Types of Dark Marks and Acne Scars

• Post-Inflammatory Hyperpigmentation (PIH) is commonly considered acne scarring, but is actually discoloration of the skin (darker than your natural skin tone) where it has healed, caused by inflammation during healing.
  
  Often referred to as dark marks or spots, it can affect all skin tones, but is more common among people with darker complexions. With the right treatment and sun protection, you can fade them early – left untreated, it can take up to 18 months - but exposure to UV rays can make them worse.


• PIH is different to red or purple marks that remain on the healed skin (more common on lighter complexions), which normally fade after a few months. However, you can reduce their appearance more quickly with treatment.


• Atrophic scars appear as sunken depressions in the skin, because the skin hasn’t produced enough collagen while your blemishes were healing. There are three main types:
  • Ice pick scars: jagged-edged and deeper than their width.
  • Boxcar scars: Wide rectangular hollows with steep, defined edges.
  • Rolling scars: Broad hollows with rounded, sloping edges.


• Hypertrophic scars are thick and stand out above the skin. They’re often red or pinkish. It may appear as though you still have acne.


• Keloid scarring is hard and smooth and stands out above the skin. It occurs when the skin overproduces collagen during the healing process. This tough scar is usually genetic and tends to form most commonly on dark brown and black skin (about 1 in 6 people with black skin and acne vs 1 in 20 people with white or Asian skin types, according to American research). These require more specialist treatment than ordinary acne scars, as the wrong treatment could cause more scarring.

How To Treat Dark Spots On The Face

• Sunscreen is an absolute must. Not only will sun protection products prevent new dark marks from forming but they will also help fade the ones you already have. Use a trusted range with both UVA and UVB protection at high levels.
  
  We recommend: BioNike B-Lucent Anti-Dark Spots SPF 50+, La Roche Posay Anthelios SPF50+ sun range, Bioderma Photoderm Anti-Spots Antioxidant Gel-Cream SPF50, Vichy Capital Soleil Dry Touch Mattifying Face Fluid SPF50 and Eucerin Even Skin Perfector Sun Fluid SPF50.
   
• Skin brighteners. For brown marks, pigment-lightening ingredients like retinol, niacinamide, vitamin C, kojic acid, and liquorice can help treat discoloration.
   
  Our product picks for targeted dark mark treatment: BioNike B-Lucent Anti-Dark Spots Roll-on, La Roche Posay Pure Niacinamide 10 Serum, Uriage Depiderm Brightening Corrective Serum, Eucerin Even Pigment Perfector Dual Serum and Dermactin Equatone Dark Spot Serum.
   
  From medispas and doctors, we recommend Neostrata Enlighten Dark Spot Corrector, Lamelle Correctives Brighter Serum and Dermaceutic Yellow Cream.
   
  For darker complexions, a dermatologist may prescribe hydroquinone.


• Topical vitamin C serum helps build collagen, promote healing and fade dark spots and hyperpigmentation.
  
  Our product picks: We love the beauty industry’s gold standard, SkinCeuticals C E Ferulic Serum and their potent Vitamin C serum, SkinCeuticals Phloretin CF.
  
  Other great options are Uriage Depiderm Brightening Corrective Serum, La Roche Posay Pure Vitamin C10 Serum, Solal Healthy Ageing Vitamin C Serum, Bioderma Pigmentbio C-Concentrate Brightening Pigmentation Corrector and Elizabeth Arden Vitamin C Ceramide Radiance Renewal Serum.


• Vitamin A (aka retinoid) cream or serum. This skin normalising vitamin has a powerful sebum regulating and skin exfoliating action which will gradually fade dark marks. You can buy a quality retinol-based skin cream or serum, or your dermatologist can prescribe the renowned Retin-A.
  
  Our product picks: SkinCeuticals Retinol 0.5, La Roche Posay Retinol B3 Serum, Neutrogena Retinol Boost Serum, L'Oréal Revitalift Laser Retinol Serum, and Skin Republic Serum Pure Retinol 0.2%.
  
  Caution: Retinoids make your skin super-sensitive to the sun, so you have to wear sunscreen and avoid excessive sunlight.


• Chemical peels are at-home or in-salon treatments using ingredients such as glycolic acid, beta-hydroxy acid or TCA to give skin either a superficial or deeper exfoliation to remove dark spots.
  
  Ones we like: Cosmelan and DDermamelan Depigmentation Peels available at Skin Renewal. NeoStrata Enlighten Dual Acid Brightening Peel, plus NeoStrata Smooth Surface Daily Peel Pads, both with exfoliating glycolic acid, can also help.

Hyperpigmentation and Scar Treatments For The Face: The Low-Tech Options

• For keloid and hypertrophic scarring, the treatment of choice by dermatologists is steroid creams or steroids injected directly into the skin to thin, soften and flatten raised scars. Skin Renewal Clinics also use Titan infra-red light, Laser Genesis (as well as dark skin laser treatments) and Carboxytherapy treatments along with the steroid treatment.
  
  Unfortunately, this type of scar is prone to recurrence and will need a maintenance programme.  


• With hollow atrophic scars, dermal fillers with hyaluronic acid can provide a temporary fix as they plump up certain scars (lasting between six months and a year).

• Microneedling (aka derma rolling) stimulates the skin's ability to repair itself and works for either dark spots or scarring. There are many options, which work by moving a sterile needle head over the targeted area, the microneedles create "mini wounds" that stimulate your body to release healing growth factors, triggering the production of collagen and elastin. This new, fresh collagen forms a smoother, more even appearance on the treated area over time.
  
  While in-office microneedling treatments are the most effective, see how you can also continue with DIY derma rolling at home.


• Platelet-rich plasma treatments, aka vampire facials, make use of your own blood – it’s drawn, put in a centrifuge to separate the plasma, which is then injected back in to the targeted area to stimulate collagen production.
  
  These options are most effective for boxcar and rolling scars.

• Icepick scars are more problematic because of their depth and they are usually wider at the top and narrower at the bottom. The best option may be a punch excision, where the scar is cut out using a minute ‘cookie cutter’ device, then stitched up, so you end up with a smaller, more even, much flatter scar.


• Scar subscision can improve the appearance of very deep scars. A trained doctor will insert a special needle into the scar to break the tether that pulls the scarred skin downwards. Following this, other treatments will smooth out the scar tissue itself and leave its colour more even.

Dermatologist Hyperpigmentation and Scar Treatments For The Face: The High-Tech Options

• Pink or red acne marks can be lightened considerably with pulsed-dye laser (like V-Beam), which targets haemoglobin (red pigment).


• For dark spots and scars that are no longer red, Fraxel™ DUAL incorporates 2 lasers in 1 - used separately or together, depending on skin needs, and shows results in as little as 2-3 treatments, with hardly any downtime. It can treat all forms of hyperpigmentation, skin texture and improve acne scars. 


• The Laser Genesis five-in-one treatment reduces the size of the sebaceous (oil) glands, eliminating inflammation, reducing pore size and improving acne scarring and hyperpigmentation. It is recommended for people with darker skins especially, and is even more effective when combined with Carboxy Therapy and Dermaroller skin needling, say the specialists at Skin Renewal.