What you think may be acne scars, may be this

What you think may be acne scars, may be this

Acne, especially large and chronic cysts or pimples and blackheads that we squeeze or pop, may damage skin tissue permanently, forming acne scars. The only real way to make sure that you do not get acne scars is to PREVENT acne from forming and to break the acne cycle.

There is however a condition that may follow acne, but is NOT permanent, that sometimes is confused with acne scars; this condition is known as Post Inflammatory Hyperpigmentation (PIH)

What is PIH?

PIH is the medical term for skin discoloration resulting from an inflammatory injury to the skin tissue. It is the skin's natural response to inflammation. PIH is a flat area of discoloration on the skin ranging from pink to red, purple, brown or black, depending on your skin tone and depth of the discoloration.

How PIH Develops

PIH forms when a wound, rash, pimple, or other skin damage causes skin inflammation, which triggers the skin to produce too much melanin. Melanin is the protein in the skin that gives the skin its color. Too much melanin darkens and discolors the skin in the area of former inflammation. This discoloration stays on the skin even after the pimple, cyst or other skin "injury" has healed.

PIH is very common among acne sufferers, both men and women. It can occur in all skin types, although it is more common with darker skin complexions. PIH is not however a true acne scar. For acne sufferers, PIH can follow both severe cysts and relatively minor pimples and papules, but usually more inflammation produces larger and darker PIH. As we said, picking, squeezing or popping pimples increases the chances of developing post inflammatory hyperpigmentation.

How To Tell If You Have PIH or Acne Scars

You can identify post inflammatory hyperpigmentation by carefully examining the skin. PIH can be a range of colors, however, the skin will not be wrinkled or depressed. PIH may look like a large freckle or as a large, dark discoloration or spot and sometimes it may even look like new skin.  Scars can be recognized for their texture whereas PIH is more about discolorations, and scars also involve indentations.

How To Treat PIH

It is good to know that PIH is not scarring, and in most cases it will fade away over time, even without treatment, but it can take anywhere from 3-24 months (sometimes even longer) for most of the PIH spots to fully disappear. The time it takes for PIH to fade depends on how dark the PIH spot is compared to your skin tone. The bigger the contrast between the PIH and your natural skin tone, the longer it will take to fade.

There are treatment options available to help fade Post Inflammatory Hyperpigmentation quicker. However, your acne should be under control before beginning any treatment for PIH. Otherwise, each new pimple could cause another PIH, reducing the effectiveness of treatment. So treating your PRESENT ACNE and PREVENTING NEW ACNE from coming are the first conditions to treat and prevent PIH.

Whatever treatment option you choose, understand that improvement will take time, requires persistence and patience and may cost a lot of money. Think in terms of months rather than weeks. Also, if you have PIH be especially diligent in applying a broad-spectrum sunscreen daily. The sun may darken the discolorations and increase fading time.

Over-the-Counter Treatments

Mild cases of PIH may respond well to natural lightening agents such as lemon juice and some over-the-counter "lightening" products. Many of them use a combination of alpha and beta hydroxy acids (including glycolic acid), vitamin A, vitamin C, and other ingredients to exfoliate the skin and speed up the growth of new cells. Some products include lightening agents to "bleach" discolorations. If you have a darker complexion beware of " bleaching" products as they may actually leave you with another type of spots. Also, you don't want to expose your skin to all of these chemicals.


Hydroquinone is a common treatment for post inflammatory hyperpigmentation. It is available over-the-counter at 1% to 2% strength, and in 3% to 4% prescription creams. Hydroquinone works by blocking the enzyme responsible for melanin production, thereby lightening the skin.

Hydroquinone creams often contain additional lightening ingredients, such as kojic acid, glycolic acid, tretinoin and other retinoids, or vitamin C. These combinations of creams can give you better results than using hydroquinone alone BUT THERE IS A SERIOUS WARNING HERE.

Hydroquinone products should be used with caution and sparsely on affected areas only, to prevent the unwanted lightening of your natural skin color. Hydroquinone may also cause irritation in sensitive skin.

Topical Retinoids (by prescription)

Retinoids that exfoliate the old skin cells are often prescribed to treat PIH. Obvious results may not be apparent for several weeks to several months and topical retinoids may cause excessive dryness, redness, and/or irritation, which may in turn increase hyperpigmentation.

Glycolic Acid

Glycolic acid is an alpha hydroxy acid found in many skin care products. It effectively exfoliates the skin, helping to lighten post inflammatory hyperpigmentation. Available in cleansers, creams, and gels, glycolic acid not only helps improve postinflammatory hyperpigmentation, but also leaves your skin smooth and soft.

Cleansers, gels, pads, and lotions containing glycolic acid are available over-the-counter. Higher concentrations are available with a prescription only. As, with all products improvement may not be seen for several months.

Azelaic Acid

Azelaic acid is used in prescription only products that attempt to treat PIH. It works by decreasing inflammation and speeding up cell turnover rates. It is an alternative for those who may be unable to use hydroquinone. Since azelaic acid has not been tested on those with dark complexion so it may actually be responsible for hypopigmentation. It may also irritate, burn and sting the skin. Azelaic acid is available in cream and gel form, and is sometimes used in conjunction with glycolic acid or retinoids. As always, monitor your skin for redness and irritation and let your doctor know right away if you experience these side effects.

Other Treatments

More persistent cases of post inflammatory hyperpigmentation can be attended to with the use of professionally done chemical peels and microdermabrasion.  A series of treatments is needed to adequately fade PIH and some side effects may be associated with those treatments. None of them may be used when you still have active acne.

Natural Ways to Fight Hyperpigmentation

As always, we support a search for natural ingredients being used to help improve skin conditions. The products mentioned above may take time and patience to help brighten your skin, but they are chemical based solutions you certainly should be careful about.

None of those natural ingredients should also be used on skin that still have active acne, and since they all exfoliate the skin, sun protection.  Here are some ingredients you need to look out for as they certainly may speed up the healing of PIH:  Raw honey, lemon juice (fresh from a lemon contains citric acid that will both lighten the skin and speed up skin regeneration), yogurt (contains lactic acid that works similar to citric acid but will also moisturize the skin), wheat germ oil (natures collegian helper), rosehips oil, aloe vera juice and of course raw sugar cane sugar (produces glycoloc acid, praised by the cosmetic industry now).  None of these natural ingredients however should be used on skin that still has active acne and since they all exfoliate the skin, sun protection is necessary.

Honey Exfoliating Mask

Use organic and non-GMO ingredients when possible


  • 2 tablespoons of raw honey
  • 2 tablespoons of raw sugar cane sugar (show be ground until very fine powder)
  • Lemon juice from half of a medium size lemon (no pits)


Mix well in a small bowl. Use fresh applying on freshly cleaned skin with clean fingers or a clean natural hair brush. Avoid eye area. Keep on for 5-10 minutes. Wash with luke warm water. If stinging occurs, wash off immediately. Use 2-3 times per week. Follow with chamomile astringent and non comedogenic moisturizer. Always follow this with sun protection and do NOT use on active acne or before you go outdoors. Evening is the best to do this.

Need to know what type of acne you have?  See here how to easily find out!

With a promise of clear skin,
Dr. A

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