The cosmetic effects of acne are not limited to the active comedones, pustules, nodules and cysts that characterize acne. Acne is often accompanied by scarring and skin discoloration that can prove to be a major cause of distress for acne sufferers.
Read on to find out what acne dark spots are and the best ways to get rid of them.
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Acne dark spots¹ are areas of more deeply pigmented skin that develop after the skin has been damaged. The medical term for them is postinflammatory hyperpigmented lesions.
Acne pustules, nodules, and cysts can all cause infection to spread to the deep layer of the skin (the dermis). As part of the healing process, the cells in the inflamed area of the dermis release more melanin.
Melanin is the pigment that gives your skin color. The more melanin you produce, the darker your skin tone. The end result is a darker lesion over the area of skin that was inflamed.
In most cases, only moderate to severe acne will cause dark acne spots. However, if you pick and squeeze more superficial pimples, the damage can be bad enough to trigger the same process and result in dark acne spots.
Increased melanin² in the epidermis (the more superficial layer of the skin) will form tan, brown, or dark brown spots. When there is increased melanin in the dermis layer, it can result in hyperpigmented lesions that appear blue or grey in color.
Postinflammatory hyperpigmentation affects all skin types¹, although it is more common if you have darker skin. One study³ in the US found postinflammatory hyperpigmented lesions in 65.3% of Black subjects, 52.7% of Hispanic subjects, and 47.4% of Asian subjects who had acne.
Both acne dark spots and scars are a consequence of skin damage resulting from acne.
Acne scars form when there is disruption to the actual structure of the skin. Although scars may fade slightly over time, it is unlikely that they will go away without treatment. Acne scars can often be felt on the surface of your skin as pits or raised areas. Treatment of acne scars is usually more invasive than treatment of skin discoloration due to acne.
On the other hand, acne dark spots are the result of increased melanin production in response to inflammation, rather than structural changes to the skin itself. Unlike acne scars, acne dark spots cannot be felt on the surface of the skin as they are not raised or indented. These spots will usually resolve on their own¹ over a period of 3-24 months, but there are ways you can help them to fade more quickly.
Dark acne spots can be treated² as follows:
Minimizing sun exposure — To prevent lesions from forming due to sun damage.
Topical depigmenting treatments — While often available over-the-counter, these should be used under the guidance of a dermatologist, especially if you have darker skin.
Chemical peels — These should be performed by a dermatologist.
Physical treatments — Procedures such as microdermabrasion, laser therapy, and photodynamic therapy should be done by a dermatologist.
1. Prevention is better than treatment
In order for hyperpigmented lesions to form, there needs to have been inflammation. The best way to get rid of dark acne spots is to prevent them from forming in the first place. Early, appropriate treatment of your acne will limit its severity, decreasing the risk of developing pustules, cysts, or nodules that may lead to dark acne spots.
Likewise, refraining from picking¹ or squeezing your pimples will help to prevent the formation of hyperpigmented lesions. As much as you may be tempted to pop that pimple, any interference with your acne lesions will worsen the inflammation they cause, which in turn increases the risk of developing hyperpigmented lesions later on.
2. Wear sunscreen
Exposure to ultraviolet (UV) light¹ from the sun triggers the production of melanin in your cells. If you have a dark acne spot, exposing it to the sun will cause it to darken further, making it more obvious and it can take longer to fade.
Whenever you are outside, make sure to wear a non-comedogenic (won’t clog your pores), oil-free sunscreen to prevent your acne dark spots from getting darker.
3. Select your cosmetics carefully
You may be desperate to hide your acne dark spots under a thick concealer, but this could only make the problem worse. Thick, occlusive makeup and cosmetics can contribute to clogged pores⁴, which end up making your acne worse and causing more dark spots to form. To avoid that cycle, choose makeup that is non-comedogenic, non-acnegenic, and oil-free.
