The Most Frustrating Part of an Acne Breakout Can’t Be Fixed With a Cream

… Diane Berson, a medical and cosmetic dermatologist in New York. “The … on the surface of your face; it can pierce deep into … Musk.
While some products, like Clinique’s Radical Dark Spot Corrector … alter a scar with a cream. The Murad InvisiScar contains salicylic …

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The evidence of an acne outbreak can persist long after the painful red bumps themselves have disappeared, in the form of pigmented blemishes, and scars. If you’ve ever tried to treat them with home serums and creams, you might be familiar with just how hard they are to get rid of.

Plenty of over-the-counter products like gels, oils and serums make attractive claims about  making even tough scars, like those left behind by cystic acne, fade away. How effective are these kind of products, really? I spoke with a few dermatologists who work with clients every day that want to get rid of marks caused by pimples.

First, all three dermatologists that I talked to pointed out that there’s a big difference between an acne scar, and a pigmented blemish. Scars are more severe and thick, with indented or raised areas. They are likely to be permanent unless they are treated at a dermatologist’s office, says Diane Berson, a medical and cosmetic dermatologist in New York. “The only way to really get rid of that is to have a procedure done, like, lasers or peels or even filler injections,” says Berson.

The type of acne marks that topical products are potentially effective against are the smoother red and brown spots that occur after acne outbreaks, explains Debra Jaliman, a New York-based dermatologist. Technically, doctors call it “post-inflammatory hyperpigmentation.” Here’s what that means: The skin develops inflammation as a natural response to acne. During the healing process, it produces a bunch of melanin, the pigment which is naturally found in our skin and hair. But more melanin than is typically found in your skin is produced after acne episode. This additional melanin gives skin a brownish discoloration, or dark spots.

Robert Anolik, a specialist in laser skin surgery recommends couple of chemicals that could potentially work on the hyperpigmented spots. Over-the-counter salicylic acid peels, can help exfoliate away at least some of the hyperpigmentation. Another key ingredient in topical products geared toward hyperpigmentation is retinol, which is a derivative of vitamin A. Both salicylic acid and retinol help with hyperpigmentation by limiting additional pigment production, explains Anolik.

Not everyone is equally prone to acne spots. If you tan easily and develop hyperpigmentation from scratches and bug bites, you’re more likely to get spots from acne, too, Anolik says. Berson added that the discoloration and post inflammatory pigmentation is more common in people with a darker skin tones, or dark eye or hair color. This is because people with dark skin produce more melanin in general.

Spots caused by melanin production won’t necessarily stick around forever, even if you don’t treat them. “Usually, hyperpigmentation caused by acne could go away eventually, if you don’t traumatise them or rub them,” Berson says. She also advises patients to use sunscreen, as skin tends to secrete more melanin as it works to absorb the ultra-violet rays from the sun. So, if you wear sunblock and avoid sun exposure, the spots often can fade on their own.

But with acne scars, the story is entirely different. A pimple isn’t just a dot on the surface of your face; it can pierce deep into the skin, and damage the tissue that is underneath. Once the acne clears, skin secretes collagen in order to heal. Too much or too little collagen produces raised or depressed acne scars.

Scarring correlates with the severity of acne: the worse your original acne are, the more likely you are to develop acne scars. Unlike hyperpigmentation which only gives a change of color to the skin, acne scar alters the texture of the skin, giving an elevated or dented appearance to the spot where acne existed.

Regardless of skin tone, acne scars are not simple enough for the topical creams and serums to work. The treatment has to be targeted towards remodelling the skin, or stimulating collagen production, which is possible only by procedures such as laser.

While some products, like Clinique’s Radical Dark Spot Corrector limit their claims to fading post-inflammatory hyperpigmentation, other products, such as Murad InvisiScar, are marketed with claims about how they reduce the appearance of post-acne scars. According to the dermatologists I spoke with, it’s not really possible to alter a scar with a cream. The Murad InvisiScar contains salicylic acid has plenty of good reviews—perhaps what it’s really acting on is hyperpigmentation, and not true scarring. (Murad did not respond to my questions about their claims).

“The products help fade some of the pigmentation that’s left over from having had acne, and they’re referring to it as ‘scar treatment,’” says Berson. “But in reality, it’s a fading treatment to help fade only the pigmentation,”.

Even when it comes to hyperpigmentation, Anolik says that there is a limit to how much penetration we can see with creams alone, since the skin is such an amazing skin barrier. While superficial discoloration can improve over time with over-the-counter topical treatments, more dramatic changes require more dramatic treatments—or else, acceptance.

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