What is the relationship between dark marks, scars and acne? – Musings of an NYC Dermatologist

Many patients come seeking help regarding dark spots on their faces that they sometimes refer to as scars. They are surprised to learn that their primary problem is acne and that, technically, these marks are not scars but what we refer to as post inflammatory hyperpigmentation.

Acne is a common skin condition that starts with a keratin plug in the hair follicle. The body can react to this plug by mounting an inflammatory response, with redness and swelling, much like it might to a splinter in the skin. In people with dark skin, or skin that tans easily, the body’s response with making extra pigment leaving a dark mark. In people with lighter skin inflammation appears as redness or erythema. Although acne can cause scars, neither the dark marks, nor the red marks, made by acne are scars. True acne scars occur when the inflammation is more severe causing destruction of tissue or an abnormal healing response causing thickening of tissue. Discoloration caused by acne is generally temporary. Scars, however, are permanent, although they improve over time.

Another way to distinguish discoloration caused by acne and scars caused by acne is to compare them to a tee shirt. If one were to spill wine or coffee on a white tee shirt, this would be the equivalent to post inflammatory hyperpigmentation (dark marks) or persistent erythema (pink marks). These marks could generally be removed. If one were to tear the fabric of the tee shirt and then patch it up, this would be like an acne scar. The hole would be gone but the texture would not be the same.

Either way, the best way to treat and prevent dark marks, red marks and scars from acne is to treat the acne.


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