Post-Inflammatory Hyperpigmentation Treatments

How To Treat Dark Acne Marks

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Even after pimples have healed, they may leave dark marks behind. These spots may be red, brown, pink or purplish.

These acne marks are called post-inflammatory hyperpigmentation, and they are your skin's natural reaction to an inflammatory injury, in this case inflamed pimples. 

Post-inflammatory hyperpigmentation will, in most cases, fade over time. But because it can make you feel self-conscious about your skin, you can treat it and speed up the fading process.

Tips for Before You Start Treating Post-Inflammatory Hyperpigmentation

Before you jump in and start treating your post-inflammatory hyperpigmentation marks, use these tips to set the stage for the best results possible.

Your acne should be under control or at least being treated. Otherwise, each new pimple could cause another dark spot and you would never get ahead of the curve (and never see the clear, even skin tone you're looking for).

Over-the-counter acne products are effective for treating mild acne. More stubborn or severe breakouts need to be treated with prescription acne medications if you want to see real improvement.

Use sunscreen daily. The sun may darken the discolorations and increase fading time. Plus, many post-inflammatory hyperpigmentation treatments (and many acne treatments, too) can make your skin more sensitive to the sun.

If you're worried that sunscreen could make your breakouts worse, don't be.

There are many sunscreens available that are appropriate for breakout-prone skin.

Monitor your skin for irritation. Although they are helping you clear your skin, acne treatments and post-inflammatory hyperpigmentation treatments alike also have the potential for causing irritation.

Unfortunately, irritated skin could lead to even more dark spots and uneven skin tone.

If post inflammatory hyperpigmentation is a problem for you, let your dermatologist know if your skin becomes irritated from your acne treatments.

Be prepared to be patient. Post-inflammatory hyperpigmentation takes a long time to fade, whichever treatment option you choose. Think in terms of months rather than weeks. Slow and steady and consistent treatment is your friend.

When you're ready to begin treatment, you have plenty of options. Remember, this isn't a comprehensive list. Other treatments may be available. Your dermatologist can help guide you to the right treatment for your skin. Here are some options you and your doctor may consider.

Alpha Hydroxy Acids (AHAs)

Alpha hydroxy acids, especially glycolic acid, are a good starting point for post-inflammatory hyperpigmentation treatment. Alpha hydroxy acids (AHAs) help speed up the skin's natural exfoliation process, which can help improve the look of post-inflammatory hyperpigmentationPIH.

Many over-the-counter cleansers, lotions, creams, and gels contain AHAs. These may be a good choice if hyperpigmentation is fairly mild.

Stronger AHA treatments are available with a prescription. AHAs are often used as anti-aging treatments too, and will leave your skin super soft and smooth.

Topical Retinoids

Topical retinoids are often prescribed to treat acne. Retinoids help clear acne by speeding up cell turnover rates. This rapid exfoliation can also help fade post-inflammatory hyperpigmentation.

Retinoid creams include Retin-A (tretinoin) and Retin-A Micro, Tazorac (tazarotene), and Differin (adapalene). The fact that they lessen post inflammatory hyperpigmentation as they treat acne breakouts is an added benefit for many people.

With the exception of Differin, these medications are available with a prescription only.

Hydroquinone

Hydroquinone is a widely used treatment for hyperpigmentation.

It is available over-the-counter at 1% to 2% strength, and in 3% to 4% prescription creams. Hydroquinone works by blocking the enzyme responsible for melanin production, which helps lighten the skin.

Hydroquinone creams often contain additional lightening ingredients, such as kojic acid, glycolic acid, tretinoin and other retinoids, or vitamin C. These combination creams can give you better results than using hydroquinone alone.

Hydroquinone creams should be carefully applied to darkened areas only to prevent the unwanted lightening of your natural skin color. Hydroquinone may cause irritation in sensitive individuals. It's worth talking to your doctor before beginning hydroquinone treatment.

Azelaic Acid

Azelaic acid is another medication used to treat acne as well as post-inflammatory hyperpigmentation. It works by decreasing inflammation and speeding up cell turnover rates. Azelaic acid is sometimes used in conjunction with glycolic acid or tretinoin.

Some studies have shown azelaic acid to be as effective as hydroquinone at treating hyperpigmentation. It is a good alternative for those who may be unable to use hydroquinone. 

To get azelaic acid, you'll need a prescription from your doctor.

Salon and In-Office Treatments

Post-inflammatory hyperpigmentation can also be treated professionally at skin spas, medispas, or your dermatologist's office. Procedural treatments include various chemical peels and microdermabrasion.

But just one treatment isn't enough to fade PIH. Most likely you'll need a series of treatments spaced a week or so apart (depending on the procedure you're having done).

Your doctor can help determine which of these treatments, if any, would be most effective for you.

Sources:

Mohamed Ali BM, Gheida SF, El Mahdy NA, Sadek SN. "Evaluation of Salicylic Acid Peeling in Comparison with Topical Tretinoin in the Treatment of Postinflammatory Hyperpigmentation." Journal of Cosmetic Dermatology. 2017 Mar;16(1):52-60.

Sarkar R, Parmar NV, Kapoor S. "Treatment of Postinflammatory Hyperpigmentation With a Combination of Glycolic Acid Peels and a Topical Regimen in Dark-Skinned Patients: A Comparative Study." Dermatologic Surgery. 2017 Apr; 43(4):566-573.

Shokeen D. "Postinflammatory Hyperpigmentation in Patients with Skin of Color." Cutis. 2016 Jan;97(1):E9-E11.

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