1. Differin 2. Hydrocortisone 1% cream 3 Duac topical gel
Which Medication Heals Post Acne Redness the Best?
Doctor Answers 3
Post Acne Redness
Post Acne Redness otherwise goes by the name Post Inflammatory Pigment Alteration (PIPA) or Post Inflammatory Hyperpigmentation (PIH). The key is that you start with an active acne lesion, a papule or pustule (the acne bump) that is usually inflammatory (red and inflamed), though it does not necessarily have to be. Once the acne resolves it leaves pigment alteration, usually a red or brown mark, at the site of the previous acne lesion, thus post-inflammatory pigment alteration. Of the medications you listed, I would favor a combination approach using Differin (Adapalene) 0.1% or 0.3% gel long term to help regulate the keratinization of the skin, improving the appearance of the skin post acne as well as to help prevent acne and its side effects in the future. This in combination with a short course of Hydrocortisone 2%, twice a day for 1-2 weeks to treat the active redness and knock down the inflammation in the skin would probably work well. Duac is a combination of Benzoyl Peroxide and Clindamycin and is used for active acne lesions, I do not believe it would be effective for post acne redness. Other treatments that may be effective for redness post acne include other retinoids such as Retin-A Micro (tretinoin) and Tazorac (tazoratene) and their derivatives, nicotinamide medications such as Nicazel seems to be effective in clinical practice for this redness as does Aczone gel (topical Dapsone) although potentially it may be more effective for redness due to hormonal acne particularly in females. As well, a consideration may be low dose oral antibiotics such as Oracea (Doxycycline 40mg) to prevent inflammation in the skin. For brown pigmentation after acne, topical bleaching creams like Hydroquinone 4% or other non-hydroquinone based products may be effective as well as chemical peels and lasers. For darker skin types (Fitzpatrick IV-VI) with pigmentation post acne, I have found Finacea gel 15% (Azelaic Acid) to be very effective and safe.
How to Treat Post Acne Redness
Post acne redness is usually post inflammatory hyperpigmentation. Duac and Differin both have acne medications in them, so they are more for active acne. Hydrocortisone cream 2% - available by prescription - is what I'd recommend more, as well as good sunscreen. And if the spots are brownish, not reddish, hydroquinone is also quite effective. Additionally, very light laser treatments like Cutera Laser Genesis is extremely effective for PIH and I recommend and do this often on patients.
Treatment for Redness Secondary to Acne
Redness secondary to acne is what we call post-inflammatory hyperpigmentation (discoloration). Essentially, you start with an acne lesion such as a papule or pustule, and when that goes away, it can stain the skin a red or brown (in darker skin types) color which can last for months to years. Of the three medications you mentioned, Differin (topical adalapene which is similar to topical Vitamin A) and hydrocortisone cream cam be helpful in fading discoloration. Duac is a combination of antibiotic and benzoyl peroxide and is better suited for combating active acne. Other treatments which can improve the redness are topical tretinoin, topical bleaching creams like hydroquinone and chemical peeling.
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