The initial joy we feel as a pimple recedes is slowly replaced by dismay at the mark it leaves on our skin. The ghost of pimples past can linger for months and years, often causing just as much distress as they did when they were fresh, red, and angry.
Thankfully, post-acne hyperpigmentation is a well-studied phenomenon. Decades of research have uncovered ways to banish pimples once and for all.
What causes post-acne hyperpigmentation
The first step to solving a problem is understanding it. We know that post-acne hyperpigmentation is caused by the tendency of keratinocytes to produce excessive amounts of melanin in response to injury and inflammation. If the damage is in the superficial layers of the skin, it’s usually colored tan or brown. If the damage is a few layers deeper, the melanin is eaten up by immune cells called macrophages, and it’s more grey-blue in color.
It is important to differentiate between post-acne hyperpigmentation and post-acne scarring. The former is an uneven skin color, while the latter is an uneven skin texture. The interventions we’ll discuss here are appropriate for hyperpigmentation, not scarring.
The problem of dark spots is more prevalent in colored skin than white skin. Studies show that those with African, Asian, Pacific Islander, Middle Eastern roots experience hyperpigmentation more often and more severely because their melanin production is higher to begin with. What more when it’s exacerbated by injury.
Inflammation is a given when it comes to acne, particularly pimples. Getting a zit, particularly if you are a person of color, practically guarantees that you’ll have to deal with its aftermath for weeks to come. The bigger and deeper the pimple is, the larger and darker its mark will be. But if you pick at it, you’re setting back your skin’s healing time by months or even years.
That is because picking is a surefire way to make an angry pimple even angrier. We know, it’s all too tempting to just pop that zit, but unless you want an uneven skin tone, you should stop. Binge-watch pimple popping videos if you must satisfy that urge. Just don’t take it out on your skin!
Another way to exacerbate post-acne hyperpigmentation is failing to protect your skin from the sun. Melanin production is directly influenced by sunlight--that’s the principle behind sunbathing to get a tan. The rest of our skin may become a beautiful toasty brown, but the hyperpigmentation will also get a few shades darker along with it.
How to deal with post-acne hyperpigmentation
Let’s say past is past. You’ve had your fair share of pimples, popped a few in desperation, and painfully living through the consequences. But no fear! You can hasten the journey to clear skin by using products backed up by scientific research.
Use of depigmenting agents
Excessive melanin production is the key issue behind hyperpigmentation, so the best way to address the problem is to incorporate a depigmenting product into your skin care routine.
But note that ingredients that do the job are quite strong. Before trying anything, make sure to read the instructions carefully and conduct a patch test on a small area of your skin to make sure it doesn’t cause an adverse reaction. Better yet, consult a dermatologist on what works best for you.
Hydroquinone is the first line of therapy for those pesky dark spots. It blocks the action of tyrosinase, an enzyme responsible for the final step in the production of melanin. Hydroquinone is well-known to be effective on its own, but many products combine its skin-lightening effect with chemical exfoliators and anti-inflammatories to increase its efficiency and decrease its side effects. While hydroquinone-based products have been known to significantly lessen hyperpigmentation in as early as 4 weeks, they may cause irritation and allergic reactions. Care should be taken to apply this correctly to avoid lightening the skin around the mark, causing a “halo effect” on post-acne lesions. Using these for a long period of time may cause the development of blue-black marks, a condition called exogenous ochronosis, in those with darker skin tones. Following label instructions and consulting a medical professional will help ensure you get the most out of this powerful ingredient.
If you’ve suffered from acne before, you’ve probably heard of retinoids. These Vitamin A derivatives are superstars in the pimple-fighting movement, but studies show that they could achieve the same status in the battle against hyperpigmentation. This is another potent product that must be used carefully in order to prevent side effects like irritation, excessive dryness, and retinoid dermatitis. Try over-the-counter topical retinoids with low concentrations and follow the directions on the label. These products come in creams or gels, some with slow-release formulations to help address the side effects. When used properly, retinoids are great at combating existing acne spots and old acne spots at the same time.
It may be strange to use something that comes from a disease-causing fungus, but studies have shown the safety and effectiveness of azelaic acid in addressing both acne and post-acne hyperpigmentation. This ingredient is derived from a fungus that causes pitryiasis versicolor, a condition wherein patches of typically lighter-colored skin appear. It inhibits enzymes that produce melanin and control populations of rogue melanocytes that produce way more pigment that they should be. This is also used to treat other dermatological conditions including rosacea and melasma, where it has been proven safe and effective for people of color.
We’ve listed three of the top shelf choices for hyperpigmentation, but there are a lot of options available. Niacinamide, arbutin, kojic acid, ascorbic acid are just some ingredients that have performed well in lightening skin spots. Whichever you choose, make it a point to do a background check on the active ingredients to know if it’s right for you and your skin!
