Hyperpigmentation and Acne

Published August 4th, 2021 by Emily Wagner
Fact Checked by
Chris Riley
Medically Reviewed:
Dr. Angel Rivera

Acne is the most common skin condition that affects people of all ages. In fact, roughly 80 percent of people ages 11 to 30 have experienced acne of some kind. This means that many people will also develop dark spots where their acne once was. This is known as post-inflammatory hyperpigmentation (PIH).

If you struggle with dark brown spots or patches after your acne has cleared, you are not alone. The American Academy of Dermatology has found that acne PIH can have a negative impact on self-esteem. Fortunately, there are several treatments and methods to prevent PIH from developing. These are available over-the-counter (OTC) or with the help of a dermatologist. 

Acne

Acne vulgaris, or more simply acne, is a skin condition that develops when hair follicles are clogged with dead skin cells, bacteria, and/or oil. It mainly occurs on the face, upper back, shoulders, and chest.

Acne can be caused or worsened by a number of factors, such as hormones, diet, certain medications (testosterone, corticosteroids), and stress. There are several types of acne that vary in appearance and severity.

Blackheads

Blackheads are clogged pores that are filled with oil and bacteria, and when they are exposed to the air they become dark.

Whiteheads

Whiteheads are clogged pores that are closed off from air, making a raised, white bump.

Papules

Papules are an early form of pimples that are small, inflamed red bumps on the skin.

Pustule

When papules are filled with pus (a yellow-white fluid), they are known as pustules

Cystic Acne

Cystic acne is the most severe form, and it develops when there is inflammation and bacteria deep inside the hair follicles. This can lead to even more inflammation and result in large, red boils on the skin’s surface. In some cases, acne cysts may also contain pus.

Hyperpigmentation After Acne

Hyperpigmentation refers to the dark spots that can develop after acne has healed. These dark spots are caused by special skin cells, known as melanocytes, making too much melanin (the brown pigment that makes our skin tone). Melanocytes are found in between the outer layer of the skin (the epidermis) and the inner layer of the skin (the dermis). 

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) is a specific type of hyperpigmentation that occurs after skin injuries and inflammation. Inflamed acne can lead to PIH, but other causes include family history, and using certain skin products or medications.

During PIH, inflammation causes melanocytes to make more melanin than they normally would, which can make areas of the skin a darker brown color.

This inflammation can also affect another type of skin cell that is responsible for making keratin. These cells are found in the deeper layers of skin, and when they are damaged they release melanin; this creates a blue-gray skin discoloration, which can be permanent.

People with darker skin tones are more commonly affected by PIH. This includes populations such as:

  • African Americans
  • Asians
  • Hispanics/Latinos
  • People of Middle Eastern descent
  • Pacific Islanders
  • Native Americans

Acne Scars

In some cases, acne scarring can also develop after blemishes have healed. This scarring is also caused by inflammation, which causes the pores to swell and break down the skin. In order to heal this breakdown, the skin creates new collagen; however, this can cause raised scars to form.

PIH is different from acne scarring because PIH is typically a round, flat area of discoloration. On the other hand, acne scars can be raised bumps or pits on the skin due to skin damage and tissue loss. 

Treatments for Post-Inflammatory Hyperpigmentation 

Acne can be troublesome, and dark marks that hang around after the blemishes heal can be even worse. The good news is there are a number of treatment options for every skin color that can help get rid of these spots and also treat your acne.

Topical Treatments

Topical treatments include ingredients like skin acids to help lighten the skin and even skin tone. Many are available OTC, while others are given as prescription creams or gels by a dermatologist.

Kojic Acid

Kojic acid treats PIH by stopping skin cells making melanin. It also has antioxidant effects, which can help fight the inflammation that causes hyperpigmentation. Products typically contain 1 to 4 percent kojic acid.

Azelaic Acid

Azelaic acid stops the skin from producing keratin, while killing bacteria that can infect and clog pores.

Ascorbic Acid

Ascorbic acid is a compound derived from vitamin C. It stops skin cells from making melanin, and it can also break down the pigment that has already been made. Ascorbic acid also offers anti-inflammatory benefits because it is an antioxidant.

