Can I treat acne and post acne marks in one routine?

Which marks are you treating?

Brown marks left where acne has healed are called post inflammatory hyperpigmentation: extra pigment following inflammation. They can affect anyone, but are more common, darker and longer lasting in darker skin tones. Treating new breakouts matters alongside treating existing marks. Picking or squeezing acne increases the risk of dark spots and scars, so a fading routine has little to gain from extra excavation.345

Choose treatment that fits your acne

Topical retinoids are medicines derived from vitamin A. They treat clogged pores and inflamed acne, and also help brown post acne pigmentation. Adapalene is an acne retinoid available without a prescription; tretinoin is another retinoid used for acne and pigmentation. Azelaic acid is also used for both acne and brown marks.1236

For blackheads and whiteheads, a retinoid plus a benzoyl peroxide wash is an established approach. For small inflamed or pus filled pimples, a benzoyl peroxide or salicylic acid wash is an option. These are acne treatments, not interchangeable promises to fade pigmentation. If you already use prescription treatment, tell your prescriber about your skincare before adding another active product.67

How to put the routine together

1. 1In the morning, wash gently with a mild cleanser and your fingertips. Wash up to twice daily and after sweating; do not scrub.
2. 2Use a gentle moisturiser for dryness. Choose skincare labelled noncomedogenic, meaning formulated not to clog pores, and avoid greasy products that can worsen acne.
3. 3Apply broad spectrum SPF 50 or higher sunscreen daily to exposed areas with brown marks, because sunlight can darken them. When outdoors, choose a water resistant sunscreen, seek shade and use protective clothing.
4. 4At bedtime, cleanse gently and pat dry. If using adapalene gel or cream, spread a thin film over the entire affected area, not just individual pimples. Follow the package or prescription directions; its usual schedule is once daily at bedtime.
5. 5Keep irritating extras out of the routine. Avoid scrubs, harsh toners and exfoliants. For other treatments, follow their own directions rather than borrowing adapalene's schedule.

What should you expect?

Check acne progress after six to eight weeks, rather than changing treatments every few days. Adapalene can initially bring previously unseen pimples to the surface, and full benefit can take eight to twelve weeks or longer. Most acne treatments take two to four months for their full effect. Brown marks can persist longer in darker skin, and pigment treatments have differing degrees of success.2367

When should you get help?

Adapalene can cause early dryness, redness and peeling. If skin burns, stings or becomes irritated, contact your doctor; moisturiser or less frequent application can help. Do not apply adapalene to broken, sunburned or eczema affected skin until it heals. Get urgent medical help for hives, breathing difficulty or swelling of the face, lips, tongue or throat.7

If you are pregnant, planning pregnancy or breastfeeding, discuss treatment before using adapalene. Some topical retinoids are contraindicated during pregnancy. Sensitive skin and eczema also need care because retinoids can irritate skin and worsen eczema.17

See a dermatologist for deep nodules or cysts, which can leave permanent scars, or pimples that have not improved after six to eight weeks. For stubborn brown marks, discuss targeted treatment rather than adding home peels: procedures that injure the skin can worsen pigmentation.36