I had acne for 14 years now, I've been to numerous dermatologist, pills, creams, chemical peels, retin A. (photo)

I'm extremely frustrated with it and the fact it's not getting better. My current problem is tone, enlarged pore size and hyperpigmentation. Can you please tell me what to do next or how else to fix my cursed skin?

Doctor Answers 3

Your skin color is a limiting factor to getting quick dramatic result

First, don't do chemical peels. From your photos, I can say you are a Fitz V. Ethnic skin and chemical peels usually don't do well together. More often than not, you end up with post inflammatory hyperpigmentation. The very first thing to do in your condition is make a good assessment of your acne scar type: ice pick, box car and rolling. It looks like you have mostly ice pick plus a few box car and rolling. Next is to figure out how bad the scars are. Are they shallow or deep?  Try to light your face in an angle to see how much light is trapped in the scars. This way you'll know how deep your scars are. Next is to control your acne because if you are still breaking out, you will keep getting the hyperpigmentation and  keep developing scars. There is no single treatment to your "curse". It involves a multi-disciplinary approach. Contrary to common beliefs, dark, ethnic skin is very sensitive and it should be approached very gingerly, carefully and slowly. With appropriate treatment protocol, it is possible for your skin to improve by as much as 80 - 90% over a period of 2 years. Your pigmentation will be the last thing to improve. As shown by your photos, your pigmentation seems to have already gone dermal. Improving pigmentation in ethnic skin is like walking on a tight rope. The key is slow but surely. With patience, your skin should clear.

Fresno Physician
5.0 out of 5 stars 1 review

Enlarged Pores, Hyperpigmentation -- Clear + Brilliant, Sublative/Viva, Eclipse Micropen

I suggest you speak to a cosmetic dermatologist who specializes in the treatment of acne and acne scarring.  You will need a combination approach for improvement.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews


You have mild inflammatory acne and scars from picking. Post inflammatory hyperpigmentation is very common, especially in people with dark skin. Treatment for that should probably be delayed until your acne is well under control. Same thing for your scarring. Probably the best treatment for inflammatory acne is antibiotics, which are available in both oral and topical forms. Even with antibiotics, it can take 6 to 8 weeks before you might notice any improvement. Sometimes any of a number of topical medicines can be added to the antibiotic as a supplement. You indicate you have taken pills. Sometimes, if a given antibiotic doesn't work, another one might be just the right one. But, again, you have to wait the 6 to 8 weeks. See a good dermatologist, and be sure to take a list of all the medicines you have used for your acne and for how long you used them.                    jlr

John Louis Ratz, MD
Clermont Dermatologist

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