After acne improves, there can be red or black acne scars left on the face, sometimes even both occurring simultaneously. Why do some people develop red acne scars after the pimples fade, while others experience pigmentation issues?
This is primarily related to individual skin color. According to Fitzpatrick’s skin type classification, we can categorize skin into six levels where level 1 is very fair skin, and level 6 is very dark skin. Most Asian skin falls around levels 3 to 4, which can affect the formation of acne scars. Lighter skin types tend to get more reddish pigment left behind, while darker skin types are more prone to developing pigmentation issues, creating black acne scars.
The mechanism behind acne formation typically involves four main factors: first, there is excessive keratinization of the skin follicles, preventing the expulsion of certain secretions; second, there is over-secretion from the sebaceous glands, leading to inflammation around the hair follicles; third, inflammation may cause proliferation of blood vessels in the dermis and epidermis; and finally, damage to the basement membrane can lead to excessive melanin production, creating alternating red and black pigmentation marks.
Squeezing pimples or other irritative behaviors may exacerbate this situation, so controlling existing acne is essential to effectively reduce the formation of acne scars. Maintaining good sleep and dietary habits is very important. In severe cases, doctors may need to prescribe oral antibiotics or use topical retinoids and azelaic acid products to help reduce red pigment production, as these ingredients have antioxidant and anti-inflammatory effects.
Many people find that pigmentation issues do not improve even after using azelaic acid. At this point, considering laser-assisted treatment can be beneficial. The most common laser treatments for red pigments include pulsed dye laser therapy, which utilizes 595nm wavelength light to achieve anti-acne effects and reduce redness.
For example, a patient with fair skin showed significant improvement in red pigmentation after undergoing 595 laser therapy because this laser can target the underlying red blood cells, effectively absorbing light and heat to constrict blood vessels. Of course, if skin barrier damage is detected during treatment, it is advisable to use products containing ceramides or Vitamin B3 to promote skin repair and to opt for lightweight products to avoid clogging pores.
Additionally, if pigmentation marks accompany excessive melanin accumulation, aside from using azelaic acid, incorporating Vitamin C and Vitamin A (such as retinoids) can help stimulate metabolism and accelerate the turnover of pigments in keratin.
If you want to further improve uneven skin tone, considering Q-Switched 1064 laser or the latest picosecond lasers can be beneficial. After several treatments, patients can see improvement in melanin. It is worth noting that the treatment of red acne scars should not be taken lightly; if not handled properly, it could lead to permanent pockmarks.
Besides the treatment options mentioned above, ongoing inflammation and the emergence of new acne will exacerbate the issue of red acne scars. Therefore, our primary task is to manage existing acne effectively while ensuring proper sebaceous gland and keratin metabolism. Although laser treatments are effective, continued use of skincare products is essential to maintain efficacy, such as antioxidant products containing Vitamin C and retinoids to ensure normal keratin turnover.
In summary, to prevent and treat pigmentary acne scars, we must correctly understand their causes to take appropriate measures. Prevention is always better than treatment, and taking action early can effectively reduce subsequent treatment troubles.