Asian and Middle Eastern patients who suffer from acne will often develop darkening of the skin. This is called post-inflammatory hyperpigmentation & is very commonly seen. Early and effective treatment of acne can reduce or prevent pigmentation changes.

There are several methods to lighten the skin if you have pigmentation changes-

1. Twice daily use of a high factor SPF, we recommend La Roche Posay sunscreen in acne-prone patients.
2. A topical Vitamin A cream can both treat acne and reduce pigmentation
3. Chemical peels with AHA fruit acids can treat acne, reduce pigmentation and help with mild scarring
4. Laser treatment with QSL or Q switches laser & pico laser can help with pigmentation. Other lasers I use include Fraxel, Clear & Brilliant & LaseMD Ultra fractional lasers.
5. Most importantly, time will fade pigmented scars, but this can take 9-12 months.

I did use the first pico laser (Picosure) over 6 years ago. It was a good generation one device. I have replaced it with Picoway. In the context of pigmentation, especially PIH, the latest generation Picoway is miles ahead of Picosure.

Most cases of PIH will respond within 2-3 sessions of Picoway, compared to over 6-8 sessions with older technology.

Yes they are. A correct match of the type of chemical peel and the concentration of peeling agent makes chemical peeling a very safe treatment for even the darkest skin type. Chemical peels can be tiered to treat both acne & acne scarring.

Chemical peels for acne: we use two types of chemical peels to treat active acne, including an AHA or Glycolic acid Peel, and a BHA or Beta Hydroxy Acid peel, also known as a salicylic acid peel. The concentration is tailored according to your acne and skin type.

Chemical peels for acne scarring: we use a special peel called TCA CROSS chemical peel to treat deep ice pick and box car scars. Once again the concentration is tailored according to the skin type, and severity of the acne scars.

Yes, but… treatments will need to be tailored to the skin and acne scar type. Unlike fair skin patients, treating acne scars in darker skin patients can be harder, and different lasers and techniques are used.

I was fortunate enough to have worked in Asia after my primary dermatology degree, hence I do have experience in treating acne scars in all skin types, including very dark skin types.

‘As emphasised throughout this website and in my lectures on acne scar revision, I choose a method based upon 3 factors- acne scar type, skin type or skin colour & the downtime of the patient. In treating darker skin patients, the order of importance is, firstly skin colour, secondly scar type, and thirdly down time. Treating darker skin patients is a lot more difficult compared to lighter skin patients due to two reasons.

1. Scarring after a laser procedure is more commonly seen in darker skin patients.
2. Skin colour changes (either lighter or darker skin) is more likely to occur in darker skin patients. In some cases, it is universal. In all cases it is temporary & there are methods to speed up healing & fading of dark spots.

Bearing all this in mind, laser treatments in darker skin patient with acne scars can still be safely and effectively performed however I advise the following-

• I choose Erbium ablative over CO2 fully ablative as erbium laser has less chance of causing post laser skin colour changes
• I use a short pulse duration CO2 laser for darker skin types, the CO2 lasers I use include the Ultrapulse, Mixto MT, CORE, & the eCO2
• I don’t laser as deep, nor do I treat as aggressively compared to fair skin patients. This means darker skin patients may need an extra two or three laser treatments to achieve a similar improvement in acne scarring compared to lighter skin patients.
• I raise deep scars with a customised TCA CROSS Chemical peel- this elevated deeper ice pick and box car scarring. This in turn will make laser treatment safer, as I do not need to go as deep to target these scars
• I advise treatments such as Tixel, vascular lasers, or Pico lasers early in acne treatment, as these treatments are safe, effective and can prevent scar formation
• I always emphasise a high factor SPF sunscreen 2-3 times a day, before any acne scar treatments. Occasionally I use a bleaching cream to help reduce any post laser complications.
• Laser for acne scars in darker skin patients can be effective, however safety is always the number one priority.

Acne scarring can be treated just as effectively in darker skin types compared to Caucasian patients. There are however key differences, but the end goal is the same.

• Firstly PIH or skin pigmentation changes are universally seen in darker skin patients. This is 100% certain, however will fade with prescription creams and sunscreen.
• Secondly treatments with lasers can be just as powerful, but the ‘overlaps’ are less. Laser treatments must be conservative.
• To reduce the chances of skin lightening, I usually perform an extra one or two TCA CROSS treatments prior to full laser resurfacing.
• For laser resurfacing, I use both erbium or the CO2 laser, albeit gentler settings

For an understanding of what is your ideal peel, book a consult with my clinical team @cliniccutis.

Acne scars in Asian and ethnic skin types can be treated with Fraxel or Fractional lasers. 3-4 fractional laser treatments are needed for best results. The same applies to Pico lasers.