Acne pigmentation

Acne breakouts are aggravating enough, but the wounds it leaves behind can be downright devilish. Fortunately, the great news is acne wounds can be healed.However, before you can begin treatment, you must first eliminate all acne for good, as new breakouts can lead to new acne scars.

Some of the scar treatments can’t be used in conjunction with standard acne drugs, and the inflammation caused by breakouts can make treatment less successful.

Everything you should know about Acne pigmentation

What is acne pigmentation?

The term "hyperpigmentation" is made up of two words: "hyper," which means "excessive" or "over," and "pigmentation," which refers to the coloring of skin tissue. Thus, hyperpigmentation is a condition in which the skin has an excess of pigment. Hyperpigmentation is much more common in non-Caucasian skin, and it can last for months, if not years, causing some people to mistake it for scarring.

Acne hyperpigmentation affects men and women of all skin types, although it is most common in acne sufferers. These darkened spots can occur anywhere on the body and can be brown, red, or pink in color.

Post-acne hyperpigmentation, also known as post-inflammatory hyperpigmentation, is a form of hyperpigmentation that occurs after an acne breakout (PIH). It's frequently more irritating and distressing than pimples.

Hyperpigmentation is the term for the dark and/or red patches that remain on the skin after acne lesions have healed.

The two most crucial factors to consider:

  • If you are out in the sun, keep the areas out of it or use sunscreen. This will hasten the fading process.
  • Picking at acne lesions is not a good idea. Picking can result in even more hyperpigmentation than acne.

In India, Chemical peels cost between Rs 1,800 and Rs 5,500, laser treatment costs between Rs 4,000 and Rs 30,000, and skin lightening injections cost between Rs 6,000 and Rs 40,000. Similarly, fairness creams will cost anywhere from Rs 200 to Rs 2,000.

It’s important to remember that hyperpigmentation doesn’t always disappear. Some hyperpigmentation will be permanent, even with treatment. However, it takes around 3 to 24 months to see any difference without any medication. It all depends on the degree of the darkened skin and how much of it is covered by hyperpigmentation.

There is no such thing as a permanent cosmetic solution. Anti-pigmentation creams or packs may help to lighten it. For permanent removal, peeling and laser techniques are available. Avoid exfoliating your skin with harsh chemicals. Brands that are natural and herbal should be tried.

Redness of the skin, swelling of the treated area, and moderate inflammation, similar to a mild sunburn, are all common side effects. Burning, scarring, or a change in the skin’s pigmentation have all been recorded in rare cases involving laser skin resurfacing.

Patches, dark spots, discoloration, or darker skin are signs that the skin produces more melanin than normal. Hyperpigmentation can be thought of as a catch-all word for darkened pigment.

Melanin is the pigment that gives skin its color. Since the skin produces extra melanin after a pimple heals, dark spots can appear on the skin. In addition, overproduction of melanin on the skin's surface may cause it to appear tan, brown, or dark brown in one spot or area.

Some inflammatory and immune factors, according to researchers, may stimulate melanin development. Although the exact mechanism is unknown, the following factors may be involved:

  • Prostanoids 

Produced by the chemical modification of three essential fatty acids in the body, Prostanoids are biologically active, pro-inflammatory compounds. In addition, these compounds serve as signaling molecules, facilitating contact within the central nervous system and regulating immune and inflammatory responses.

  • Cytokines 

A broad term for a group of low-molecular-weight proteins that affect the proliferation, differentiation, and function of immune system cells by stimulating or inhibiting them.

  • Chemokines 

Chemokines are signaling proteins that are secreted by immune system cells and promote cell movement. They are pro-inflammatory mediators that are generated as a result of the action of primary pro-inflammatory mediators. 

  • Reactive oxygen species 

Also known as reactive oxygen species or ROS, reactive oxygen molecules are metabolic products generated by the endoplasmic reticulum and the mitochondria, two groups of cells involved in development and metabolism.

Some other common factors that contribute to hyperpigmentation include:

  • Exposure to the sun or UV rays 

In the long run, too much sun exposure can lead to pigmentation problems. In the future, the skin could be more vulnerable to sunspots and fine lines. Use a non-comedogenic concealer for your skin type instead of tanning in the sun if you want to minimize the appearance of acne or hyperpigmentation momentarily.