Alpha Hydroxy Acids

Alpha hydroxy acids (AHAs) are a group of skin acids that exfoliate and help remove dead skin cells. They are gentle on the skin and are commonly used in treatments for both acne and PIH. There are several AHAs, including:

  • Mandelic acid
  • Citric acid
  • Lactic acid
  • Glycolic acid
  • Tartaric acid

Salicylic Acid

Salicylic acid is a common substance found in many acne treatments because it reduces inflammation and can treat hyperpigmentation.

Topical Retinoids

Retinoids are compounds derived from vitamin A that were traditionally used for treating fine lines and wrinkles. However, they have proven to be useful for treating acne and PIH. Retinoids work by exfoliating the skin, helping it get rid of dead cells to make way for new ones.

One retinoid, hydroquinone, has been called the “gold standard treatment for hyperpigmentation.” Others include tretinoin, adapalene and tazarotene, which have all been shown to be effective in treating PIH.

Chemical Peels

Chemical peels use skin acids to intensely exfoliate the skin, “peeling” away the top layers that are affected by acne and hyperpigmentation. The new skin that heals in place of the removed layers is smoother and lighter in tone.

Depending on how deep the hyperpigmentation is, you can use an OTC chemical peel or get one in a dermatologist’s office. These can be intense treatments and cause skin irritation; in some cases, they can make hyperpigmentation worse, so use caution.

Laser Therapy

Laser therapy (also known as laser resurfacing) uses intense beams of light to peel away the top layer of skin and remove hyperpigmentation. It can also be used to stimulate the deep layers of skin to make collagen, smoothing the skin and improving tone.

Dermabrasion

Dermabrasion uses an abrasive brush to gently scrape the layers of skin from the face, leaving room for healthy skin cells to grow. After around 8 weeks, the healed skin will be smoother and lighter. It can take multiple dermabrasion sessions to see results, depending on how dark and deep the hyperpigmentation is.

Taking Care of Your Skin

Many of the treatments used for PIH and other types of hyperpigmentation can make the skin sensitive. Proper sun protection can help you get the best results from your treatments.

It is important to apply sunscreen with a high SPF to protect your skin from further damage. UV radiation from the sun can create dark spots known as age spots; it can also make PIH worse. You can also wear protective clothing to limit your sun exposure.

References

  1. Acne Scars – Cleveland Clinic
  2. Postinflammatory Hyperpigmentation – The Journal of Clinical and Aesthetic Dermatology
  3. Acne: Signs and Symptoms – American Academy of Dermatology
  4. Acne Vulgaris: Diagnosis and Treatment – American Family Physician
  5. Acne – Mayo Clinic
  6. Whiteheads – MedlinePlus
  7. How To Treat Different Types of Acne – American Academy of Dermatology
  8. Cystic acne – Mayo Clinic
  9. Skin layers and melanin – Mayo Clinic
  10. Postinflammatory Hyperpigmentation – StatPearls [Internet]
  11. Cosmeceuticals for Hyperpigmentation: What is Available? – Journal of Cutaneous and Aesthetic Surgery
  12. Azelaic Acid Topical – MedlinePlus
  13. The effect of Vitamin C on melanin pigmentation - A systematic review – Journal of Oral and Maxillofacial Pathology
  14. Dual Effects of Alpha-Hydroxy Acids on the Skin – Molecules
  15. Comparative Study for 35% Glycolic Acid, 20% Salicylic Acid–10% Mandelic Acid, and Phytic Acid Combination Peels in the Treatment of Active Acne and Postacne Pigmentation
  16. Alpha Hydroxy Acids – Food and Drug Administration
  17. Topical Retinoids for Pigmented Skin – Journal of Drugs in Dermatology
  18. Chemical peel – Mayo Clinic
  19. Laser resurfacing – Mayo Clinic
  20. Dermabrasion – Mayo Clinic
  21. The Role of Sunscreen in Melasma and Postinflammatory Hyperpigmentation – Indian Journal of Dermatology

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