Use of chemical peels
Another way to get rid of post-acne hyperpigmentation is to undergo regular exfoliative treatments. Many of the active ingredients, including glycolic acid, salicylic acid, and trichloroacetic acid, may sound familiar to you because they’re also available as over-the-counter topical products. However, when used for chemical peels, these come in much higher concentrations and are therefore sold on a prescription-only basis.
On the upside, their potency increases. Chemical peels are able to remove the top layer of the skin (and the excess melanin pigment in it) to reveal the healthy, even-toned layers underneath.
However, when potency goes up, you can expect safety to go the opposite direction--hence the regulation on these products. It’s best to have these products administered in a dermatologist’s clinic. They will conduct a thorough exam on your skin and assess your medical history (including existing conditions and medicines you’re currently on) to know if the peel is safe for you.
Use of laser therapy
The fact that melanin is influenced by light gave rise to laser therapy. There are specific wavelengths used to target the cellular components responsible for making and strong melanin. By destroying these at different layers of the skin, it would be possible to remove hyperpigmentation.
Laser therapy has been known to be as effective as topical treatments, but there is a tendency to make skin more sensitive to sunlight. There is still much to learn about using light therapy for your marks.
Sun protection and Vitamin D supplementation
Regardless of what product you buy or treatment you use, there is one thing that is absolutely essential when getting rid of post-acne hyperpigmentation: sun protection. While it may not lighten skin, it stops it from getting darker.
Short of covering up every inch of your skin with clothes or hats, the next best thing to do is using a water-resistant, broad spectrum sunscreen with at least SPF30 every single day. Whether you’re potting plants in your garden or going for a run in the park, whether it’s an overcast winter’s morning or a hot summer midday, you must protect your skin from the sun.
There are a lot of good products out there, but you won’t get bang for your buck if you don’t use your sunscreen properly. For your face, it’s best to apply a layer, allow it to dry, then apply a second layer. For your body, you should be able to use a shot glass’ worth everyday. Reapply every few hours, especially if you’re outdoors and sweating.
If you’re protecting yourself from the sun, you are also depriving yourself of Vitamin D. UVB rays catalyze the activation of Vitamin D3 that your body needs to control blood calcium levels, among other important functions. So make sure to get your share by taking Vitamin D supplements.
Learn cosmetic camouflage techniques
No matter what product you use, expect that it will take weeks to months for hyperpigmentation to improve. Achieving complete skin tone evenness will take years.
If your post-acne lesions make you feel less confident about yourself, you can use the power of make-up for a temporary solution. Cosmetic camouflage is a term used for make-up techniques that hide hyperpigmentation that results from dermatological conditions like vitiligo, melasma, maturation dyschromia, lentigines, and yes, post-acne marks. Studies show that there is significant improvement in the patient’s quality of life when properly educated by medical cosmeticians and aestheticians about how to cover up their dermatoses.
Because cosmetic camouflage is used for medical diseases that cause hyperpigmentation, they use products that go above and beyond your run-of-themill full coverage foundation. Many of those prescribed by dermatologists incorporate sunscreen and antioxidants, exclude parabens, comedogenic ingredients, fragrances, and other irritating substances that could cause more lesions.
Cosmetic camouflage also makes use of color correcting. It may be intimidating to use green or purple concealers at first, but the principle is scientifically sound. You negate the color of the acne mark with the hue opposite it on the color wheel.
Acne prevention
If you’ve got acne scars, chances are, you still have acne eruptions now and then. As much as we wish we only had to deal with one skin problem at a time, the reality is we have to juggle acne treatment with hyperpigmentation treatment.
Make sure that your skin regimen is composed of products that do not negate each other’s effects. Doing your research about potential interactions between active ingredients, having a different acne regimen in the morning and the night, or spacing out certain products for once-a-week use are a few good ways to help minimize adverse reactions.
Conclusion
Post-acne hyperpigmentation can be just as self-esteem crushing as live acne. We may have been dealt the wrong card when it comes to our skin condition, but that does not mean we do not have control over it. Consistent use of evidence-based solutions for hyperpigmentation can speed up our journey to clear skin and remove the barrier between us and the people we could become.
This content is for general information only and is not a substitute for medical advice.
Resources:
Davis, E. C., & Callender, V. D. (2010). Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of clinical and aesthetic dermatology, 3(7), 20–31.
Seite, Sophie & Deshayes, Philippe & Dréno, Brigitte & Misery, Laurent & Reygagne, Pascal & Saiag, Philippe & Stengel, F & Roguedas-Contios, Am & Rougier, A. (2012). Interest of corrective makeup in the management of patients in dermatology. Clinical, cosmetic and investigational dermatology. 5. 123-8. 10.2147/CCID.S33172.
Vashi, N. A., & Kundu, R. V. (2013). Facial hyperpigmentation: causes and treatment. The British journal of dermatology, 169 Suppl 3, 41–56. https://doi.org/10.1111/bjd.12536
