Post-inflammatory hyperpigmentation: Q & As

Can you suggest something regarding scars (dark spots) that have been left by past pimples? I was thinking about either microdermabrasion or using products containing kojic acid* that promises to lighten scars. Any thoughts on these?

*Kojic acid is a skin lightening ingredient. It can inhibit the formation of melanin.

You could try microdermabrasion. It is expensive, but it may work for you. You could try kojic acid products and see for yourself if their promises are well-founded. As I have said, no product or procedure is for everyone. And many things out on the market may work for you. My belief, however, is that many will not.

True scarring from blemishes is a tissue-related problem. I think the scarring this reader is talking about is really post-inflammatory hyperpigmentation. Because the dark spots never seem to go away, it probably seems like a scar, but in reality it is an overaccumulation of melanin at the site of the blemish. This caused the dark spot and sun- light is helping it to remain there. What I know is that if you become diligent and hyperaware about sun exposure, your “scars” will lighten and go away—as long as you keep sun off your face.

I am in need of a spot lightener. Basically I suffered from acne when I was pregnant, and the blemishes caused dark spots on my face. I need something to make the spots lighten up. Do you have a product that will reduce the darkness? PS: Why did these dark spots appear in the first place?

When you have breakout, especially deep cysts or pustules loaded with infection, the spots are like tiny wounds, and this wounded tissue is subject to variations in pigmentation. For example: One summer I tripped on my office patio as I was leaving work. My right foot caught the fall, but I ended up deeply scraping the top of it. Once a scab had formed, I stopped wearing Band-Aids; when the scab came off, scar tissue was left in its wake. Since it was summer, the area received all kinds of sun exposure due to wearing flip flops and sandals, leaving the injured tissue full-on exposed to sunlight. When I thought about it, I would put sunscreen there, but for the most part I was a “bad client” and just forgot about protecting it from UV light.

Due to the amount of sun that area received, and the extent of the injury with its resulting scar tissue, a large dark spot existed where the scrape occurred. Some people even thought it was a tattoo! But in actuality it was hyperpigmentation around the outside edge of the injury along with pigmentless scar tissue inside. Had it been winter, the area would have received little or no exposure to the sun, and no doubt it would be less discolored. Now the scar is barely noticeable, but when summer rolls around the darkness will probably reappear and then fade again in the winter. This example is of a foot; imagine how much sun your face is getting in the summer (or winter), subjecting your “injuries” to the potential for hyperpigmentation.

One way to avoid some of the darkness of post-inflammatory hyperpigmentation is to stop picking at your skin! It’s a bad habit and can cause damage to the area. With that said, a picker is going to pick. I can’t change your predilection for doing this; you believe you are helping your skin by picking. Perhaps when you can install a different belief, you can change your behavior. Try the belief: “When I pick at my skin, I am causing further damage. And it will take my skin longer to heal. Picking does not help.” Adopt this, and you are on the road to recovery.

I am not saying that extracting the infected mass from a spot isn’t advantageous. It is. However, in my experience, most people have little or no restraint when it comes to self-extraction. And sometimes tools are needed to properly get to a plug; the use of which is best left to an aesthetician in the course of a facial treatment. If you can’t get a facial, at least put healing products on the blemishes (geranium, for instance) and know this will go a long way to getting rid of the spots faster. Picking will only prolong the healing process and create the potential for post-inflammatory hyperpigmentation.

In conclusion, as long as you are experiencing breakout and receiving sun exposure (even limited amounts), you have the potential for causing dark spots where the blemishes are located. So, don’t pick at your skin, always wear sunscreen when you are out, and find ways to heal the blemishes without causing further damage. Many tools for having healthy skin are listed throughout this blog.

For more information, see:

• What is Post-Inflammatory Hyperpigmentation?
• Hyperpigmentation: A reader’s question(s)
• A Note to All Pickers—you know who you are!!! (Please read!)