When Acne Puts You On The Spot
One of the least frequently considered complications of acne is hyperpigmentation, the formation of small, or not so small, brown spots on the skin after pimples heal. Hyperpigmentation can occur on all skin types1 and all skin shades, but it tends to be more prominent with darker skin.
Why Acne Causes Hyperpigmentation
The pigment making melanocytes in the skin are cells that fill at least two different needs. They produce the black and red pigments that blend with the natural tones of the skin and the coloration caused by the flow of blood to give the skin a recognizable overall tone. Your melanocytes are an important part of what makes you recognizable as you by helping create your skin tone.
The melanocytes also perform another very significant function. The pigments they release serve double duty as antioxidants. They stop the oxidative reactions that generate inflammation in the skin.
In fair skin, there are not as many melanocytes to make the pigments that quench inflammation. When the pimple heals, there is not as much leftover pigment available to form brown spots.
In Asian, Hispanic, and African skin types, there are more melanocytes in the skin to make the pigments that serve as the antioxidants to stop acne inflammation. There is more melanin pigment left in the skin at the end of the healing process. People who have darker skin have more pigmentation after acne heals. Since the pigments that quench inflammation are brown and the predominant tones in Asian skin are golden, hyperpigmentation is especially noticeable on Asian skin. These spots are known as melasma.
To A Certain Extent, Acne Is All In Your Head
The formation of pigments in your skin actually begins in your brain. The melanocytes, which make up about 3% of all the cells in your skin, a little higher percentage in dark skin, a little lower percentage in fair skin, have a direct connection to the brain3. Because a related chemical process makes the sleep chemical melatonin, not getting enough sleep or not getting enough uninterrupted sleep has a direct and immediate, although subtle, effect on your skin tone.
A part of the brain known as the pituitary gland coordinates the skin’s release of antioxidant pigments with the adrenal glands’ production of stress hormones. Both the cortisol produced by the adrenal glands and the melanin produced by the skin are found to reduce inflammation4. The pituitary gland increases the production of both substances to deal with inflammation caused by acne or sunburn. That’s why sunburn or excessive sun exposure during the healing process makes brown spotting after acne so much worse.
Your brain also protects you from the emotional distress of acne by producing a feel-good chemical called dopamine. When the brain senses inflammation in your skin, the pituitary releases a compound called tyrosinase that breaks down certain tyrosine-containing proteins (tyrosine is an amino acid) into dopamine. That’s mostly a beneficial process, except for some people who have Asian skin types. More on that in a moment.
Why It’s Not A Good Idea To Blast Away Skin Spots
Dermatologists used to think that melasma after acne was a good reason to use their high-powered, high intensity carbon dioxide lasers to blast the spots right off your face. Of course, the treatment got immediate results. On darker skin types, however, the results were less than desirable5. The blast of laser light removed the brown spot but inflamed the skin around it, and the skin repaired itself by making a still larger brown spot.
Many dermatologists then turned to a kind of chemical “skin blaster” known as hydroquinone. On many skin types, hydroquinone works quite well. But some people used it developed visible, banana-shaped fibers in the skin. They might also develop a rough texture on the skin that some dermatologists compare to caviar (which must really be irksome if you paid for the procedure on your credit card). And in time the skin that is treated with hydroquinone sometimes develops black and blue spots. The treatment in effect replaces brown spots with black spots and blue spots.
Sensitivity to hydroquinone is tied to a condition called ochronosis6. People who have ochronosis have a hereditary deficiency of the enzymes that recycle the amino acid tyrosine. That means when the brain senses the irritation in the skin caused by hydroquinone and triggers the release the processes requiring the above-mentioned tyrosine to be broken down, the enzymes needed to complete the process are not available. Black and blue pigment accumulates in the skin. Anyone can have ochronosis, but it is most common in people who have Asian skin types.
Getting Rid Of Brown Spots The Slow And Easy Way
If you have skin discoloration after acne, especially if you have dark skin, it is very important to avoid inflaming your skin to cure it. Chances are that your dermatologist will not even offer carbon dioxide laser treatment, but some dermatologists are willing to take risks by offering hydroquinone treatments to patients who have Asian skin types. (This is OK if your dermatologist has run a urine test for a compound called homogenistic acid and ruled out ochronosis as a cause of your symptoms.) You also need to avoid the over-the-counter skin lightening products made by Murad.
The most effective ways to get rid of brown spots on all types of skin are skin peels with7 salicylic acid or glycolic acid, administered by an aesthetician, and treatments with a form of vitamin A known as retinol and a form of vitamin B known as niacinamide.
Skin peels do exactly what the name suggests. They remove upper layers of the skin so that the basal layer of the skin can replace them with unpigmented skin. This process takes at least a month.
Retinol and niacinamide keep the melanoctyes from transferring pigments to the rest of the skin. Retinol accelerates growth of the skin, and niacinamide does double duty as an anti-inflammatory agent.
These agents are applied to the skin, but that’s not all you can do to prevent and reverse brown spots on the skin.
Treating Brown Spots From The Inside Out
Since the process that forms brown spots begins in the brain, it won’t come as a surprise if brain health is reflected in skin health8. You don’t have to follow a complicated routine of maintaining your brain to fight acne-related changes in your skin. Simply getting enough sleep, with the help of melatonin or GABA if necessary, is reflected in your complexion.
It also helps to take a B vitamin supplement that provides all eight essential B vitamins, biotin (B7), cyanocobalamin (B12), folic acid (B9), pantothenic acid (B5), niacin (B3), pyridoxine (B6), riboflavin (B2), and thiamine (B1). You need antioxidants—but don’t take large amounts of vitamin E, since it can increase sebum production. And if you are a woman, the calcium and vitamin D you take for your bone health also support the health of your skin9.
- Davis E.C., Callender V.D. Postinflammatory Hyperpigmentation. The Journal of Clinical and Aesthetic Dermatology. 2010;3(7):20-31.
- Gasque P., Jaffar-Bandjee M.C. The immunology and inflammatory responses of human melanocytes in infectious diseases. The Journal of Infection. 2015;71(4):413-21.
- Cichorek M., Wachulska M., Stasiewicz A., Tymińska A. Skin melanocytes: biology and development. Postȩpy dermatologii i alergologii. 2013;30(1):30-41.
- Lin T.K., Zhong L., Santiago J.L. Association between Stress and the HPA Axis in the Atopic Dermatitis. International Journal of Molecular Sciences. 2017;18(10).
- Trivedi M.K., Yang F.C., Cho B.K. A review of laser and light therapy in melasma. International Journal of Women’s Dermatology. 2017;3(1):11-20.
- Bhattar P.A., Zawar V.P., Godse K.V., Patil S.P., Nadkarni N.J., Gautam M.M. Exogenous Ochronosis. Indian Journal of Dermatology. 2015;60(6):537-43.
- Desai S.R. Hyperpigmentation Therapy: A Review. The Journal of Clinical and Aesthetic Dermatology. 2014;7(8):13-7.
- Chen Y., Lyga J. Brain-Skin Connection: Stress, Inflammation and Skin Aging. Inflammation and Allergy Drug Targets. 2014;13(3):177-90.
- Shahriari M., Kerr P.E., Slade K., Grant-Kels J.E. Vitamin D and the Skin. Clinics in Dermatology. 2010;28(6):663-8.
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