Red and Black Acne Scars: Treatment and Care Tips

Red and black acne scars?

I have a question for the doctor.
Recently, I visited a dermatologist for acne scars, and the doctor prescribed a yellow ointment for me to apply (it looks like tretinoin).
He instructed me to apply it to the areas with acne and red or dark pigmented scars.
He said that I need to apply it until the skin peels and the pigmentation fades.
Is this true? Does the skin need to continuously peel for the pigmentation to rise and eventually fade away? Thank you.

Xiao Nan, 10~19 year old female. Ask Date: 2000/11/30

Dr. Zheng Lizhen reply Dermatology

Applying tretinoin can indeed improve acne and hyperpigmentation.
After application, it may cause peeling due to the exfoliation of the skin.
It is important to apply a "thin layer" at "night" to allow for mild peeling, which yields the best results.
If peeling is too severe, reduce the amount used or extend the interval between applications to every two to three days.
Gradually increase the dosage as your skin adapts.

Reply Date: 2000/11/30

More Info

When it comes to understanding and treating red and black acne scars, it's essential to grasp the underlying mechanisms of skin healing and the various treatment options available. Acne scars can be classified into two main types: post-inflammatory erythema (PIE), which appears as red or pink marks, and post-inflammatory hyperpigmentation (PIH), which manifests as dark spots. Both types can be distressing and may take time to fade, but there are effective strategies to manage and treat them.

The use of topical retinoids, such as tretinoin (often referred to as A acid), is a common recommendation for treating acne scars. These medications work by promoting cell turnover, which helps to exfoliate the skin and encourage the growth of new, healthy skin cells. This process can lead to a reduction in the appearance of both red and dark scars over time. However, it is crucial to understand that while retinoids can facilitate skin peeling and renewal, they should be used cautiously and under the guidance of a healthcare professional.

Your doctor’s advice to apply the retinoid until the skin peels is based on the principle that as the outer layer of skin sheds, it can help to fade the discoloration beneath. However, it is not necessary for the skin to peel excessively for the treatment to be effective. Mild peeling is often sufficient to promote the desired results. Overuse or aggressive application can lead to irritation, redness, and increased sensitivity, which can complicate the healing process.

In addition to retinoids, there are several other treatment options available for managing acne scars:
1. Chemical Peels: These treatments involve applying a chemical solution to the skin, which causes the outer layer to exfoliate and eventually peel off. This can help reduce the appearance of scars and improve skin texture.

2. Laser Therapy: Various laser treatments, such as fractional laser or pulsed dye laser, can target the deeper layers of the skin to stimulate collagen production and reduce the appearance of scars.

3. Microneedling: This procedure involves using fine needles to create micro-injuries in the skin, which can stimulate collagen production and improve the appearance of scars over time.

4. Hydroquinone and Other Brightening Agents: For dark spots, topical agents like hydroquinone, azelaic acid, or vitamin C can help lighten hyperpigmentation.

5. Sun Protection: It is crucial to protect your skin from sun exposure, as UV rays can exacerbate hyperpigmentation. Using a broad-spectrum sunscreen daily can help prevent further darkening of scars.

6. Moisturization: Keeping the skin well-hydrated can support the healing process and improve overall skin texture.

While the goal is to achieve a smoother and more even skin tone, patience is key. Treatments for acne scars often take time to show results, and it may require a combination of therapies to achieve the best outcome. Regular follow-ups with your dermatologist can help tailor the treatment plan to your specific needs and monitor progress.

In summary, while the use of retinoids can be effective in treating red and black acne scars, it is essential to approach treatment with a comprehensive plan that includes various modalities, sun protection, and proper skincare. Always consult with your dermatologist before starting any new treatment to ensure it is appropriate for your skin type and condition.

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