Acne is one of the most common reasons to visit a dermatologist, and an important secondary issue can be discoloration caused by the healing process, called postinflammatory hyperpigmentation. This a particular issue for patients with skin that is of darker pigmentation. Patients are often as bothered by the dark marks as they are by the pimples.
Although these spots are distressing, there are treatment options. Our first goal is to manage the acne and prevent additional pigmentation. I encourage patients to adhere to acne treatment for at least eight to twelve weeks, before we try to attack the discoloration. This is to ensure that they are not still getting many new acne lesions. Also, some of the prescription medications that we use to treat acne have intrinsic lightening effects. Topical retinoids, which are the mainstay of acne treatment help the top layers of the skin turn over faster and inhibit the production of melanin, the darker pigment produced by melanocytes or pigment-producing cells.
Once acne is under better control, then we can discuss specific therapy for the discoloration. One of my favorite treatments is a compounded lightening cream that contains hydroquinone, a topical retinoid and a topical anti-inflammatory. In addition, some light chemical peels that contain either glycolic acid or salicylic acid can help speed the process along.
Many patients who do not have acne are very concerned about discolored patches on their faces. Often this is melasma. Melasma can be very difficult to treat and it is important to determine in what layer of the skin the discoloration resides. Epidermal melasma affects the epidermis, or the top layer of skin. These patches are usually dark brown with well-defined borders, and they respond easily to treatment. Dermal melasma affects the second, deeper layer of skin, called the dermis. In dermal melasma the patches are lighter brown than epidermal melasma, have borders that are less precise and do not respond well to treatment. There is also a third type of melasma is a mix of both dermal and epidermal. Once that is determined, different treatments can be customized. These treatments range from topical agents, such as lightening agents similar to one used to treat post-inflammatory hyperpigmentation to lasers, particularly the ND:Yag laser.
The most important word of advice that I have for both post-inflammatory hyperpigmentation if to wear a broad spectrum sunscreen every day, regardless of the weather!
Post provided by Dr. Angela Lamb