As if a major breakout wasn't enough, once the trouble clears another is often left in its wake: dark spots and bumps for some, redness and pocks for others. While certain kinds of marks are considered scars, you’ll be happy to know not all discolorations will become a permanent addition to your complexion.
Whether you’re experiencing temporary hyper-pigmentation or true scaring, it’s important to know the difference when looking in the mirror. Here are the key facts you should know in order to help you identify, treat, and avoid further damage.
Many patients assume the worst and mistake dark spots for scars said New York City-based dermatologist Whitney Bowe, M.D in Teen Vogue. "The red or brown hyper-pigmentation that appears following an acne lesion is caused by temporary inflammation.” Post-inflammatory hyper-pigmentation (PIH) is not an acne scar, but a normal remnant of the skin's inflammatory process.
For those with pale skin tones, the color change from PIH is usually pink, red, or purple. Patients with darker skin tones may develop brown or black spots. PIH can fade unassisted. But it takes awhile: the average healing process can take between six months and a year.
Permanent acne scars occur when normal tissue in the skin and collagen are destroyed and replaced with fibrous tissue. Some scars are thick and raised, while others form a soft, saucer-shaped depression (aka a pock mark) or a jagged “ice pick” scar.
“You can think of an acne lesion as a wound. When the damage caused by acne is severe, the body can respond by creating too much tissue or too little tissue. The production of too much tissue forms a keloid or a hypertrophic scar, and too little tissue leads to that depression in the skin, or atrophic scar,” says Dr. Bowe. “The deeper and more inflamed the acne lesion, or the more that it is picked or squeezed, the more likely it is to scar."
Ninety-five percent of acne patients will develop scarring to some degree. Unfortunately there is often no single "best" solution that applies to every individual or acne scar. Location, depth, size, and the number of scars can all affect what treatment course might be best for your skin. It’s important to talk with your dermatologist to decide what’s best for you.
Treatments for hyper-pigmentation include a wide variety of alpha hydroxyl acids ( glycolic, lactic, mandelic acids, for example) and topical retinoid products (Retin-A) that help support natural cell turnover and encourage collagen production.
If you’re looking to treat scars, over-the-counter products will most likely fail to impress. Permanent removal generally requires a professional procedure, like laser treatment, injectable fillers, dermabrasion, and chemical peels.
Whatever treatment option you choose, understand that improvement will take time. Think in terms of months rather than weeks. And in the mean time, always use a broad-spectrum sun screen. Ultraviolet light can darken the skin, thereby making scars more visible and increasing fading/healing time.