There are two types of post acne marks: Scars and Brown Spots. Scars are a result of damage to the dermis. Brown Spots are a result of excess pigmentation. The rest of the article will focus on the treatment of the post acne brown spots, which is far more common than post acne scars.
Sometimes, after acne clears up, it leaves small, flat dark marks in place of where the pimples was. These marks are due to excess pigmentation that is a result of the inflammation induced by the acne. Pressing or squeezing pimples can also contribute to inflammation and will worsen the post acne brown spots. People with darker skin types are particularly vulnerable to post acne brown spots.
There are 2 main treatment options for post acne brown spots:
1. Wear a sunblock on a daily basis. This will prevent the sun from further tanning and darkening the dark spots.
2. Apply a skin lightening cream to the brown spots once or twice a day. Effective skin lightening creams are prescription medication and include products like Hydroquinone and Retinoids.
Lightening the post acne brown spots can take weeks to months.
Dear Dr Louw
I am a dark skinned person with curly hair that is more susceptible to in grown hairs and shaving related bumps. I have used many OTC medications such as Bum Patrol, Vaya Smooth and DX Smooth, but they are not working.
I visited a dermatologist for shaving bumps (pseudofolliculitus barbae) and the dark spots that were left behind by teenage acne as well as the shaving.
She prescribed Minocycline 100 mg for a 6 month course. These are to stop the condition from getting worse, she said. She also prescribed a Benzac Facial Wash and Cetaphil Gentle Facial Cleanser.
Apparently the dark spots are difficult to treat or manage and she does not recommend anything at all. Is there anything that I can do to improve these dark spots?
Are teh above the best treatmenst for pseudofolliculitus barbae? Is there anything else that I should be considering or getting a second opinion.
Dear Peter. The only permanent solution is laser hair removal…if that is an option for you. The primary treatment of the dark spots is the treatment of the condition leading to the dark spots, which in your case is pseudofolliculitis barbae. The medication your doctor prescribed is a reasonable start.
Dear Dr.
I have recently just come off Roaccutane ( about 3 months ago ) – but now i am left with redness and one or two acne scars. My dermatologist prescribed me elidel to get rid of the redness but it still hasn’t gone away. I am struggling to get rid of this condition. Should i use differin ? Or could you recommend something different ?
Much Appreciated.
Ben
Dear Ben. Generalised facial redness is common post Roaccutane treatment. It tends to fade spontaneously over months. Are you wearing a sun block? Differin will make it more red.
Would using bio-oil work?
Dear Lesnar. The treatment of pigmenation involves sunblock, retinoid containing creams, azeleic acid containing creams, hydroquinone and various lasers.
Hi Dr Louw
I have had acne for a number of years and it seems that it has cleared. I however am left with the brown/dark spots on my face and I want to have these removed. Please recommend something (can be a cream/tablets) that can assist with removing spots on my face. The one doctor gave me Tetralysal and Ilotycin and I am not seeing results.
Thanks
Lesnar
Dear Lesnar. Tetralysal will help for actice Acne, not for the brown spots. Ilotycin will to some extent help for post inflammatory hyperpigmentation. Other treatment options for post inflammatory hyperpigmentation (the brown spots) are sunblock, laser and certain other creams, like Skinoren, Differin and Hydroquinone.
Dr Louw. Could you please recommend a few “medical grade creams” that you have mentioned.
Dear Safi. There are 3 types that are commonly used. Hydroquinone containing creams (needs to be made up specially), retinoid containing creams (Differin, Retacnyl, Retin-A etc) and azeleic acid (Skinoren).
Hi Dr Louw,
I am white female (age 32) and I have had acne since puberty. I was clear for years on Diane but I had to stop taking it due to migraines. I can’t take Roaccutane either because of the Migraines.
I just started taking Androcur and Ethyromycin (until the Androcur kicks in)
Topically I am using Cetaphil, Aloe vera and Emu Oil.
I don’t get a lot of acne, but when I do they are large cysts and the PIH stays for months.
Can I have laser treatment for the PIH? I dont really have much problems with dents just dark red spots that look like they are shallow. I have read that a lot of people get bad scarring from laser, so I am a bit scared.
I think it could help because my skin is white and the marks are very dark.
What would be the best laser?
What would it cost?
What is the downtime?
Regards,
Nicky
Dear Nicky. The first and most import step is to clear the Acne. Androcur and the antibiotic is a good start. Please stop using the Emu oil, because oils can aggravate acne. I would not suggest and laser treatment until the acne is clear. Once clear melanin targeting lasers can be used. The cost for a whole face treatment will be around R2000 for one treatment. There are no practical downtime for non-resurfacing lasers or IPL’s when targeting melanin, except that the pigment will look darker for a few days, before fading. If possible, rather come and show me.
I have been using a product called Dermaplex for the past 4 weeks and it is not showing any improvement in my dark spots.
This product is for Dark Spots and pigmentation.
I have also tried other products like the Clarity range to help improve my skin but it made it worst! I have spent lots of money on treatments that have not given me satisfactory results.
What is the best way forward as nothing that I am trying is helping.
Dear Rafiek. Please read this article about how to remove brown spots. Over the counter products are of very limited efficacy. In addition to the options mentioned in the article certain pigment removing laser can also be used. Read this article about laser pigment removal.
I also suffer from post acne pigmentation. I am fair skinned and although the pimples go my face constantly looks blotchy and uneven. Please recommend products available in S.A that is proven effective.
Dear Safi. There are no OTC products, except for sunblocks, that have been subjected to quality clinical trials. Start with a good sunblock, something from Bioderma, Vichy or Galderma. Use that for a few months. If there is no improvement after that, you will most likely need a medical grade cream.