Skin Color Changes: Spots May Fade with Right Treatment

When acne clears, spots sometimes appear on the skin where the acne once was. These spots may be pink, red, or purplish in people with lighter skin and tan to dark brown in people with darker skin. Many people believe these spots are scars. The good news is that these are not scars.

Unlike scars, these spots will eventually fade. Fading, however, can take months. Dermatologists offer treatment and advice that can help you fade these spots more quickly.

Avoid the Sun and Protect Your Skin with Sunscreen
Yes, that right. Even people with brown and black skin need to protect their skin from the sun. Sun exposure can make these spots, which your dermatologist may call “postinflammatory hyperpigmentation” (PIH), darker and even more noticeable.

To prevent the spots from darkening, dermatologists recommend sunscreen. To get the best results, you should:

• Apply sunscreen to all skin that will be exposed, such as your face and neck

• Wear sunscreen daily

• Apply the sunscreen 20 minutes before going outdoors

It is important to use a sunscreen that is broad spectrum, has a Sun Protection Factor (SPF) of 30 or higher, and is oil-free. Broad-spectrum means the sunscreen protects the skin from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. An oil-free sunscreen will help prevent new acne breakouts. New breakouts can lead to more spots of discolored skin. The label may not say “oil-free.” It may say “won’t clog pores” or “non-comedogenic.”

Treatment Options
While it can be tempting to skip the sun protection and just try the treatments, don’t. Sun protection is essential. Without it, treatment will likely be less effective.

To treat color changes on the skin, your dermatologist may recommend a combination of treatments. Combining treatments often works best for treating dark spots. Your treatment plan may include:

Bleaching Creams
For fading tan to dark-brown spots, a bleaching cream that contains hydroquinone can be effective. Some bleaching creams are available without a prescription. By law, these can contain up to 2% hydroquinone.

When buying bleaching creams, be sure to read the bottle to find out how much hydroquinone is in the bleaching cream. If the bottle does not say how much hydroquinone is in the product, it is best not to risk using it. Some products contain much more than 2% hydroquinone. Using a product that contains a lot of hydroquinone can cause severe skin discoloration — and this discoloration can be nearly impossible to treat.

Your dermatologist may prescribe a product that contains 4% hydroquinone. These products are safe when used as directed by your dermatologist.

Other Skin Lighteners
You may be able to lighten your skin more effectively with a prescription cream that contains a few active ingredients instead of just one. One cream that your dermatologist may prescribe contains hydroquinone, a corticosteroid, and tretinoin. This combination often helps to lighten the dark spots without irritating the skin. Irritation can cause more spots of darker skin.

Some medications used to treat acne also can lighten the skin. These include tretinoin, tazarotene, adapalene, and azelaic acid.

Light Chemical Peels
A series of light chemical peels can help fade spots of dark skin. Your dermatologist can tell you if these may help. Usually a minimum of 4 to 6 chemical peels is needed.

While chemical peels are available for at-home use, these peels may not effectively treat skin discolored by acne. If the peel irritates the skin, the irritation can cause more dark spots to appear.

Microdermabrasion
This can be an effective part of your treatment plan. To perform a microdermabrasion procedure, a dermatologist uses a machine to remove the top surface layer of skin. With a series of microdermabrasion sessions, the spots of discolored skin tend to fade.

Dermatologists generally do not recommend the at-home microdermabrasion kits. New spots of discolored skin can appear if the kit is used too aggressively.

Lasers
In some cases, laser treatment may be an option for treating skin discolored by acne. Lasers are generally only used on darker skin when other treatments do not work.

Trust Your Dermatologist
Treating the spots of discoloration that can appear after acne clears can be like walking a tightrope. Both require a fine balance of skill and training. Dermatologists have the skill and training to help you fade these spots.

References:
Alexis, AF. “Issues and approaches in skin of color.” Presented during focus session U012 at the Summer Academy Meeting of the American Academy of Dermatology, July 2009: Boston.

Halder RM. “The role of retinoids in the management of cutaneous conditions in blacks.” Journal of the American Academy of Dermatology, August1998; 39: S98-103.

Halder RM, Nootheti PK. “Ethnic skin disorders overview.” Journal of the American Academy of Dermatology, June 2003; 48: S143-8.

All content solely developed by the American Academy of Dermatology