Dark marks after acne: how to fade them on darker skin

What are dark marks after acne?

When a spot is inflamed, nearby pigment cells can make extra melanin. Once the spot heals, that pigment stays behind as a flat brown, dark brown or grey patch. Doctors call this post-inflammatory hyperpigmentation, or PIH. The surface of the skin is unchanged, which is why these marks can fade.

Anyone can get PIH, but it is more common, more noticeable and slower to fade on darker skin, which reacts to inflammation by making more pigment. Many people find the marks more upsetting than the acne itself.

That makes acne marks a common concern in South Africa. Researchers who studied acne in Black patients at hospitals in KwaZulu-Natal concluded that dark marks remain a major concern even after active acne has settled.

Treatment aims to fade marks back to your usual skin tone. It should never lighten your natural colour.

Is it a dark mark or an acne scar?

Marks and scars need different treatment, so it helps to know which you have. Run a clean fingertip over the area. A mark feels flat, while a scar changes the texture of the skin.

Keloids are firm, raised scars that grow beyond the edge of the original spot. They are more common in people with darker skin. Early, effective acne treatment lowers the risk of scarring, including keloids.

• Flat brown or dark brown marks are PIH in the upper layers of the skin. Grey-blue marks sit deeper and usually take longer to fade.
• Flat red, pink or purple marks are post-inflammatory erythema, caused by widened small blood vessels near the surface. They show up more on lighter skin and can take months to settle.
• Dents, pits and raised bumps are scars. Pigment treatments don't change skin texture, so scars need a different plan.

Should you treat acne or dark marks first?

Start with the acne. Every new inflamed spot can leave a new mark, so fading treatments struggle to keep up while breakouts continue. Reviews of acne in darker skin describe early, effective treatment as a key step in preventing marks.

The American Academy of Dermatology's 2024 acne guideline strongly recommends benzoyl peroxide and topical retinoids, and conditionally recommends azelaic acid, among other options. Retinoids and azelaic acid also help pigment fade, which makes them useful when you have both problems. If your breakouts follow your menstrual cycle, our guide to hormonal acne covers other causes and options.

Irritation matters on darker skin, because a product that burns or peels too much can leave marks of its own. Doctors often start with a lower strength or less frequent use and build up slowly.

• Don't pick, squeeze or scratch spots. The extra injury adds inflammation and makes a mark more likely.
• Avoid harsh scrubs, drying toners and astringents, which irritate the skin.
• Use a mild cleanser and a moisturiser labelled non-comedogenic, which is less likely to block pores.

Does sunscreen help acne marks fade?

Yes. Sun exposure can darken existing marks, so doctors treat daily sun protection as a core part of managing PIH. In a Durban hospital study of 600 women, only a quarter used sunscreen.

Visible light, the light you can see, matters too. In a study of volunteers with darker skin, visible light caused darker and longer-lasting pigmentation than long-wave ultraviolet A, while lighter skin did not darken at all.

Most sunscreens mainly block ultraviolet light. Tinted sunscreens that contain iron oxides also block some visible light. In a randomised trial in people with melasma who all used the same fading cream, an iron oxide sunscreen gave better results than a UV-only sunscreen of similar SPF. That research was in melasma, a related pigment condition, so the evidence for acne marks is indirect.

• Apply a broad-spectrum sunscreen with SPF 30 or higher every morning, including on cloudy days and indoors near windows.
• Choose a tinted formula that lists iron oxides, in a shade that blends with your skin.
• Reapply when you spend long periods outdoors, and use a hat and shade in the middle of the day.

What treatments help fade dark marks?

Once acne is under control, a doctor may add treatments that target pigment. Research in darker skin is limited. A 2024 systematic review found no treatment that worked reliably for everyone, and most people saw partial improvement.

Are hydroquinone and skin-lightening creams safe?

Hydroquinone slows pigment production and has been used for decades on melasma and other dark patches. The 2024 review found no clear advantage over other options for marks on darker skin. It should only be used under a doctor's supervision.

Long-term use can cause exogenous ochronosis, a stubborn darkening of the skin that is difficult to treat and improves only slowly after the product is stopped. A 1989 survey at two South African hospitals found ochronosis in 69% of people who used skin lighteners, including some whose products contained 2% hydroquinone or less.

Unregulated lightening creams carry further risks. Some contain mercury or potent steroids, and long-term use has been linked to kidney damage, infections, poor wound healing and steroid-related skin and hormone problems. In the KwaZulu-Natal acne study, acne caused by steroids was the second most common type seen, and the authors called for more awareness of steroid-containing lightening creams.

In 2015, South African researchers noted that regulations had aimed for more than 20 years to stop the sale of cosmetics containing mercury, hydroquinone or corticosteroids. Even so, one in three women in the Durban study used skin-lightening products, most often to treat a skin problem. If a product promises to lighten or whiten your skin, or doesn't list its ingredients, check with a doctor or pharmacist before using it.

How long do acne marks take to fade?

Brown marks near the surface can take up to a year to fade, and deeper grey-blue marks can last for years. Acne usually clears weeks before the marks catch up, so fading lags behind even when treatment is working.

Marks also fade partly on their own. In the 2024 review, about two in three people who had no treatment saw some fading, though none cleared completely.

Give any plan at least three months before judging it, and keep treating acne and using sunscreen in the meantime. A monthly photo in the same light makes slow change easier to see. If you'd like a doctor to look at your skin, you can start an online assessment.

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