MY ACNE HAS LEFT BEHIND DARK SPOTS

I have severe acne on my cheeks. The pimples that erupt turn into dark spots. Please help.

AFrom your letter I understand that you are referring to the dark spots left on your face by acne lesions which you have suffered in the past. Medically, this condition is known as postinflammatory hyperpigmentation (PIH) and can be seen as a post skin disease sequel in large number of other dermatological disorders as well, other than acne. Most of the sufferers of PIH are of Asian origin and individuals from the subcontinent are at the highest risk.

I usually classify post-acne PIH sufferers in three main groups: First group is composed of those who do not treat their acne timely and allow it to damage the affected hair follicles to the extent of getting them ruptured and spreading their melanin pigment into the superficial and deeper layers of skin. The second group comprises individuals who tend to poke or break their active acne lesions. The third group is those whose acne get treated by certain topical medicaments with potential of causing a mild skin burn on the applied areas and thereafter leaving these areas darker in colour.

Many of the topical acne gels can cause these side-effects. The risk of these side effects gets further multiplied in situations where the patients using such medicaments also get extended sun exposures while being using the treatment.

Superficial (Epidermal) component of PIH can usually improve with topical treatments. Certain superficial chemical peels can also prove effective. The real challenge is posed by the deeper (dermal) component of PIH. This can respond to deep acid chemical peels, but unfortunately in Asian skin, these treatments are not among the safest ones because they can be counterproductive by producing a peel-induced hyperpigmentation on top of the existing pigmentation. The latest option for treatment is lasers. I would advised you consult a reputed dermatologist for a detailed diagnosis.