Despite how common acne itself is, there is a lot of confusion around the marks that linger after a breakout. These are what we often call hyperpigmentation scars from acne. This is understandable, given that hyperpigmentation and scars often coexist with acne and can sometimes be hard to tell apart. There are also times when acne scars themselves may be hyperpigmented. Although these terms are often used interchangeably, hyperpigmentation and scars are, in fact, very different. This matters because the treatment for these post-acne marks also sometimes differs. In this article we explore the differences between hyperpigmentation and scars from acne and the best treatment options for them.
The Difference Between Hyperpigmentation and Acne Scars
At first glance, hyperpigmentation and acne scars may seem similar, but they are very different. Hyperpigmentation is a skin condition where patches of skin become darker than the nearby area due to excess melanin deposits. In acne, this happens due to inflammation and is what we call post-inflammatory hyperpigmentation (PIH). These dark marks are usually flat, small and in the same location as the original acne lesion. They are more common in people with skin of colour, though they can affect anyone. PIH often goes away by itself. However, in people with darker skin tones it may persist for months or years. Depending on your skin tone, these marks can range from pink-red to brown-black. To add to the confusion, they are also not the same as post-acne erythema, which shows up as red marks rather than brown.
On the other hand, acne scars occur as a result of skin damage following a breakout. This disrupts the skin’s collagen and often appears as indents or raised tissue on the surface. Acne scars vary in size, and over time, if they accumulate, they can give the skin a rough texture. They are more common after certain types of acne lesion such as nodules and cysts. Unfortunately, acne scars don’t usually go away by themselves. However, they may flatten and become less visible over time if the acne clears completely.
Treatments for Hyperpigmentation & Scars from Acne
Put simply, whilst hyperpigmentation affects the skin’s colour, acne scars alter its texture. In addition, whilst many types of lesion can cause hyperpigmentation, more severe types of acne usually cause scars. However, both acne scars and hyperpigmentation can develop after a breakout at the same time. Some people may also develop scars that are darker than the surrounding skin.
Whilst there is some crossover in treating the two, the best treatment depends on a number of factors. This includes whether there is ongoing acne, whether you have hyperpigmentation or scars or both, the severity, and your skin. You can broadly split treatments into simple skincare, medication and professional skin treatments. Below we dive into these options.
Over-the-Counter Treatments
There are a number of over-the-counter skincare products that can help with mild hyperpigmentation and acne scars. For hyperpigmentation, brightening ingredients like kojic acid, tranexamic acid, arbutin, niacinamide and licorice root extract can be effective. Antioxidants like vitamin C, ferulic acid and glutathione are also useful. These ingredients help lighten dark spots and even out skin tone. Gentle exfoliating acids and retinol can also help, but if you are prone to hyperpigmentation, approach these with care. Lastly, LED masks with red light therapy can help even out skin tone over time, though they are most effective alongside a good skincare routine.
For scars, retinoids and exfoliating acids can help smooth the skin texture over time. Vitamin E, peptides and hyaluronic acid can also soften the skin and improve its moisture. Whilst this doesn’t treat the scars, it enhances the skin’s overall quality and appearance.
Prescription Treatments
For moderate to severe hyperpigmentation or acne scars, prescription treatments may help. Topical prescription retinoids such as tretinoin and tazarotene, and oral options such as Roaccutane, work by speeding up cellular turnover and boosting collagen production. For this reason they can treat both hyperpigmentation and acne scars.
For severe hyperpigmentation alone, or hyperpigmented acne scars, hydroquinone can be used alongside retinoids. Hydroquinone targets hyperpigmentation directly by inhibiting the enzyme responsible for melanin production. This leads to a noticeable fading of dark spots.
For raised scars or keloids, treatments like steroid injections, special dressings and 5-FU might be considered to flatten them.
Professional Skin Treatments
For more pronounced hyperpigmentation or scarring that hasn’t responded to topical treatments or medication, professional treatments may be worth considering. Chemical peels and lasers can effectively reduce hyperpigmentation and treat scars. For widespread or deep scars, treatments like microneedling can stimulate collagen production. This improves the appearance of indented scars and overall texture. In the most stubborn indented scars, or for keloids, surgery may be a last resort.
Prevention & Maintenance
Preventive measures are crucial in managing both hyperpigmentation and scarring. In fact, before treating these, the most important thing is to clear the acne first, so that you are not stuck in a vicious cycle of whack-a-mole. Start with basics like reinforcing your skin barrier with a good moisturiser and using sunscreen to protect the skin. To keep acne under control, use a consistent routine with acne-fighting ingredients like retinoids, beta hydroxy acids and benzoyl peroxide. If your acne is severe, consider seeing your doctor for acne medication to prevent extensive scarring.
Once your acne is under control, you can explore the hyperpigmentation and scar treatments mentioned above. Ultimately, maintenance is key, and you will likely need an ongoing routine using exfoliating acids, retinoids and antioxidants to prolong and build on your results.
Understanding the differences between hyperpigmentation and acne scars is the first step to treating them effectively. It is also vital to accept that everyone is different, and the best treatment for you will depend on your skin type, concerns and goals. Whether you opt for skincare, medication or professional treatments, a few things stay the same. No treatment works straight away, and you will need a lot of patience and consistency. It is also crucial to control the acne before treating post-acne marks, so that you are not trapped in a vicious cycle. Finally, what works for one person may not work for another, so it is vital to seek professional help if your acne, hyperpigmentation or scars are severe, so that you can start the treatment most likely to suit you.
At City Skin Clinic, we are super passionate about personalised skincare. Through our online skin clinic, we offer safe and effective individualised acne and hyperpigmentation treatments with prescription-strength ingredients like tretinoin and hydroquinone where appropriate. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