Hydroquinone⁵ is a depigmenting agent that can be applied topically. It works by decreasing the number of melanin-producing cells (melanocytes). As your melanocyte numbers decrease, melanin levels drop, which lightens your skin.
Hydroquinone typically takes about four weeks for the treatment to start to work, and can take several months for you to see full results. It is usually applied in concentrations of 2% as stronger concentrations can produce unwanted side effects.
5. Kojic acid
Kojic acid⁵ is another topical depigmenting agent. It is a byproduct of several types of fungi; Acetobacter, Aspergillus, and Penicillium).
Kojic acid works by inhibiting the action of tyrosinase, which is necessary for the production of melanin. Kojic acid is usually used in concentrations of 1% to fade dark acne spots as higher concentrations can cause skin irritation.
Retinoids⁵ are vitamin A derivatives that can be used topically to treat acne, as well as to fade acne dark spots.
Retinoids decrease the amount of melanin in your skin by inhibiting tyrosinase action and dispersing melanin that is present in the epidermis. They are a good option for fading your acne dark spots if you still have active acne, as they can treat both conditions simultaneously.
7. Azelaic acid
Azelaic acid² is a naturally occurring acid found in some grains, such as wheat and barley. It can be used topically as a depigmenting agent.
Azelaic acid has been shown to be effective in managing postinflammatory hyperpigmentation. It works by both inhibiting the action of tyrosinase and killing off abnormal melanocytes.
Azelaic acid is also used to treat acne, so topical use of a 20% gel form of azelaic acid would treat both ongoing acne lesions and residual acne dark spots.
8. Chemical peels
Chemical peels are agents that break the bonds between skin cells to cause peeling of the superficial layers of the skin. They are effective in fading acne dark spots and other hyperpigmented lesions.
A range of different chemicals, applied at different strengths and concentrations, can be used to induce peeling and penetrate the skin to varying depths in the skin, from very superficial to deep.
Some of the chemicals typically used in chemical peels include:
Alpha-hydroxy acids such as glycolic acid
Chemical peel procedures should be done by, or under the guidance of, a dermatologist, as they can cause skin irritation and, if done incorrectly, can even burn the skin. This is especially important for people of color as they are at higher risk of developing hyperpigmented lesions if a chemical peel is too strong or incorrectly applied.
Microdermabrasion is a procedure in which the surface of the skin is buffed, like a very deep exfoliation. It can help to fade superficial dark acne spots.
10. Blue-light photodynamic therapy
Blue-light photodynamic therapy (PDT)² has been used successfully in the treatment of postinflammatory hyperpigmented lesions. It may be an option when other treatment options have failed, and should be done by a dermatologist.
When darker skin becomes inflamed, it is more likely to lead to hyperpigmentation. Postinflammatory hyperpigmentation following acne lesions is both more common and more severe² in people with darker skin. Some of the products used to treat acne dark spots can cause damage and inflammation to the skin, which may lead to further skin discoloration and postinflammatory hyperpigmentation.
Although all of the treatments for acne dark spots discussed in this article are safe for people of color to use on their skin, they should be used under the guidance of a dermatologist to avoid or manage any potential side effects. This is especially the case with treatments that deeply penetrate the skin, such as chemical peels.
Acne dark spots can be a distressing and lasting consequence of acne. They are the result of increased melanin production in the skin as it tries to heal from inflammation. Postinflammatory hyperpigmentation is both more common and more severe in people with darker skin.
The first rule of treating acne dark spots is to prevent them. Avoid picking your pimples, avoid sun exposure, treat acne early and effectively, and treat dark spots as soon as they appear.
Treatment for acne dark spots includes topical depigmenting agents, chemical peels, microdermabrasion, and photodynamic therapy.
If you have darker skin, it is important that you undertake any treatment under the guidance of a dermatologist to avoid or manage any potential skin irritation, which could lead to further inflammation, hyperpigmentation, and dark spots.
Post acne hyperpigmentation: A brief review | Research Gate
Acne | MSD Manual Consumer Version