Improving Acne Scars and Discoloration

Long after your acne outbreaks have vanished, unsightly marks and discoloration can still remain — leaving you embarrassed, upset and frustrated. So, what can you do? Start by learning about your treatment options and consult a reputable and experienced dermatologist.

Is it even a scar?

For starters, it’s important to determine whether your scar really is a scar and not temporary redness — or macules, which can last as long as six months — or discoloration — known as post inflammatory hyperpigmentation (PIH), lingering for up to 18 months — according to the American Academy of Dermatology (AAD).

To distinguish short-term spots from authentic acne scars, dermatologist Leslie Baumann, M.D., suggests these tell-tale signs on Yahoo Health:

• A scar feels different from the rest of your skin.
• Its base is typically higher or lower than the surrounding skin.
• If redness or discoloration persists after three months, it’s likely a scar (though this isn’t always the case).

If it isn’t

Over time, hyperpigmentation will fade on its own. But if you’d like to accelerate the process, the below treatments can help. Unfortunately, it’s not an instant recovery — expect to see results in months, not weeks, writes skincare expert Angela Palmer for About. It can take six to 12 months for discoloration to fade with treatment, according to eMedicine.

• Sunscreen: Though you should use sunscreen every day anyway, when treating discoloration, it’s even more important. Sun exposure can stall any noticeable results from treatment or exacerbate discoloration overall.
• Product picks: Z. Bigatti Silk Screen SPF 30 Sunscreen, Dr. Michelle Copeland SPF 40 Lotion Mist Sun Block, MD Skincare Powerful Sun Protection SPF 30 Sunscreen Lotion.
• Hydroquinone: It’s the most common and effective ingredient to lighten the skin. Hydroquinone works by blocking the enzyme, tyrosinase, which produces melanin. It comes in strengths of 2 percent over the counter or higher by prescription only. Palmer recommends consulting your dermatologist before using a hydroquinone product.

  Recently, the FDA raised some concerns over hydroquinone’s safety, proposing a ban on over-the-counter products. In response, the dermatology community has voiced their disagreement, pointing to hydroquinone’s history as a safe and effective treatment.

  • Product picks: DDF Fade Gel 4, Murad Post Acne Spot Lightening Gel, Celazome Fade Shades Lightening Cream.

• Kojic acid: If you’d prefer an alternative to hydroquinone, try kojic acid, which also inhibits tyrosinase. Derived from fungus, kojic acid seems to be just as effective as hydroquinone, according to research. Unfortunately, it’s fairly unstable in skincare formulas. So, some companies use kojic acid dipalmitate instead, but it’s unclear whether this derivative is as effective as kojic acid.
• Product picks: Jan Marini Bioglycolic Lightening Gel, NeoStrata Skin Brightening Gel, Dr. Michelle Copeland Pigment Formula.
• Azelaic acid: Another alternative to hydroquinone, azelaic acid is a naturally occurring chemical that’s available by prescription only. Used commonly to combat acne, this tyrosinase-inhibitor is also prescribed to treat hyperpigmentation.
• Retinoids: Well-known for their powerful ability to increase cell turnover, retinoids, like Retin-A, are highly effective in treating acne. Fortunately, they can also help with hyperpigmentation.
• Alpha hydroxy acids: Also a well-established acne treatment, alpha hydroxy acids are effective exfoliators that combat hyperpigmentation. Particularly helpful is glycolic acid. When combined with 2 percent hydroquinone, glycolic acid-based products make for a successful treatment, according to iVillage.
• Product picks: MaMa Lotion, pH Advantage Boosters Pigmentation Fader.

Common acne scars

• Icepick scars: So called because it looks like an icepick pierced the skin, these scars are narrow but deep. They "usually result from severe, pustule-like acne" and are more prevalent in light-skinned individuals, according to iVillage.
• Rolling scars: As their name suggests, rolling scars have a wave-like appearance.
• Boxcar scars: They resemble chicken pox scars, appearing commonly on the cheeks and temples.
• Keloid/hypertropic scars: These raised scars are the result of an overgrowth of tissue during the healing process. African Americans are particularly prone to this kind of scarring.

If it’s a scar: Professional treatments

There isn’t a one-size-fits-all, standard treatment for acne scars. Factors like the type of scar, location, depth and size determine the treatment your dermatologist will recommend.

• Chemical peels: A peeling solution that uses chemicals, such as glycolic acid, salicylic acid or trichloroacetic acid (TCA). Chemical peels eliminate dead skin cells, so that new, healthier skin can emerge. Each solution has a varying strength. Not surprisingly, the deeper peels are more effective, but have potential side effects like skin discoloration and scarring.

  According to the AAD, chemical peels aren’t effective for icepick or keloid scars. Agrees acne specialist Jerry K. L. Tan, M.D., who writes that chemical peels "do little for scars" but are useful for improving skin tone. Also, chemical peels can help to reduce the appearance of acne, including whiteheads and blackheads, notes the AAD.

• Dermal fillers: To improve the look of acne scars, doctors inject them with fillers like collagen and hyaluronic acid. This stretches the scars and gives skin a smooth appearance. The Skin Care Guide points out that injections are only effective for rolling scars. Also, because results last three to six months, follow-up injections are necessary.
• Dermabrasion: A surgical procedure used effectively for years, dermabrasion uses a quick, sharp instrument — a brush or wheel — to remove the damaged surface skin. During the healing process, new, smoother skin appears.

  Dermabrasion is an appropriate treatment for boxcar scars, according to Dermatology Times. Whether it works on icepick scars is unclear. Heather Brannon, M.D., for About, writes that dermabrasion usually doesn't work, due to the depth of icepick scars. However, according to iVillage, these scars do respond well to dermabrasion.

• Microdermabrasion: Known as a "lunchtime procedure," microdermabrasion removes a superficial layer of skin, exfoliating it. It’s useful for mild scarring and most effective in a series, according to the Skin Care Guide.
• Laser resurfacing (or ablative lasers): Removes the top layers of skin and encourages collagen production. Laser resurfacing is particularly helpful for boxcar scars, according to the Skin Care Guide. But, typically, it isn’t effective on icepick scars, notes Dr. Brannon. On the other hand, iVillage states laser therapy is an ideal treatment for these scars.

  The most common lasers are carbon dioxide, or CO2, and Erbium YAG lasers. Though effective, laser resurfacing has a long recovery and side effects, such as "permanent whitening of the skin and scarring," as with CO2 lasers, notes Eric F. Bernstein, M.D., for The Patient’s Guide to Acne Scars. Also, because your skin requires more time to heal, it remains open, leaving it sensitive and susceptible to infection.

• Fractional laser therapy: Unlike ablative lasers, fractional laser therapy, a non-ablative option, doesn’t wound the skin. This makes for a faster healing time and less side effects. Fractional treatment works by puncturing some parts of the skin and leaving others untouched. The untreated skin then begins to heal the treated skin with new tissue.

  Dr. Baumann describes the results (after about three sessions) as "impressive." She writes that the key lies in Fraxel’s ability to heal scars from the inside out by encouraging collagen production.