postacne

Postacne refers to skin changes that remain after acne lesions have healed. It includes both discoloration and scarring and can affect people of any skin type. Postacne changes may persist for months to years if not addressed.

The main manifestations are post-inflammatory hyperpigmentation (PIH), which appears as dark or red-brown spots, and various types of scars. Atrophic acne scars create indentations in the skin and include ice-pick, boxcar, and rolling styles. Hypertrophic or keloid scars are raised, excessive scar tissue formations. In some cases, texture changes occur without well-defined scars, resulting in rough or uneven skin.

Causes involve inflammatory damage from acne that alters pigment production and collagen remodeling in the skin. Risk factors include darker skin tones, prolonged or severe inflammation, picking or squeezing lesions, inadequate acne treatment, and sun exposure, which can worsen pigmentation and prolong visibility.

Diagnosis is usually clinical, based on examination of the skin and history. Treatment is individualized according to scar type, severity, and skin type. Post-inflammatory hyperpigmentation is managed with sun protection, and topical lightening agents such as retinoids, azelaic acid, and vitamin C; hydroquinone may be used under supervision. Superficial chemical peels can help some individuals, but aggressive procedures carry a higher risk of worsening PIH in darker skin. Atrophic scars may respond to microneedling, fractional laser resurfacing, or dermal fillers for volume loss; deep ice-pick scars may require punch techniques. Hypertrophic or keloid scars are often treated with silicone sheets or gels and intralesional corticosteroid injections, with laser therapy as an adjunct.

Prevention focuses on early and effective treatment of active acne, sun protection, and avoiding picking. With appropriate therapy, improvement is possible, though some deep scars may persist.