(Picture Cr: navanskincare)
Post-inflammatory hyperpigmentation (PIH), the dark spots or red spots that are left after acne lesions heal, develops when the inflammation inherent in acne lesions causes skin cells to produce more melanin, which is the pigment that gives skin its color. An increased amount of melanin makes the skin appear darker. These marks are sometimes referred to as “macules” and can last for months or even years in some cases.
Hyperpigmentation is common among people of African, Asian, and Latino descent, as well as other forms of non-Caucasian skin.1-5 Hyperpigmentation can also occur in Caucasian skin, albeit less frequently. UV light – the light from the rays of the sun – can make hyperpigmentation worse and cause it to remain longer. However, it is not clear whether UV light worsens acne itself, as research studies have reported that UV radiation can both increase6 and decrease7 acne. Regardless, for all skin types, it is important to take appropriate steps to protect your skin from excessive sun in order to avoid worsening of hyperpigmentation and allow any hyperpigmentation you currently have to heal as fast as possible.
Various forms of acne therapy, such as lasers and chemical peels are often mistakenly blamed for the creation of hyperpigmented marks, but it is the skin's inflammatory process that creates them.8 Although people often call them scars, they are not permanent and will disappear with time. Nonetheless, they can cause intense distress. Often, people with hyperpigmentation describe this issue as more concerning than the acne itself.
How to prevent hyperpigmentation
Picking at acne lesions is the worst culprit when it comes to creating hyperpigmentation. Absolutely do not pick at acne lesions. Properly pop a pimple only when it is ready to be popped, and then leave the lesion alone. Also, while it may seem intuitive to scrub marks away, harsh scrubbing will only prolong their duration and should be avoided. Be sure to wash gently. Next, as mentioned, keeping hyperpigmented skin out of the sun when possible is a huge help in allowing these marks to fade as quickly as possible. Wearing a sunscreen is important as well.
The best way to prevent hyperpigmentation is to treat the acne itself, thus preventing future acne lesions and any hyperpigmentation that they might leave behind. Acne is treated the same regardless of skin color and responds extremely well to proper topical treatment with benzoyl peroxide. When acne is severe, widespread, and deeply scarring, Accutane (isotretinoin) is also an option.
How to treat hyperpigmentation
First, get your skin completely clear from active acne. This way you are preventing any future hyperpigmentation. Once you are clear, you can try a hyperpigmentation treatment to reduce the marks you might have. Topical treatments are the first choice for treating hyperpigmentation.
Niacinamide, also known as Nicotinamide.
Niacinamide is a B vitamin that can be administered topically, and is currently being investigated as a potential therapy for hyperpigmentation. A study published in the journal Cutis in 2015 showed that a topical cream containing 4% niacinamide in combination with the other pigment-lightening and anti-inflammatory compounds arbutin, bisabolol, and retinaldehyde reduced hyperpigmentation due to melasma by 34% over a period of two months. Melasma is a common skin problem where brown marks appear on the face due to pregnancy or sun exposure. To date, there exists no published research that has investigated whether niacinamide is also effective in treating PIH, but studies are currently in progress.
Sources: acne.org