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If you’re unsure whether you have hyperpigmentation or acne scars, you aren't alone. The causes of both conditions can result in dark patches that last for long periods, and approximately one in five acne sufferers will develop scarring. Hyperpigmentation affects a similar portion of the population, though it affects women more often than men, and people with darker skin more often than those with lighter skin.
Here’s how to tell the difference between hyperpigmentation and acne scars, and what to do about the condition you have.
In most cases, acne scars are easy to distinguish from hyperpigmentation. This is because scarring includes changes to the surface of the skin that have nothing to do with the coloration of the skin. Often, these changes present as low, depressed areas on the cheeks or brow. In medical circles, depressed acne scars are often categorized by the kinds of depressions they form. These have been described as "icepick," "boxcar," or "rolling." Perhaps confusingly, acne scars can also be raised above the surface of the skin due to a buildup of collagen that occurs during the healing process.
Scratching or popping zits can cause both hyperpigmentation and scarring. This is why it’s important to refrain from popping your pimples. While using topical treatments can take longer than popping to rid your face of pimples, open wounds caused by popping zits can allow harmful bacteria through your usual protective barrier, resulting in further inflammation. The damage can result in discoloration that’s known as hyperpigmentation.
Hyperpigmentation is characterized by an increase in the melanin present in a specific area. This results in patches of skin that are darker than they might otherwise be. While hyperpigmentation can be caused by physically disturbing the skin, it can also be caused by certain medical conditions, reactions, and, frequently, sun exposure.
Once acne scarring has occurred, the best course of treatment depends on the type of scarring and the length of time since scarring began. When scars are relatively new, topical treatments can effectively prevent highly visible, permanent changes. In the later stages, most treatments are designed to address the appearance of raised or depressed areas.
In many cases in which raised scarring is present, dermatologists may suggest you wait until the body has done everything it can to eliminate the raised features on its own before beginning any sort of treatment. Of course, before you begin any treatment, you should talk to a knowledgeable dermatologist. A prescription-strength retinoid is one of their likely go-tos in fighting the appearance of acne scars, and it can be effective in hyperpigmentation too.
When dealing with chronic acne, never pop, scratch, or disturb pimples. Once a scar has begun to develop, it is also important not to disturb skin in the process of healing. Protect your face from sun damage and over-exposure to UV rays, and continue to maintain a regular skincare routine. Do not attempt to improvise a treatment regimen.
Topical treatments for scars typically exfoliate the skin to remove dead skin cells and restore a natural appearance, and may also accelerate the process of surfacing new skin cells. Treatments that encourage regeneration and reduce discoloration are also helpful. Here are some common treatments:
These acids are common in acne products, as they exfoliate the skin's outermost layer, removing dead cells and helping to keep pores clear and unclogged, which can contribute to the development of pimples and papules.
Retinoids work by facilitating cell regeneration at the skin surface and are one of the most trusted and proven approaches to skin revitalization. You should use them with caution, however, as they can increase your sensitivity to the sun and sometimes create sensitivities as your skin adjusts. Reduce the risk of sun damage by using a sunscreen with a moderate SPF when using a retinoid, and make sure you understand what to expect when you first start using one.
Laser resurfacing is an in-office procedure that removes the top layer of skin. While this can prove highly effective, you may be asked to cover the affected area with a bandage for a while after a procedure as the top layer heals. Laser resurfacing and other relatively intensive procedures are best done after you have stopped experiencing new breakouts.
Salicylic acid is another common ingredient in acne medication. It works by exfoliating and clearing pores. As with any exfoliator, you should avoid overuse, as this can result in irritation. Skin dryness is another common complaint with salicylic acid.
Fillers are a temporary treatment of collagen injected under the skin that can last for variable amounts of time. They can, however, effectively reduce the appearance of depressed scars, as they are one of few treatments that work from underneath the skin.
To amplify the effects of an exfoliating process, your dermatologist may recommend a chemical peel. Chemical peels use a strong acid to remove the top layer of skin in a similar manner to laser resurfacing. Your skin will often be left dry and sensitive afterwards, and it will require some healing time.
Although hyperpigmentation can have several causes, it’s known as post-inflammatory hyperpigmentation when it follows a physical disturbance such as a wound or distressed pimple. Unlike severe scarring, post-inflammatory hyperpigmentation usually goes away on its own. Healing, however, can take a long time. Most patients notice a significant improvement in three to 24 months, though sometimes the color changes last much longer. As hyperpigmentation often coincides with acne, you should do your best to holistically treat your skin problems when dealing with a concentration of melanin.
Because melanin is a natural response to sun exposure, some people find that intense sun exposure leads to hyperpigmentation. You should avoid intense sun exposure if dealing with altered pigmentation is a common occurrence for you. Wear sunscreen whenever possible. Since your altered complexion may have resulted from a physical disturbance, avoid irritating the skin when you can.
Treatments for dark spots focus on either decreasing the production of melanin or treating underlying causes of hyperpigmentation. In most cases, treating both acne and inflammation is vitally important.
Wearing sunscreen is perhaps the simplest and most important way to handle hyperpigmentation. The sun can increase melanin production and darken your areas of concern, slowing the recovery process. Wearing sunscreen is almost always a good idea for dealing with chronic breakouts and hyperpigmentation, as sun exposure often worsens extant skin problems. Sun protection is generally a good idea to keep your skin looking young in the long-run, as well.
Hydroquinone is a common topical treatment that lightens skin by slowing the production of melanin. Although it directly lightens your complexion, many formulations containing hydroquinone may use other ingredients that have a lightening effect in conjunction.
Alpha hydroxy acids are common ingredients in brightening treatments for a reason. They result in a brighter skin tone and can be found in both over-the-counter and prescription medications.
Azelaic acid is a treatment for hyperpigmentation that is only available as a prescription. It works by increasing the rate at which skin cells die and regrow. This can reduce inflammation and accelerate the healing process.
Retinoids like tretinoin (which is prescription only) are common treatments for both scarring and hyperpigmentation. Talk to a professional for help deciding whether a retinoid treatment is appropriate for you.
The difference between hyperpigmentation vs acne scars may be clear, but the best treatment options for you may not be. Proper treatment depends on a variety of important factors, and speaking with a skincare specialist can go a long way in determining the right treatment for your situation.
At Nava MD, we understand that finding professional help with acne can be both intimidating and confusing. That’s why we’ve streamlined the process by allowing you to do everything you need online. Fill out a questionnaire, connect with a clinician, and receive a personalized treatment shipped to your door, if appropriate. Our clinicians can prescribe custom formulas for your situation, all online and with ongoing access through our secure patient portal.