POSTED: 22 Feb 2024

Hyperpigmentation or Scars From Acne, Here’s How to Tell The Difference & Why it Matters

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 as the treatment for these post acne marks also sometimes differs. In this article we explore the differences between hyperpigmentation and scars for acne and the best treatment options for them.

The Difference between Hyperpigmentation vs. Acne Scars

At first glance, hyperpigmentation scars and acne scars may seem similar but they’re every different. Hyperpigmentation is a skin condition where patches of skin become darker than the nearby area due to excess melanin deposits in the skin. 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 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 further add to the confusion, they are also not the same as post acne erythema which we’ve blogged about before.

On the other hand, acne scars occur as a result of skin damage following an acne breakout. This results in disruption to the skin collagen and often appear as indents or raised tissue on the skin’s surface. The acne scars may differ in size. Over time, if they accumulate, then they can give the skin a rough texture. They are more common after certain types of acne lesions 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. Also, some people may develop scars that have a darker colour than the rest of the skin.

Whilst there’s some cross over in terms of 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, 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 skin ingredients like kojic acid, tranexamic acid, arbutin, niacinamide and licorice root extract can be effective. In addition, antioxidants like vitamin C, ferulic acid and glutathione are also useful. These ingredients help to lighten dark spots and even out skin tone. Gentle exfoliating acids and retinol can also help but if you are prone to hyperpigmentation, then approach these with care. Lastly, LED masks with red light therapy can also help even out skin tone over time. However, these are most effective if used alongside a skincare routine.

For scars, retinoids and exfoliating acids can help smooth the skin texture over time. Furthermore, vitamin E, peptides and hyaluronic acid can also help soften and improve the skin’s moisture. Whilst this doesn’t treat the scars, it helps enhance the skin’s overall quality and appearance.

Prescription Treatments:

For those dealing with moderate to severe hyperpigmentation or acne scars, prescription treatments may be helpful. Topical prescription retinoids, such as tretinoin, tazarotene and oral versions such as roaccutane work by speeding up cellular turnover and boosting collagen production. For this reason they can effectively treat both hyperpigmentation and acne scars.

For severe hyperpigmentation alone or hyperpigmented acne scars, hydroquinone can also 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 5FU might be considered to flatten these.

Professional Skin Treatments:

For more pronounced hyperpigmentation or scarring that hasn’t responded to topical treatments or medications, professional treatments may be worth considering. Chemical peels and lasers can effectively reduce hyperpigmentation and treat scars. For wide spread or deep scars, treatments like microneedling can stimulate collagen production. This improves the appearance of indented scars and improve texture. In the most stubborn indented scars or for keloids, surgery may also be a last resort.

Prevention & Maintenance

Preventive measures are crucial in managing both hyperpigmentation and scarring. In fact before starting to treat these, the most important things is to clear the acne first so that you’re not stuck in a vicious cycle of wack-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 skincare 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 scars from forming.

Once your acne is under control, you can explore the hyperpigmentation and scars treatments mentioned in the last section. 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 effectively treating them. It’s also vital to accept that everyone is different and the best treatment for you will depend on your individual skin type, concerns and goals. Whether you opt for skincare, medication or professional treatments there are a few things that remain the same. No treatment works straight away and you will need a lot of patience and consistency. It’s also crucial to start with controlling teh acne before treating post acne marks so that you aren’t trapped in a vicious cycle. Finally, what works for someone may not work for another so it’s vital to seek professional help if your acne, hyperpigmentation or scars are severe so that you can get started on the treatment that is 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 treatments with prescription-strength ingredients like Tretinoin and Hydroquinone. Our doctors treat a range of skin conditions including acne and scars, hyperpigmentation, melasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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