Why Does Acne Leave Dark or Red Marks?
Dealing with active acne is a struggle in itself, so it can be especially frustrating when they leave a mark after. Acne scars are a common phenomenon that occurs after active acne breakouts subside. Genetic makeup, high-levels of inflammation, and physical irritation can encourage the skin to become atrophic or hypertropic during the healing process. However, many experience no compromise in the skin’s texture. Instead, they may notice spots that are more red or brown than their natural skin tone left behind after a breakout. These spots are known as postinflammatory hyperpigmentation. The “hyper-” prefix indicates an excessive amount of color or “pigment” of the skin. The stark difference in color between the darker regions and the surrounding skin may encourage our eyes to be drawn to them and pose several health concerns.
Here at the Scar Healing Institute, we provide care to patients from a large range of backgrounds and history. The skin is a characteristic unique to each person, so our goal is to treat various skin conditions with methods that reduce and prevent scarring while tackling the emotional or physical toils that are often associated with them.
Types of Pigmentation
In the world of dermatology, there are several types of pigmentation that different skin conditions can be characterized as:
- Melasma: Larger gray/brown dark spots typically caused by factors such as: genetic predisposition, hormonal changes, sun exposure, stress, etc. Melasmas are most commonly spotted on the cheeks, forehead, and upper lip regions.
- Sun Spots: These areas of hyperpigmentation are caused by excessive UV damage during frequent sun exposure. Therefore, this type of sun damaged skin is commonly found on areas of the body that come into contact with the sun, such as: face, neck, hands, or chest. The common term of “age spots” also fall into this classification.
- Post-inflammatory hyperpigmentation: Hyperpigmentation that is formed as a response to centralized irritation and inflammation of the skin. This type can be found across the entire body.
Most examples of hyperpigmentation can be labeled by one of these titles; however, there is a high chance for variability between the standard depictions of these lesions in comparisons to the ones that form on the body. It is critical to receive professional care in order to confirm diagnosis and select safe treatment plans that are designed for the skin condition.
Why does the skin hyperpigment after inflammation?
Acne forms on the skin when the pore becomes filled with debris or bacteria, irritating the skin and causing inflammation at the site. This inflammation stimulates the melanocytes in the skin, inducing overproduction of melanin in the affected area, and making the skin darker.
It is important to note that postinflammatory hyperpigmentation is not a response limited to acne breakouts. General trauma to the skin can induce high levels of inflammation and trigger this rapid melanin production. Some examples of skin injury that may lead to hyperpigmentation include:
- Surgical procedures
- Eczema
- Psoriasis
- Razor Bumps
- Picking of the skin
- Cuts or burns
- Bug bites
Hyperpigmentation of Darker Skin Tones
You may notice that even the smallest pimples, minor scratches, or singular bites leave these darker spots behind. Everyone is susceptible to experiencing hyperpigmentation, but some people are more prone to this phenomenon than others. Generally, people with darker skin tones, Fitzpatrick skin types III to VI, have a higher chance of experiencing postinflammatory hyperpigmention due to larger melanocytes and a higher count of them. This leads to extra melanin production at the site of irritation. Additionally, darker skin tones tend to hold onto that pigmentation longer. It takes a long time for the body to break down and disperse the high concentration of melanin, so many may find that these dark spots stick around for several weeks, months, or even several years.
Can hyperpigmentation be treated?
Most hyperpigmentation is generally harmless, but the red or dark spots that are left behind can pose significant cosmetic concerns for many.
The first step in the treatment process is to limit the cause of the problem and prioritize preventative treatment. Addressing conditions such as active acne, eczema, or psoriasis will reduce the risk of the additional postinflammatory hyperpigmentation. Limiting the root cause of the inflammation will reduce the risk of additional hyperpigmentation after the inflammation subsides. This provides a fresh starting point to begin treatment of the darker skin color.
The human body performs remarkable operations on a daily basis. In many cases, the body is capable of dispersing that melanin naturally over time. The skin color lightens in this area as the older layers of skin approach the outer layers and are shed away from natural exfoliation. Unfortunately, it is difficult to predict how long this process may take. Superficial pigmentation typically disappears within several months, but deeper pigment may take upwards of several years to fade away.
