Effective Ways to Treat Red and Dark Acne Scars on Your Skin

How to remove red and dark acne scars?

I have had a lot of acne on my face since high school.
I am afraid to squeeze them, but after the acne goes away, the original spots leave behind red pigment scars (many of which have not faded even after six months).
I haven't squeezed them, so why do I still have scars? I have previously undergone glycolic acid peels and used retinoids, but the red pigment scars have not noticeably faded.
I visited a dermatologist, and the doctor said that glycolic acid and retinoids can cause increased redness and should not be used.
Is this true? After exercising, my face becomes red all over, and I don't know what to do.
Should I continue using glycolic acid and retinoids, or should I use other medications?

Se Su Dou Ba Nan Hai, 10~19 year old female. Ask Date: 2000/11/19

Dr. Zheng Lizhen reply Dermatology

Although you may not have squeezed the pimples, the inflammation from the acne can severely damage the surrounding tissue, leading to scarring.
This is why dermatologists emphasize the importance of early treatment for acne.
Alpha hydroxy acids (AHAs) and retinoids (commonly referred to as A acids) are acidic and can be irritating, so the concentration and dosage are crucial.
In particular, retinoids should only be used at night and washed off during the day, ideally in conjunction with sunscreen.
Redness of the face may also be caused by other factors, which can only be determined through a clinical examination.
If you are concerned that your symptoms are due to AHAs or retinoids, it is advisable to temporarily discontinue these products, apply cold compresses to alleviate redness and heat, and consult a dermatologist for a proper diagnosis.

Reply Date: 2000/11/19

More Info

Dealing with red and dark acne scars can be a frustrating experience, especially when they linger long after the acne itself has resolved. It’s important to understand that the skin's healing process can vary significantly from person to person, and several factors can contribute to the formation of these scars, including inflammation, skin type, and even genetics.

When acne lesions heal, they can leave behind post-inflammatory erythema (red marks) or post-inflammatory hyperpigmentation (dark marks). These are not technically scars but rather changes in skin pigmentation that occur as a result of the inflammation caused by acne. The redness often indicates that the skin is still healing, while darker spots are a result of excess melanin production in response to inflammation.

Why Do Scars Form?
Even if you avoid picking at your acne, the inflammation itself can lead to these marks. When the skin is inflamed, it can trigger a response that results in increased blood flow to the area, leading to redness. Additionally, the skin may produce excess melanin as a protective response, which can result in darker spots once the acne resolves.

Treatment Options
1. Topical Treatments:
- Retinoids (AHA/BHA): Topical retinoids, such as tretinoin (A acid), can help accelerate cell turnover, which may reduce the appearance of both red and dark spots over time. However, they can cause irritation and redness, especially if used excessively. It’s crucial to follow a dermatologist's guidance on how to incorporate these into your routine.

- Alpha Hydroxy Acids (AHAs): These can help exfoliate the skin and improve texture and pigmentation. However, as you mentioned, some dermatologists caution against using them if they cause increased redness. It’s essential to monitor your skin's response and consult with a dermatologist if you experience irritation.

- Niacinamide: This ingredient can help reduce redness and improve skin tone. It’s generally well-tolerated and can be used alongside other treatments.

2. Professional Treatments:
- Chemical Peels: These can help improve skin texture and pigmentation. A dermatologist can recommend the right type of peel based on your skin type and the severity of your scars.

- Laser Therapy: Treatments like fractional laser therapy or pulsed dye laser can target redness and pigmentation effectively. These treatments work by stimulating collagen production and can significantly improve the appearance of scars.

- Microneedling: This procedure involves using fine needles to create micro-injuries in the skin, promoting healing and collagen production, which can help reduce the appearance of scars.

3. Sun Protection: Regardless of the treatment you choose, protecting your skin from the sun is crucial. UV exposure can worsen pigmentation and delay healing. Use a broad-spectrum sunscreen with at least SPF 30 daily, even on cloudy days.

4. Consultation with a Dermatologist: Since you have already seen a dermatologist, it might be beneficial to seek a second opinion if you feel your concerns are not being addressed. A dermatologist can provide personalized recommendations based on your skin type and the specific characteristics of your scars.

Conclusion
In summary, while red and dark acne scars can be persistent, there are effective treatments available. It’s essential to approach your skincare routine with patience and care, as the skin can take time to heal. Monitor how your skin responds to different treatments, and don’t hesitate to reach out to a dermatologist for tailored advice. With the right approach, you can significantly improve the appearance of your skin over time.

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