What is the treatment for acne dark spots?

Treatment for Acne Dark Spots (Post-Inflammatory Hyperpigmentation)

Azelaic acid is the most effective topical agent specifically for treating post-inflammatory hyperpigmentation from acne, and should be your first-line choice for acne dark spots. 1

Primary Treatment Approach

• Azelaic acid is particularly useful for patients with post-inflammatory dyspigmentation and serves dual purposes as both a comedolytic and antibacterial agent while directly addressing the hyperpigmentation. 1, 2

• The American Academy of Dermatology specifically recommends azelaic acid for patients with post-inflammatory hyperpigmentation, which is particularly relevant for patients with darker skin tones. 1

Foundation Therapy to Prevent New Dark Spots

While treating existing dark spots, you must simultaneously prevent new ones from forming by controlling the underlying acne:

• Start all patients on a topical retinoid (adapalene 0.1-0.3% or tretinoin 0.025-0.1%) combined with benzoyl peroxide 2.5-5% as the foundation to control acne and prevent future post-inflammatory changes. 1, 2

• Topical retinoids have direct anti-inflammatory effects and resolve microcomedones, which helps prevent the inflammatory cascade that leads to dark spots. 1

• Adapalene 0.1% is available over-the-counter and is better tolerated than tretinoin, making it an excellent first choice. 1, 2

Combination Strategy for Optimal Results

The most effective approach combines:

1. Azelaic acid for direct treatment of existing hyperpigmentation 1
2. Topical retinoid + benzoyl peroxide to control active acne and prevent new inflammatory lesions that cause dark spots 1, 2
3. Daily sunscreen is mandatory, as retinoids cause photosensitivity and UV exposure worsens hyperpigmentation 1

Additional Adjunctive Options

• Salicylic acid 20-30% chemical peels can provide intensive treatment for resistant cases, with alternative alpha hydroxy acids like glycolic acid, lactic acid, and mandelic acid also available. 1

• For patients with moderate inflammatory acne contributing to ongoing dark spots, adding topical antibiotics (clindamycin or erythromycin) combined with benzoyl peroxide may be necessary, but never as monotherapy due to resistance risk. 1, 2

Critical Pitfalls to Avoid

• Never stop treatment once dark spots fade - maintenance therapy with topical retinoids is essential to prevent new acne lesions that cause recurrent hyperpigmentation. 2

• Avoid sun exposure without protection, as UV radiation will worsen post-inflammatory hyperpigmentation and counteract your treatment efforts. 1

• Don't treat the dark spots without controlling the underlying acne, as new inflammatory lesions will continue to create new areas of hyperpigmentation. 1, 2