Saturday, February 13, 2016

Excoriated Acne with Hyperpigmentation

A 37 yo Haitian woman was seen complaining about hyperpigmented lesions on face and back.  By history, these followed acne which she has excoriated.  Her health is good otherwise and she takes no medication by mouth.

O/E:  Hyperpigmented papules and macules on face and torso in a young woman with Type V skin.  Some lesions show mild excoriation.

Clinical Photos:
Diagnosis:  Post-inflammatory hyperpigmentation in excoriated acne.

Comment:  In my area, we have few patients with Type V and VI skin.  This is a common problem, but I do not have much experience treating it.  What is your protocol?  I started her on tretinoin 0.05% cream as this may be covered by her insurance.

Note:  A Pubmed search for hyperpigmented acne scars retrieves only three references and all are to laser surgery which this patient can not afford. This problem must be extraordinarily common; yet the biomedical literature is strangely silent about it.


  1. From Henry Foong, Ipoh, Malaysia: We do see Malay and Indian patients with similar problem in Malaysia.

    I don’t think laser treatment with QS NdYAG or fractional laser will help. In fact it will make the hyper pigmentation worse as these patients are of the skin type IV or V.

    We treat as in acne vulgaris with topical retinoids e.g. adapalene cream nocte but it will take weeks for the pigmentation to clear. There are some who use 2% - 4% hydroquinone cream as a lightening agent but I did not find it useful. Avoidance of sunlight and use of water-based sunblocks does help.

  2. I often see this type of postinflammatory pigmentation in patients with acne and especially when they pick at the acne. I have had good results with adapalene or retin A with or without azelaic acid(azelex). If her insurance won't pay for the retin A she should trip Costco or walmart pharmacy for a lower priced generic. I think that chemical peels with salicyclic acid/lactic acid help the acne and the pigmentation too. Sunscreen is a must although I am sure that she is not getting much sun this winter. I encourage my patients to wear makeup and cover the areas so that they are less apt to want to pick and try to remove the scabs. When they cover the areas effectively they feel better about themselves too.
    Would spironolactone help her active lesions?


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