I have a lot of discoloration, dark spots, acne scaring and I want to get rid of all of it. Any suggestions? (photos)

What cleared up majority of my acne was accutane. I am now sufferin with the after math, the scarring, dark spots , uneven skin tone. I have a yellow undertone with dark marks, red marks all over my face and neck . I really need a solution. I've done microdermabrasion and peel in the past, it really helped me. I also used honey cinnamon buttermilk and it helped a lot. I was wondering what I can do to get clear skin can u me find a treatment or really good products

Doctor Answers 4

Discoloration and Acne scars and Best Treatment - NYC

I treat so many patients with marks and scars from acne and dark skin.  The key would be a combination of bleaching creams, Retinoids and chemical peels.  Any residual scars should be treated with eMatrix or microneedling/PRP since you have dark skin.  Fraxel would not be a good laser for you.  Please consult an expert. Best, Dr. Green

Accutane, faders, peels and PicoSure

You appear to still have some active acne, so seeking a dermatologist to be assessed and treated with Accutane may give you a long term solution for this.  In regards to your Post-Inflammatory Hyperpigmentation and Scarring, at this stage I would often treat with prescription faders that you may use at home, and chemical peels (low concentration glycolic acid for instance while you are on Accutane) in-clinic.  More recently we have been getting promising results with the PicoSure picosecond pigment laser in this setting also.  With your darker skin-type, seek a practitioner who has experience in this.

A Series Of Superficial Chemical Peels Can Help Speed The Resolution Of Post Inflammatory Hyperpigmentation

From the photos, it would appear that many of the residual reddish-purple and darkish spots are examples of post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH). So long as there are no new acne breakouts in the same areas, these spots typically fade spontaneously, i.e. on their own without treatment. In people of color, since they have more pigment to begin with, this process may frustratingly take place over many weeks or even months.

I have found a series of chemical peels, using such agents as full-strength glycolic acid, high concentration salicylic acid, low strength TCA and Jessner's solution to be very effective for promoting hastening of the fading and for better blending of the resolving areas with the surrounding normal skin.

It is difficult from the photos to clearly determine the kinds of true scars that are present. I see some shallow depressed scars and some pitting. Fractional microneedle resurface (aka medical microneedling, dermal rolling, etc), a relatively inexpensive treatment modality, can be quite effective for improving superficial tone and textural problems. Deeper pits (ice pick scars) might respond well to the TCA CROSS Technique. 

Your best bet would be to seek consultation with a board certified aesthetic dermatologist with experience and expertise in treating acne and acne scars. And finally, although there is newer evidence to suggest that there is no need to wait to perform aesthetic treatments after Accutane, I would still suggest postponing aethetic treatments for at least a few months, just to be on the extra safe side.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 23 reviews

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PIH and scarring from acne - dark skin type

I would make sure you are on a good skin care regime which includes Retin A and a skin bleacher. Chemical peels are a good choice. I like Infini for acne scars in your skin type. See link.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
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