How do I treat dark marks after acne?

Part of: Melasma & pigmentation

Dark marks after acne are usually post-inflammatory hyperpigmentation, not structural scars, and the most important step is stopping new inflammation while treating the color. Among the studied topical treatments are azelaic acid and topical tranexamic acid; pigmentation improved with each over 12 weeks, with no meaningful difference between them. In a newer placebo-controlled trial, azelaic acid showed improvement in post-acne pigmentation and redness, especially after 8 to 12 weeks.

Key numbers

  • 10.47 → 7.00 — Pigmentation score with azelaic acid
  • 12.10 → 7.80 — Pigmentation score with topical tranexamic acid

Why doesn't Dr. Yousef start with laser for every mark?

Post-inflammatory hyperpigmentation comes from earlier inflammation, and a procedure can itself cause new inflammation and more pigmentation, especially in darker skin. So he usually starts with controlling acne, sun protection and the right topical treatment, and keeps devices for selected cases rather than turning every mark into a laser session.

How do I know it is a mark and not a scar?

If the surface is flat and the problem is brown/gray color or redness, it is most likely a color mark. If there is a dip or raised area you can feel, there is a structural scar component that needs different treatment; a lightening cream does not release a tethered rolling scar.

Key takeaways

  • Treat new breakouts and the color together; fading marks while new inflammation continues slows the result.
  • 12 weeks is a realistic timeframe for judging a topical treatment for post-inflammatory pigmentation, rather than two weeks.
  • Not every mark after acne needs a laser.

Dark and Red Marks After Acne: Pigment or Scar, and How to Fade Them Faster

Medical references

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