How Do I Deal with Dark Spots After Acne?

Question and answer logoActive acne is distressing at any age and acne scars can remain for years.  I’ve received numerous questions on different types of scars  and now superstar dermatologist  Dr Gary Goldenberg of Mount Sinai Medical Center has provided great solutions.  Today I am starting with the most common acne scars– those red or brown spots.

Question:  I’m 27 and finally got my acne under control, but now I have dark red spots on my cheeks and chin.  How can I get rid of them? And does the redness mean that acne scars will come back?

Answer:  Those dark red spots are called Post Inflammatory Hyperpigmentation or PIH.  They are the sign of a persistant inflammation that is  located deep in the dermis.  The body has to reabsorb  this damaged tissue– a process that takes 6-12 months.  Because they are formed  in the lower layers of the skin, exfoliating  scrubs and superficial peels will not really help.  Retin A  can speed up the process somewhat but for quicker, permanent results, Dr Goldenberg uses  the Fraxel duel laser.  He can set the depth of the laser to reach the dark spots without damaging the other tissue.

Dr Goldenberg starts by numbing the skin with lidocaine gel.  One hour  after  lidocaine application, the skin is so numb the proceedure is virtually  painless. Right after the   one hour Fraxel treatment, the skin will look and feel like a sunburn– red with  some swelling. This usually last 2-3 days and an ice pack can relieve the buring sensation.  Dr Goldenberg also  recommends  putting your moisturizer in the refrigerator so that  when its applied, it literally cools and  hydrates the skin. After the redness subsides, peeling  will start and last for about 2 weeks.  After the abnormal  skin has peeled off, you will start seeing fresh , spot-free skin.

Acne Scars in  Women of Color

In darker skin tones, PIH can look dark brown and black rather than pink or red.  Over the counter skin lighteners with Koic Acid ( eg Clinique Even Better) can slowly lighten them.  These very dark areas can also be zapped with the Fraxel duel laser.  However the heat of the laser may trigger more inflammation and pigmentation.  To prevent problems, Dr Goldenberg pre-treats skin of color with hydroquinone to  slow down pigment  forming cells before firing up the Fraxel laser. Acne  can seem like the gift that keeps on giving.  In addition to PIH, acne  can leave saucer shaped depressions, enlarged pores and even   lumpy raised areas.  That’s the bad news.  The good news?  There are tools and treatments for all of them.

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