PIH vs acne scars — a critical distinction
The dark marks left behind after acne breakouts are one of the most common skin concerns treated at Plump Medical Spa in Newport Beach — and one of the most commonly misunderstood. Most patients describe them as "acne scars." Most of the time, they are not scars at all. They are post-inflammatory hyperpigmentation — and the distinction matters enormously for treatment.
Many patients have both simultaneously — flat dark marks overlying areas of structural scarring. The treatment approach differs for each. Getting this assessment right at consultation determines whether the protocol addresses the actual problem.
Why PIH happens
When skin experiences inflammation — from acne, picking, or injury — the body's healing response includes activation of melanocytes, the cells that produce pigment. In some patients, particularly those with darker skin tones, melanocytes overproduce melanin in response to inflammation. The result is a flat, hyperpigmented mark that persists after the inflammation resolves.
PIH is not a scar. There is no structural damage to the dermis. The skin surface is smooth. The discoloration exists entirely in the epidermis and upper dermis as excess melanin deposits — which is why it can fade over time, unlike true scarring which requires intervention.
Sun exposure dramatically slows and worsens PIH. UV stimulates additional melanin production in already-sensitized areas, deepening the discoloration and extending the timeline. Daily broad-spectrum SPF 50 is not optional for PIH patients — it is the single most important thing a patient can do, and without it, no topical or in-office treatment works as intended.
Who gets PIH — and why some patients get it worse
PIH occurs across all skin types but is significantly more common and more persistent in Fitzpatrick type III–VI patients. Darker skin contains more melanocytes that are more reactive to inflammatory signals. A breakout that leaves a barely-visible mark in a fair-skinned patient can leave a dark, persistent patch lasting 12–24 months in a patient with dark skin.
Other factors that worsen PIH: picking or squeezing breakouts (which deepens inflammation), using skincare products with irritants that cause additional inflammation, and sun exposure without protection during the active PIH phase.
Picking a pimple creates two problems, not one. The picking itself triggers a separate inflammatory response that generates its own PIH — often darker and more persistent than the PIH from the original breakout. It also increases the risk of true scar formation by deepening tissue damage. Patients who habitually pick their skin typically have a mix of PIH and true scarring that requires a more complex treatment approach.
What actually fades PIH
PIH management has two components: halting the stimulus (sun protection, active acne control) and accelerating pigment clearance (topicals and in-office treatments). Both are required for meaningful results.
Topical treatments — the daily foundation
In-office treatments for PIH
When topical treatments are insufficient or when patients want to accelerate fading, in-office treatments can significantly reduce PIH timeline. The choice depends on skin type.
IPL Photofacial ($350 at Plump) — appropriate for Fitzpatrick I–III skin. IPL targets melanin deposits with pulsed light energy, breaking up the pigment for clearance by the immune system. Results after 1–3 sessions. Not appropriate for darker skin tones due to PIH risk from the treatment itself.
Fractional laser resurfacing — can address surface pigmentation on appropriate skin types with similar caution as for scar treatment. More aggressive than IPL but more targeted.
Chemical peels — superficial glycolic or lactic acid peels accelerate cell turnover and help clear epidermal pigment faster. Generally safe across skin types at appropriate concentrations. A useful addition to a topical regimen.
Order of treatment matters. If you have both PIH and true acne scars, PIH should be addressed or at minimum controlled before aggressive scar treatments. Proceeding with subcision or CO2 laser on skin with active, unstable PIH can worsen pigmentation. A properly sequenced treatment plan starts with stabilizing the skin before addressing structural scars.