Acne Scars and Hyperpigmentation

Acne is very common and affects most people at some point in their lives. For reasons that we don’t fully understand some people develop severe acne that leads to permanent and sometimes disfiguring scarring. Acne develops when the sebaceous glands in a person’s skin produces excess oil and clogs the skin’s pores. Trapped oil builds up within the gland, causing inflammation and acne lesions. The swelling within the oil gland can become so intense that the oil gland can rupture, leading to further inflammation and scarring.

Acne scars are the outcome of a wound in our skin healing, resulting in too much collagen ending up in one spot. Since the wound occurs within the dermis from the inflammation brought on by acne, the scar is within the skin, rather than on it and this makes acne scarring difficult to remove. Scarring from severe acne can be permanent and disfiguring. If you have moderate to bad acne, you should be seen by a physician to discuss treatment options to avoid risk of permanent scarring. See the different types of acne scars here.

Color changes in acne in more common than scarring and can resolve but may take years to completely disappear. Color changes come in three basic flavors: post inflammatory erythema (pink and purple patches at the site of acne lesions), post inflammatory hyperpigmentation (brown/black discoloration at the site of the acne lesion), and post inflammatory hypopigmentation (white marks at the site of a healed acne lesion). Post inflammatory hyperpigmentation is very common in those with darker skin tones or in those who tan easily and can significantly worsen the appearance of acne.

Acne is one of the most common skin conditions in patients with darker skin. African American patients usually have post inflammatory hyperpigmentation and are at higher risk of scarring. Hispanics and those of Middle Eastern descent also commonly have post inflammatory hyperpigmentation. Asians have a lower risk of hyperpigmentation than African Americans, but higher risk than Caucasian patients. The risk of hypertrophic and keloidal scars is 5-15 times higher in African American patients and 3-5 times higher in patients of Asian descent. Thus, treating acne early, before scar formation and discoloration is recommended.

Acne scarring is permanent but can be treated. No treatment is 100% effective and the best result is improvement, not perfection. Treatment of scarring may require many different kinds of treatments, depending on the kind of scarring present. Treatment of acne scarring can be expensive and may not be covered by insurance. It is important that all the acne is clear before treating scarring. Otherwise, new scars form and the procedures are wasted.