  • Hormonal imbalances 

Melasma is a form of hyperpigmentation caused by hormonal changes. Melasma is thought to develop as the hormones estrogen and progesterone induce the overproduction of melanin, resulting in hyperpigmentation that is exacerbated by sun exposure on unprotected skin.

With the right skin care habits, you can safely prevent hyperpigmentation. The three measures we suggest will help you prevent or mitigate the effects of UV light or skin traumas.

Developing a skincare routine that incorporates these three pillars and sticking to them will result in a significant improvement in your skin tone. Let's take a look at each of the three phases and the advantages they have.

  • Every day, apply sunscreen

Sunspots, age spots, dark patches, and hyperpigmentation are all caused by prolonged exposure to UV rays. Remember to use sunscreen lotion on any exposed skin. Overexposure to the sun stimulates the melanin development pathway, which you can avoid by using a strong sunscreen.

  • Healthy Eating

A well-balanced diet keeps the skin and body in good shape. The vitamins and nutrients obtained from your diet will help your body recover. For example, acne can be significantly improved by consuming high-protein foods. So, start with a clean, wholesome base, such as a colorful fruit and vegetable-rich diet.

  • Anti-inflammatories should be used on the skin

If your hyperpigmentation is caused by acne, eczema, or dermatitis, darkened skin is caused by the initiation of your biological healing response. This healing response is critical; however, it is often triggered when it isn't needed, or it is triggered pathologically due to conditions like acne. In addition, skin inflammation leaves difficult-to-remove marks that darken and pigment the skin.

 Anti-inflammatory skincare products can help the skin heal.

  • After skin injury, apply brightening actives

Hydroquinone, niacinamide, N-acetylglucosamine, and licorice extract are popular ingredients in skin lightening creams and gels available in both over-the-counter and prescription forms. Although these products take longer to lighten dark patches of skin than skilled treatments such as dermabrasion or IPL therapy, they're safe and efficient on most skin types and work best on melasma and solar lentigines.

  • Always avoid popping pimples

When it comes to causing hyperpigmentation, picking at acne lesions is the worst culprit. Picking at acne lesions is a no-no. Pop a pimple properly only when it is ready, and then leave the lesion alone. Also, though scrubbing marks away can seem intuitive, doing so will only prolong their length and should be avoided.

Acne hyperpigmentation is healthy. However, for aesthetic reasons, some people can seek medical attention for hyperpigmentation acne. While hyperpigmentation acne has no physical consequences, it can have psychosocial consequences if the individual dislikes the way it looks.

People should talk to a doctor or dermatologist about their medical choices, as they can recommend effective treatments. Some therapies are only accessible with a prescription, while others may be purchased over-the-counter (OTC).

Myths about acne pigmentation treatment


Adult acne sufferers should be mindful of the following myths given below:

  • If you stop stressing, your skin will clear up
  • Your acne isn't affected by your diet
  • Pimples are ‘dried up’ by tanning
  • In your skincare routine, you just need one acne medication
  • The use of lasers will thin your skin

Although the mentioned two terms would sound similar, there are some differences in both.

  • Acne pigmentation

When a dark spot replaces a pimple that has vanished, hyperpigmentation acne occurs. Hyperpigmentation scars are more likely to occur in people with darker skin tones. This is because skin cells contain so much melanin, which results in dark spots.

Acne with hyperpigmentation may fade over time, but it might be permanent if the spots were deep. While certain topical and surgical treatments can hasten the process, it can take months or even years.

  • Post-inflammatory hyperpigmentation 

When an inflamed nodular acne lesion heals, the skin in that region also darkens. It is a condition known as post-inflammatory hyperpigmentation (PIH). The inflammation causes melanocytes (specialized pigment-producing skin cells) to create more melanin pigment, resulting in the skin's darkened appearance. People with darker skin are more likely to develop PIH.

The amount of time PIH takes to fade is determined by how dark the spot is compared to the surrounding skin. The longer it takes for the macule to disappear, the greater the contrast between it and your natural skin tone.

The word "pigmented scar" is often used to describe PIH, but it is misleading because it implies that the color change is permanent. PIH is also preventable by preventing aggravation of the nodule, and it fades with time. If the deeper layers of the skin are affected, untreated PIH can last for months, years, or even be permanent.


