Dealing with acne scarring and post acne marks

Dealing with acne is a challenge for many, and it can be extremely frustrating to be confronted with residual marks and scarring. As a dermatologist, first and foremost we aim to get underlying acne under control - most commonly with topicals like retinoids, benzoyl peroxide and/or oral medications - and then address scarring. It is important to differentiate the conditions that you may experience and recognize that treatment response depends on type of scar, skin type, and treatment modality.

When your skin heals from an acne lesion it may leave behind the following (or a combination):

👉 Post-Inflammatory Erythema (PIE) - these are reddish (or pink / purple) marks that result from damage to or dilation of capillaries near the surface of the skin, and is more common in patients with lighter skin types

👉 Post-Inflammatory Hyperpigmentation (PIH) - these are darker, pigmented spots triggered by an inflammatory response that initiates melanin production, and are more common in patients with darker skin types

👉 Scarring - While PIE and PIH are discoloration that can fade in time, scarring may also occur. Loss of collagen or tissue may create indentations (pits) in the skin that can have different presentations (Icepick, Boxcar, Rolling). Generally we want to encourage collagen production to help improve the appearance of scars.

If you are dealing with any of these here are some things to consider...

At home topicals:

🔹 Red marks (PIE): Vitamin C, azelaic acid, niacinamide and other products to help repair the damaged skin barrier

🔹 Brown marks (PIH) : Retinoids, hydroquinone, AHA / BHAs, niacinamide, azelaic acid, tranexamic acid, kojic acid, arbutin, licorice root extract and more

🔹 Scars: Retinoids can help stimulate collagen, which may improve the appearance of scars

☀️And don’t forget sun protection!

In office treatments (depending on type / severity of scar) including lasers, microneedling, chemical peels, filler injections, surgical procedures may all be utilized.

When it comes to treatment of acne scarring it is best to see a skin expert who can develop a customized plan for you.