One of the most frequent questions I am asked on Instagram is ‘what products do you use/recommend for acne scars?’ Usually, I will respond with products that I’ve used with good success (I will link these below). However, for the purpose of this post, I want to make a few suggestions on what ingredients to look for, what I have have had success with and what unfortunately goes beyond the realm of skincare.
Firstly, I think an explanation of Post-Inflammatory Hyper Pigmentation and Post Inflammatory Erythma proves useful:
Post-Inflammatory Hyper Pigmentation (PIH): By definition, PIH results from an overproduction of melanin following inflammation of the skin, resulting in an accumulation of pigment at the injury site. The colour can vary depending on skin tone (it can be red, purple or brown). For example, those with darker skin tones will more often than not suffer from brown PIH. Likewise, those with Fitzpatrick type I-II, will usually suffer from red PIH. How does this differ from Post Inflammatory Erythma?
Post Inflammatory Eyrthma (PIE): A relatively new term, PIE, by definition, is pink or red discoloration from an acne lesion that mostly affects those with fairer skin ( Fitzpatrick type I-III). Most often than not, the lesions are not hyperpigmentation, but instead ‘discrete erythematous macules.’
How do you know if you suffer from PIE or PIH? Here’s an efficient way to tell: Press (lightly!) a clear piece of glass or plastic onto the affected area. Erythema will temporarily disappear, hyperpigmentation will not.
I have PIE. What can I do? Unfortunately, not much research currently exists on treatment. There are reports that both Pulsed Dye Lasers and Silicone Sheeting can aid recovery. If you are in a position like I am and you cannot currently afford laser treatment, the best cure is time – I know it sucks to hear that. I am unfortunate and I have both PIH/PIE. But I have found that a combination of time (6-8 months in some cases) and working on my overall skin tone has drastically reduced both. PIE will fade eventually, and you may even find that some brightening agents do show minimal improvement, I have. Better than no improvement, right?
My recommendations on treating PIH with ingredients that I have personally had success with:
- Vitamin C: The gold-standard for correcting pigmentation and overall skin tone. Ascorbic Acid (think Skinceuticals C E Ferulic) at 15-20% is arguably one of the most effective ways at correcting PIH. Personally, I cannot use Ascorbic Acid, it is simply too much for my sensitive skin. Instead, I rely on other other forms of Vitamin C such as Ascorbyl Glucoside and Magnesium Ascorbyl Phosphate (MAP) to provide results, albeit at a much slower pace. If you can opt for an L-AA based serum, I would certainly recommend doing so. On top of its ability to lighten pigmentation, its antioxidant properties fight free radicals, making it perfect to use under SPF for both correction and protection. Win win! If you are an individual who prefers a minimal/simplistic routine, Vitamin C and SPF is what I would opt for.
- Azelaic Acid: Available both as a prescription (Skinoren and Finascea) and in multiple over the counter products, Azelaic Acid is one of my absolute favourites. Acting as a double-whammy (hell, triple-whammy), it tackles pigmentation, soothes inflammation and breakouts all at the same time. I will say that Azelaic Acid is a bit of a ‘slow’ burner. I.E, it has taken me approximately 3 months to see full results, but it works in a non-aggravating way, making it easy to slip into a routine with other brightening agents. My personal favourite is Paula’s Choice Multi Correctional Treatment, housed in a cream formula with both Salicylic Acid and Licorice Root Extract. Review to come!
- Niacinamide: A very popular ingredient currently on the market. Like Azelaic Acid, Niacinamide has various benefits. To speak of a few, it can aid pigmentation, enlarged pores, fine lines and help improve skin barrier function. Personally, I have seen the most progress since adding Niacinamide into my routine. It works wonderfully on my oily, acne-prone skin, and has made the most difference on my pigmentation and redness. I personally use Paula’s Choice Brightening Essence in the AM, and the Radiance Renewal Mask in the PM (give me all the Niacinamide you can get!).
- Arbutin: Branded as a ‘safer’ version of hydroqiunone, Arbutin is derived from bearberry. Personally, this was only brought to my attention only because it was included in two products I use (the Radiance Renewal mask and Brightening Essence), however it is commonly used in K-Beauty products, and many attest to its brightening qualities. Seeing as I’m using it in combination with other ingredients, it is hard to solely attribute what it has done for me. However, if you are looking for a ‘safer’ alternative to hydroquinone, or cannot obtain it, it may be worth looking into.
- Retinol: Another multi-tasker, Retinol can most definitely help hyperpigmentation over time, as well as improve signs of aging and frequency of acne breakouts by increasing cell turnover. Personally, I have found that over-the-counter products are more suited to my sensitive skin. Whilst I am currently using Differin (adapalene), it can often make my skin red/pink, even with buffering it with another product. What your skin can tolerate is down to the individual. Working up from an over-the-counter product to one of prescription strength may be the most viable option.
- Alpha Hydroxy Acids and Beta-Hydroxy Acids: AHA’s (glycolic, lactic, mandelic etc) and BHA’s (Salicylic Acid) work by exfoliating and renewing the skin’s surface, and in the case of BHA, is oil-soluble and therefore able to dissolve oil in the pore. The only product with a blend of both AHA/BHA that I use is Drunk Elephant’s Babyfacial which has provided impressive results on old pigmentation, feel free to read a more in-depth review here. If you are serious about pigmentation and also have concerns over breakouts and aging, chemical exfoliants are worth looking into. They are readily available in various strengths and different types of products (toners, masks, serums).
- SPF: Most importantly, daily SPF. It is unwise to invest time and money into multiple products if this is not one of them. I can’t imagine trying to correct pigmentation but not protecting the skin from UVA and UVB rays, especially if you’re using chemical exfoliants and retinol. Find an SPF you find cosmetically elegant, and works like a primer if you wear makeup – and you’ll never find it tedious or painful to use one again.
My philosophy is that a combination of multiple brightening agents is more effective than using one singular ingredient. On top of brightening agents, I think it is equally important to maintain a healthy barrier. You can do half the work, but allow your skin to also participate. We weren’t made to use products, our skin has amazing abilities to regenerate and repair itself! Look for ceramides, cholesterol and fatty acids (preferably at the ratio of 2:4:2) to maintain healthy barrier function. Although actives such as AHAs/BHA’s and Retinol can yield great results, it is so easy to go overboard (guilty!).
What is beyond the realm of skincare?
Personally, I have not experienced atrophic scarring from acne. However, I know it is common, particularly in severe cases. Unfortunately, I am not a physician and cannot/will not recommend types of specific treatments (laser, dermarolling etc). The best source of information here would be a Dermatologist. They will be able to guide you on what treatment is best and what expectations to have.
Below is a picture of my skin in January 2017 and one today, in April 2017.
Every breakout I had would leave pigmentation. Even if I had no active breakouts, it sure looked like I did because of the PIH/PIE. My first ‘phase’ of action was to completely clear my acne, it was impossible to focus on pigmentation when I was still getting breakouts. From January, I used a combination of Azelaic Acid 5 days a week, and Differin 2/3 times a week. My acne was mild but persistent. I would say within four weeks I saw a huge improvement in active acne. Then, I slowly integrated multiple products (Namely, Paula’s Choice Multi Correctional Treatment, Radiance Renewal Mask and Brightening Essence) to work on pigmentation whilst continuing use of Azelaic Acid and Differin to remain clear. As you can see, I still have areas of faint pigmentation, but I feel I’ve made impressive progress in just a few months. I attribute this to using various brightening agents that have worked harmoniously together.
So there we have it. My personal experience and tips with pigmentation! What are your favourite products and ingredients for PIH? I would love to hear!
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