris . However, when an outbreak is very sudden, very painful, leaves scars quickly, or is accompanied by hormonal changes or triggering medications, it's advisable to consider more than just "normal pimples" and consult a specialist. NIAMS 2023 , Sutaria 2023 , NICE 2023.

When to consult?

It is advisable to seek medical evaluation before continuing to try products on your own when any of these signs appear: NICE 2023 , Mayo Clinic 2024.

  • Injuries deep, painful, or cystic
  • Scarsdimples or persistent stains
  • Outbreaks that greatly affect back or chest
  • Acne that causes emotional distressembarrassment or affects daily life
  • Lack of improvement after a well-managed treatment over several weeks
  • Outbreak sudden or very intense in adulthood
  • Pimples associated with menstrual irregularity, excessive hair or suspected hormonal problem
  • Clear worsening after starting corticosteroids, testosterone, lithium or other medications
  • Very intense inflammation with fever or general malaise

And there is one important exception: if, after using an acne product, you experience difficulty breathing, swelling of the face, lips, or tongue, or a feeling of tightness in your throat , you need immediate medical attention. Mayo Clinic 2024.

What NOT to do?

It is not advisable to squeeze , scratch , rub vigorously , or "dry" the skin with alcohol, astringents, or aggressive exfoliation. Changing products every few days or relying on the idea that the sun "cures" the problem is also generally unhelpful. These strategies irritate the skin, prolong inflammation, and increase the risk of scarring. (AAD 2022 , AAD 2022b , NICE 2023 )

It is also unreasonable to conclude that pimples appear due to “lack of hygiene.” Washing your face too often can worsen irritation. Evidence and guidelines point instead to gentle, consistent, rather than vigorous, hygiene. NHS 2026 , AAD 2022.

Squeezing accelerates the feeling of "doing something," but often prolongs the injury and increases the risk of scarring.

What does a dermatologist usually do?

In most cases, the diagnosis is clinical : the dermatologist examines the type of lesions, their distribution, depth, whether scarring is present, and how much they affect quality of life. They also ask about age of onset, menstrual flare-ups, products used, medications, family history, and manipulation habits. (Sutaria 2023 , NICE 2023 )

Dermatoscopy is not usually essential for a typical pimple; this is a reasonable inference because the main sources describe the diagnosis of acne as primarily clinical. Biopsy is rare and is reserved for diagnostic uncertainty. Additional tests are not routinely ordered, but may be considered if there are signs of hyperandrogenism, a very sudden outbreak in adulthood, or suspicion of an associated condition. They are also often ordered to initiate systemic treatment ( Sutaria 2023 , NICE 2023 ).

Regarding treatment, the most widely supported approach in the guidelines is to combine therapies with different mechanisms depending on the severity. Among the best-supported options are benzoyl peroxide , topical retinoids , and, in selected cases, oral antibiotics or isotretinoin. The goal is not only to "dry up the pimple" but also to break the cycle of blockage and inflammation and prevent scarring. (Reynolds 2024 , AAD 2024 , NICE 2023 )

FAQ

Do pimples appear because of dirt?

  • No. Pore blockage depends primarily on sebum, skin cells, and inflammation. The color of a blackhead does not indicate dirt or poor hygiene; it won't be "cleaned" by scratching or excessive washing. NIAMS 2023, NHS 2026.

Does popping a pimple help?

  • It usually does the opposite: it increases inflammation, delays resolution, and raises the risk of scarring and post-inflammatory pigmentation. AAD 2022, NICE 2023.

How long does it take for a well-prescribed treatment to show improvement?

  • It is common to start noticing improvement in 6 to 8 weeksand many guides structure the initial assessment around a course of 12 weeksA serious pimple treatment doesn't usually prove its worth in three days. NICE 2023, AAD 2022.

Does chocolate or fatty food cause pimples?

  • This cannot be stated absolutely. The evidence does not support a universal "anti-acne" diet, although some dietary patterns, especially those with a high glycemic load, may worsen acne in certain individuals. NICE 2023, Meixiong 2022.

Why do I still have adult acne?

  • Because acne isn't exclusive to adolescence. It can persist or begin in adulthood, and when that happens, it's relatively common in women. NIAMS 2023, Mayo Clinic 2024.

When is a pimple most likely to leave a scar?

  • When it is deep, painful, nodular, or cystic, when it is frequently manipulated, or when management is delayed. The emotional impact also matters: current guidelines consider the psychological burden when assessing severity. Reynolds 2024, NICE 2023.

Bibliography and sources

Content reviewed by:
Dr. Rodolfo Suárez
Medical Pathologist and Dermatologist
Master's Degree in Advanced Cutaneous Pathology
26/05/2026
19/06/2026
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