Doctor's Answers (3)
The bumps sound like comedones and the marks you mention are probably post-inflammatory hyperpigmentation (dark marks left after en episode of inflammation/truama).
PIH is especially common and prominent in asian skin. While they do eventually go away (after weeks to months), the constant repeated formation of new marks make them seem ever-present.
While extractions can help to remove excess sebum from the face, I personally prefer a more gradual approach with chemical exfoliation - the use of acidic toners such as salicylic acid toners that gently reduce oil buildup and comedones on the face. This can reduce your need for physical extraction and the possibility of PIH formation. Should you absolutely need extraction, do see a medical-based clinic for proper extraction to prevent unnecessary damage to the skin that will lead to PIH formation.
The addition of a retin/differin will help further close pores and reduce comedone formation.
In terms of the PIH, both the acidic toner and retins do help over the long run. Vitamin C serums are a good to have, and sunscreen is a necessity.
If you want to get rid of them faster, several clinical options exist:
1. Lasers (we use the picosecond laser with very good clearance of PIH): PIH generally responds rather variably to lasers, but picosecond lasers have been shown to have more encouraging effects on them.
2. Mild chemical peels: slightly stronger than your acidic toners, these medical peels help speed up the breakdown and exfoliation of skin and hence marks left behind by inflammation.
3. LED light therapy: LED light (such as the medical-grade Omnilux we use at our clinic) aid regeneration and healing of the skin. Be weary though, as the cheaper light masks bought off the web have minimal energies and hence insignificant effects on the face.
4. Broadband Light/IPL: If the lesions are still red, BBL/IPL (such as the Sciton BBL we use at our clinic) help very well with eliminating the redness and also helping with the brown marks left on the face.
As you can see, many viable options exist, and each with their own underlying cost and efficacy.
Feel free to inquire more should you need further information on management.
Cheers, and Merry Christmas,
Dr Shane Abucewicz Tan
I am sorry to hear about what has happened after your extraction. Be rest assured that this issue of brown marks (post-inflammatory hyperpigmentation or PIH in short) will fade away with time. Due to trauma and inflammation after your extraction, the body's immune response deposited extra colour in the form of brown pigment as part of the healing process. This will eventually fade with time as the immune system digests the extra pigment in the next few months.
It is important to stop squeezing the congested or blocked pores on your face in order to prevent more marks. Think of it this way, by squeezing you hope to extrude the oil in the pores but the opposite can happen, you may drive it the other way instead. As a result inflammation occurs and things get worse, and more brown marks will develop.
Topical medical-grade retinoids such as tretinoin cream prescribed by doctors can help to gently exfoliate the skin and unblock the pores, prevent oil accumulation and pore blockage, and also lighten the marks. It is worth using tretinoin cream for a period of time to clear the skin.
Applying SPF50 sun block daily is important as this prevents the marks from darkening further. Do use a non-comedogenic (does not block pores) sun block.
Mild chemical peels, for example mandelic acid or pyruvic acid peels are specially formulated to gently exfoliate the skin, and I find them gentle yet effective, when compared to traditional glycolic acid peels. This is important for patients with sensitive skin, as they cannot tolerate harsh peels.
Lasers may have limited efficacy to remove the pigment as it is deep within the skin, and in some situations, they make worsen the brown marks. Ultimately it still depends on your body's immune system to digest and remove the extra pigment.
To summarise, the best approach for you would be topical retinoids, mild chemical peels and application of sun screens daily. The colour will fade in a few months. There is no hurry to attempt laser treatment at the moment. Do see an experienced dermatologist for further assessment.
Take care and happy holidays!
Dr Ker Khor Jia
From your description, the brownish marks are Post-Inflammatory Hyperpigmentation marks which have occurred due to the inflammation from your acne, trauma from squeezing the acne and extraction during facial.
As the name suggests, Post-Inflammatory Hyperpigmentation(PIH) may occur whenever there is an insult/inflammation to the skin, and the skin reacts by producing more melanin. It is temporary, but may take some time to heal and resolve without treatment. It also happens more commonly in darker-skinned individuals.
Treating PIH takes time and patience. In my practice, I adopt a combination therapy approach to treat PIH when it happens. The most important "treatment" in my opinion, is to prevent them from happening. Hence for you, it would be prudent to treat and reduce the comedones and congested pores, and also to reduce and stop(if possible) squeezing the comedones and congested pores. A good skincare regime and sun protection is also necessary to prevent worsening of the PIH.
To treat existing PIH marks, the following can be used:
1. Topical therapy - Topical products containing ingredients like tretinoin increase cell turnover and hence removal of pigmentation and unclogging of pores, lighteners like hydroquinone, anti-oxidants like vitamin C, as well as cysteamine cream which inhibit melanin production all help with reducing the appearance of PIH marks. Mild superficial chemical peels are also useful to exfoliate the skin and increase cell turnover which in turn remove pigmentation and decongest the pores.
2. Oral supplements like sublingual glutathione, oral carotenoids that can help to inhibit existing melanin synthesis and lighten PIH marks and even out skin tone, as well as oral polypodium leucomotos supplements that can help prevent further damage and darkening of marks from UV radiation.
3. LED light and Laser therapy - Yellow LED light is useful to reduce redness and the Near-Infrared wavelength LED light is useful for melanin pigment destruction and pigment suppression and hence very useful to treat PIH. Lasers like the Dual Yellow Copper Bromide laser, Nd-Yag laser toning and Picolaser toning have all been shown to be useful in the treatment of PIH as well.
In my practice, often a combination therapy approach gives very good results in the treatment of PIH. You should get a proper assessment by a certified and experienced doctor who will be able to come up with a customised treatment plan for you.