Treating hyperpigmentation often involves a stepwise treatment plan. This begins with learning to protect our skin and prioritize preventative skin care. Sun protection must be kept at a high priority when addressing postinflammatory hyperpigmentation. Concentrated pigmentation in one area is more susceptible to obvious change in color and appearance from excessive sun damage. Melanin does a wonderful job at absorbing a significant amount of ultraviolet rays that cause damage to the skin; therefore, it is not uncommon for the skin to stimulate additional melanin production as a form of protection. We can support sun protection with consistent use of a sunscreen with an SPF of 30 or more to effectively absorb the harsh UV rays.
Gentle treatment of the skin should also be a high priority in your day to day life. Overly harsh products, or too many of them at once, may be overwhelming the skin. Many should consider more gentle skincare products that will not cause reactions or flare ups that may contribute to inflammation.
Treatment for Reducing Dark Spots
Topicals
The topical creams are a common first approach to treat postinflammatory hyperpigmentation. These topical treatments are composed of a lightening agent that encourages the color to fade with consistent use by reducing the rate of melanin production or increasing turnover of melanin cells. Common examples include topical retinoids or hydroquinone.
Pros:
- Topicals are a non-invasive treatment option that show high rates of improvement for hyperpigmentation in the outer layer of the skin.
- Little to no risk of triggering additional hyperpigmentation.
- Topical lightening agents can be used in combination with other treatments as a preventative measure.
- Many find this method sufficient for lightening their hyperpigmentation.
Cons:
- Stubborn melanin deeper in the skin may not respond well.
- Topical treatment supports gradual improvement rather than immediate results post-treatment.
- Topicals at too high of a strength may be irritating to the skin. Retinoid and hydroquinone usage should be discussed with an expert.
Microneedling
This procedure involves the use of small needles to make micro-injuries to the skin. These disturbances trigger the skin’s healing process and encourage cell turnover. In many cases, this procedure is performed after application of chemicals such as glycolic acid or TCA.
Pros:
- Microneedling allows for better penetration of lightening agents. Combination with an acid allows for a synergistic effect that supports exfoliation of the treated skin, lightening the skin color as a result.
Cons:
- Induces temporary swelling on the treated areas.
Laser Treatment
If the topical is not sufficient to lighten the site, we have several laser skin resurfacing tecniques that target different types of hyperpigmentation on the skin. Commonly used types include carbon dioxide and erbium lasers. Our providers are well-trained experts on these various lasers, making adjustments to put forward safe but effective treatments for each patient.
Pros:
- These lasers emit a specific wavelength that can accurately target the darker regions. This wavelength is absorbed by the melanin, and converted heat has the power to disperse the pigment, making it easier for the body to disperse.
- Minimal recovery time with this process.
- The precision of laser treatment allows for specificity for the darker areas, leaving the surrounding skin unharmed.
Cons:
- Laser therapy is a more aggressive approach that must be performed with caution and expertise. Proper treatment after the procedure must be followed to prevent additional postinflammatory hyperpigmentation.
- Due to variability between each person’s skin, some require multiple sessions of pigment laser to see significant results
- Recovery time after laser resurfacing varies based on the type of laser used, varying from a few days to several weeks.
Why choose the Scar Healing Institute?
Making the steps towards professional care for your skin is a wonderful investment to make for your skin health. Everyone’s skin has their own background and personality that would benefit from the professional care of a health provider. The Scar Healing Institute was founded by Mohs surgeon Dr. Salar Hazany to provide effective skin treatments that restore lost confidence. After a thorough consultation, our providers combine their 10-year expertise of treatment plans and skin types with this medical education to generate tailored plans for each patient. This begins with a physical exam of the skin, and our experienced clinicians will generate a plan that is considerate of your medical history, external factors, and goals. The treatments performed in office all focus on addressing both the physical concerns that catch the eye and the emotional bearing that is attached to them.
Those who notice that their skin is more prone to hyperpigmentation should approach treatment after thorough understanding and precaution. Although there are several approaches to treating areas of darker skin color, aggressive procedures create a risk of triggering additional postinflammatory hyperpigmentation on the treated areas. The Scar Healing Institute advocates for gradual and safe progress rather than overly harsh methods to treat hyperpigmentation. The skin is quite delicate and sensitive, so specialized care will reduce the risk of making the skin darker in the treatment area.
Postinflammatory hyperpigmentation can change how we view existing scars or cause general stress as we work hard to protect our skin. Our experts understand how the variability of the skin can induce additional frustrations and anxiety in our daily lives. Making the step to treat your skin at the Scar Healing Institute is the first step to feeling like yourself in your own skin.
