How Dark Skin Types
Can Fight Acne Scars
Ask anyone with acne scars or post-breakout dark spots and they’ll tell you that the aftermath of a breakout can sometimes be more upsetting than the breakouts itself. Long after your skin has cleared, you’re left with the remnants of acne’s insidious presence. And while acne scars on dark skin can seem like an insurmountable issue, that doesn’t have to be the case. Minimizing the appearance of dark acne scars—and even sending them packing altogether—is possible when treated early on and with the right regimen. And fixes that are tailored to your skin tone make even more sense, especially since there are specific strategies that can ensure better results in darker skin. Here, Valerie Callender, M.D., a board-certified dermatologist in Glenn Dale, MD and an Acne Store advisory board member revels her preferred Rx for acne scars on Black skin.
Q: Is there a difference between hyperpigmentation and scarring?
A: Yes, there is a difference, and patients often confuse the two. They’ll say, “Dr. Callender, can you help me get rid of these scars,” and I have to let them know that they’re not really scars at all. Hyperpigmentation happens when your skin’s melanocytes, or the cells that make pigment, produce too much of it. That excess pigment is left in either the top layer of the skin, called the epidermis, or in the deeper level, known as the dermis. A scar is different. It occurs in the dermis when cells called fibroblasts churn out excess collagen, resulting in scar tissue. And there are three different types of scars that can result from acne: atrophic, hypertrophic, and keloid scars, with the latter two being particularly common in Black skin. Understanding the difference between the scars and hyperpigmentation is essential to treating them effectively.
Q: If you don’t pick at your pimples, are you in the clear when it comes to scarring on dark skin?
A: Unfortunately, no. There are certain areas of the body that are more prone to developing what we call idiopathic scars, meaning that there's no known reason as to why they surface. We often see them on the chest, shoulders, and back.
Q: Is scarring different in darker skin tones?
A: Yes. Darker skin has some genetic risk factors for scarring, so the scarring can be also hyperpigmented. That means not only are the fibroblasts that produce collagen affected, but so are the neighboring melanocytes that make pigment—acne scars on dark skin can actually have a combination of hyperpigmentation and scarring.
Q: How can one avoid acne scars on Black skin?
A: It’s really important to keep the skin moist and lubricated during the healing process. So I usually tell patients to use a really good moisturizer day and night. I love hyaluronic acid, and there are a lot of great serums that contain hyaluronic acid to help smooth and hydrate the skin. I also like products that have ceramides to keep skin moisturized. Sometimes I actually recommend occlusive products that contain petrolatum as well. But if you have oily skin and are acne prone, I normally recommend the lighter serums and lotions. In my darker skinned patients who are dealing with hyperpigmentation, I may also recommend treatments with ingredients like arbutin, niacinamide, kojic acid, tranexamic acid, azelaic acid, and retinol.
Q: What if the scar isn’t flat?
A: When you have a scar or a cut, your body's fibroblasts make collagen to seal it off and close it. Eventually, the collagen production is supposed to stop forming. In dark skinned patients, mainly individuals of African and Asian descent, those fibroblasts sometimes don't stop. They keep going, making more collagen, and creating what is called a keloid or a hypertrophic scar. For the latter, there are some topical products that contain silicone and may help when the trauma first occurs—the earlier you treat that scar, the more likely that it will resolve. These are usually gels—there’s even a prescription-strength tape you can use at home to try to flatten the scar. In contrast, keloids are treated in the office by a dermatologist.
Q: Are there other types of scars?
A: There are. Some go beyond where the trauma was—they're larger, they're harder, they may itch, burn, or be painful—and these are called keloids. I make sure to tell patients that it takes three months for a scar to fully mature and it should be flat. Monitor it, and if it continues to grow and expand beyond where the acne was, then you need to see a board-certified dermatologist.
Valerie D. Callender, M.D., F.A.A.D.
Dr. Valerie Callender is a member of the Acne Store Board of Dermatologists and an internationally recognized Board-Certified Dermatologist known for her sensitive and innovative approach to the treatment of pigmentation disorders. Dr. Callender is a prolific contributor to the dermatology literature and has co-edited a textbook on Treatment for Skin of Color. Dr. Callender has conducted and participated in over 60 research studies and clinical trials for both therapeutic and cosmetic products and is a consultant for some of the world’s leading cosmetic and consumer brands. She is a Past President of the Women’s Dermatologic Society and Skin of Color Society and has served on the Board of Directors of the American Academy of Dermatology. She is the Founder of the Callender Dermatology & Cosmetic Center and Callender Center for Clinical Research, which are located in the Washington, DC metropolitan region. Dr. Callender received her medical degree from Howard University, where she also did her residency and currently serves as a Professor of Dermatology at the College of Medicine.
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