Dark spots after pimples: Causes and Treatment-FAQs

Dark spots after pimples: Causes and Treatment-FAQs

Acne or popularly called as pimples is one of the commonest skin conditions and is a challenge for dermatologists. Acne (aka pimples) is multifactorial and is a manifestation of various underlying hormonal or metabolic conditions. The most distressing part for the patient is the sequelae like black spots left behind by pimples. This is known as post-inflammatory hyperpigmentation or PIH. In this blog we will discuss the various causes and ways to treat black spots or PIH by acne.

PIH is a natural response to inflammation: Why?

Many times patients ask me the reason for these black spots left behind by pimples. PIH or black spots are a result of dispersion of pigment (melanin) due to inflammation. Pimple or acne is inflammation around the sebaceous (oil) gland. When this inflammation reaches the pigment layer, it disperses the pigment in an irregular manner. This causes black spots or marks. This activity is also mediated by various inflammatory mediators like leukotrienes or prostaglandins released when a pimple is formed.

What does PIH look like?

PIH looks like a flat area of skin discoloration or mark which is darker than normal skin. It may appear round and irregular in shape. Mostly it is darker in dark complexioned persons. 

What causes the black marks after pimples resolve?

PIH is a natural response post any injury or inflammation of the skin. It is worse after recurrent or persistent pimples. It is also more severe if the pimples are squeezed or rubbed vigorously while washing the face. It is mandatory to use sunscreen especially in Indian skin while you are undergoing any treatment. Avoid the temptation of ‘popping’ pimples as they worsen the scarring. Some people remove blackheads as a practice themselves or as parlor clean ups. This can actually cause ice pick scarring or deep, open pores on the nose and cheeks. Delay in treatment of pimples increases the risk of getting black marks.

Acne scars vs PIH 

The good news is that these marks are not true scars in the sense that they become completely better with treatment. The ‘true’ acne scars which look like pits and open pores do not resolve completely with any treatment. Patients tend to panic when they see these black spots but this is perhaps the only sequelae of acne which gets resolved with proper care and treatment. A true acne scar is atrophic, depressed below normal skin and has loss of some tissue. 

Do black marks fade with time or shall we treat it?

These black spots left behind by pimples often take some time to resolve and with proper care, we can expedite their exit. Leaving them and/ or not treating them may worsen it in some cases. As a dermatologist, I advise certain tips to manage the black spots left behind by pimples or acne.

1. Tip 1: Use an AHA /BHA based cleanser: These cleansers are comedolytic and at the same time, their exfoliating action keeps the PIH in check. Remember that cleanser can achieve only deep cleansing and one should avoid the temptation of rubbing the face or scrubbing it.
   
   
    

2. Tip 2: Sunscreen: Using a broad-spectrum sunscreen every day since the beginning of treatment is very helpful practice to prevent PIH. The medications commonly used to treat pimples also make skin sensitive to light.
    

3. Tip 3: Use retinoid early: Retinoids are prescription strength medications which in a topical and oral form reduce the inflammation and decrease the chance of getting PIH. They may initially cause dryness and irritation which make people believe falsely that it increases it. Remember to moisturize liberally in the initial flaking days and add a sunscreen in your routine.
    

4. Tip 4: Depigmenting agents: Vitamin C in topical form, Kojic acid and Glycolic acid can be added over the weekend to reduce the PIH.
    

5. Tip 5: Chemical Peels: I have seen in my practice as a Dermatologist in Bangalore, addition of chemical peels early in the course of treatment helps greatly in reducing the black spots very fast.
   
   
    

6. Tip 6: Hollywood Peel: This procedure also popularly known as carbon peel utilizes carbon solution in oil base (We use patented Spectra carbon from Lutronic)  to help in reducing the active pimples and black spots. One of my personal favorite procedures for active pimples with red and black spots, Hollywood Peel is also great for skin rejuvenation and helps reduce prominent open pores. 

Will home remedies be helpful in reducing marks?

One has to understand that the marks are a cause of inflammation and until we decrease it, no home remedy can actually help in lightening the spots. Please Google a ‘dermatologist near me’ to find the nearest doctor or reach out to us for an online consultation.