Treatments with therapies and lasers

Acne scar laser therapy helps to reduce the presence of scars from previous acne outbreaks. In fact, ninety-five percent of acne sufferers have some scarring left over.

To break up scar tissue, laser treatment for acne scars shines a light on the top layers of your skin. Simultaneously, the procedure promotes the growth of new, healthy skin cells to replace the scar tissue.

The following treatments, either alone or in conjunction with drugs, can be beneficial for certain people.

  • Light therapy 

Several light-based therapies have been tried and found to be successful. The majority of them would necessitate several visits to your doctor’s office. To determine the best approach, light source, and dosage, further research is needed.

  • Peeling agent

A chemical solution, such as salicylic acid, glycolic acid, or retinoic acid, is applied repeatedly in this process. This is a mild acne drug. It may improve the appearance of the skin, but the effect is temporary, and subsequent treatments are normally needed.

Topical medications

Acne drugs are available in several forms, including topical gels and creams. These therapies are effective for a variety of acne problems, including inflammatory acne and blackheads.

  • Salicylic acid

Salicylic acid is an effective cure for blackheads and other non-inflammatory acne symptoms. It comes in over-the-counter and prescription forms, and it's used to clear pores and keep them from being clogged with sebum and dead skin cells.

Salicylic acid is used in cleansers and spot treatments for the face.

  • Retinoids and retinoid-like drugs

Retinoids, such as retinoic acids and tretinoin, are often used to treat mild acne. These come in creams, gels, and lotions options. Tretinoin (Avita, Retin-A, and others), adapalene (Differin), and tazarotene are some examples (Tazorac, Avage, others). This drug is applied in the evening, three times a week at first, then regularly as the skin becomes used to it.

  • Azelaic acid

Acne rosacea and acne vulgaris are commonly treated with azelaic acid, an antioxidant-rich, anti-inflammatory, antibacterial, and anti-keratinizing medication. It's a gentle exfoliant that evens out skin tone and smooths it out.

When used twice a day, a 20% azelaic acid cream or gel appears to be as effective as many traditional acne remedies. 

During pregnancy and breastfeeding, prescription azelaic acid (Azelex, Finacea) is an alternative. It may also be used to treat the discoloration that certain forms of acne cause. Skin irritation and redness are two common side effects.

Oral medications

Topical acne drugs alone aren’t enough for those people with extreme acne. To get extreme acne symptoms under control, a combination of oral and topical drugs can be prescribed.

  • Antibiotics

Oral antibiotics may be necessary to reduce bacteria in moderate to extreme acne. A tetracycline (minocycline, doxycycline) or a macrolide is usually the first treatment option for acne (erythromycin, azithromycin). People that cannot take tetracyclines, such as pregnant women and children under the age of eight, will be able to take a macrolide instead.

For mild to extreme acne, antibiotics are often administered for a limited time. Antibiotics prescribed by a doctor will help combat bacteria and inflammation that cause acne.

Antibiotics used to treat acne rarely cause serious side effects. Also, these medications make the skin more sensitive to the sun.

  • Anti-androgen drugs

Spironolactone (brand name Aldactone) may be a suitable option for female patients who do not respond to other types of prescription acne medication. Spironolactone prevents androgen from affecting sebum development.

  • Oral contraception in combination

The FDA has licensed four combination oral contraceptives for acne treatment in women who also choose to use them for contraception. Progestin and estrogen are combined in these drugs (Ortho Tri-Cyclen 21, Yaz, others).

Oral contraceptives for acne can take a few months to show results. Particularly at first, your dermatologist can suggest combining other treatments with oral contraceptives.

Weight gain, breast tenderness, and nausea are common side effects of combined oral contraception. These medications have also been linked to an increased risk of heart disease, breast cancer, and cervical cancer.

  • Isotretinoin

Isotretinoin is a retinoid medication used to treat mild to extreme acne when other medications have failed. It aids in the regulation of sebum production, the clearing of pores, and the reduction of inflammation.

It is a contentious drug because it has been linked to a high rate of birth defects. Thus, it is advisable, Isotretinoin users to be closely supervised by their doctors.

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