How to Get Rid of Red Acne Marks - A pharmacist Guide
Most people treat post-acne marks as a single problem. They're not. Red marks and brown marks have entirely different causes and respond to different treatments. If you are treating them the same, it's like using a anti-bacterial cream to treat a fungal problem when it hasn't progressed to the bacterial stage yet. Mixing them up is the single biggest reason people waste money on products that do nothing.
Brown acne marks, also referred to as post acne hyperpigmentation is due to excess melanin production. In contrast, red acne marks, known clinically as post-inflammatory erythema (PIE), are vascular. They're caused by damage to the dermis after a breakout. The treatment for red acne marks should be different to brown acne marks if you want them gone quickly. Red acne marks shows up most on light skin tones. Olive skin tones unfortunately, get red and brown marks the most. People with darker skin tones get hyperpigmentation the most.
Quick Reference: PIE vs. PIH
| Feature | PIE (Red Marks) | PIH (Brown Marks) |
|---|---|---|
| Colour | Pink, red, purple | Tan, brown, dark brown |
| Cause | Vascular damage | Excess melanin |
| Blanches with pressure? | Yes | No |
| Skin tone most affected | Lighter/Olive tones | Medium–darker tones |
| Location in skin | Papillary (upper) dermis | Epidermis or dermis |
| Time to fade (untreated) | 3–24 months | 6–24+ months |
Treating Red Acne Marks (PIE)
Treating red acne marks with the same melanin-reducing and brightening ingredients is a really outdated method.
Because PIE is vascular in origin, the most effective treatments should focus on wound management rather than targeting melanin. This is where our pharmacy skills comes in - in wound management.
1. Silica
Studies show topical silica is one of the most evidence-backed treatments for post-inflammatory skin changes and wound healing. Silica hydrates the stratum corneum, regulates fibroblast activity, and reduces capillary hyperaemia — directly addressing the vascular component of PIE. A systematic review by Mustoe et al. (2002) confirmed silica-based gel improved the look of post-inflammatory vascular changes.
Red Scar Therapy gel is formulated with medical-grade silica specifically to target red, vascular post-acne marks. Applied twice daily to affected areas, red scar therapy gel helps fade and improve the texture of red acne marks. Red Scar Therapy Gel is available from ellé derm australia for $33.
Typical timeline for silica to fade red acne marks is four to eight weeks, and twelve weeks for deeper red acne marks — making it the ideal first-line treatment for red acne marks.
2. Niacinamide
Niacinamide is primarily known for its role in dark spots. Niacinamide also has anti-inflammatory and barrier-strengthening properties but these actions are primarily localised to the epidermis (upper layers of skin), whereas PIE is located in the dermis and not the epidermis. That's why most people who use Niacinamide to fix their red acne marks do not see results.
Niacinamide can help reduce ongoing skin inflammation and help to prevent more damage while the existing marks heal, but it does not do very much for existing marks.
3. Azelaic Acid
Azelaic acid works on two fronts simultaneously: reducing ongoing inflammation and exerting a mild antibacterial effect that prevents new breakouts. A 2024 clinical study published in the Journal of Drugs in Dermatology 72 patients using 15% azelaic acid twice daily over twelve weeks showed improvements in post-inflammatory erythema versus no treatment group.
In Australia, Azclear Action Medicated Lotion (20%) is a available for $20 to $25 from pharmacies.
Typical timeline for azelaic acid to fade PIE is twelve to twenty-four weeks.
4. Centella Asiatica (Cica)
Centella asiatica extracts (madecassoside, asiaticoside) have demonstrated wound-healing and anti-inflammatory properties that support wound healing. Emerging evidence supports their use in reducing post-inflammatory redness (Bylka et al., 2014).
5. SPF (Non-Negotiable)
UV exposure worsens both PIE and PIH. Daily broad-spectrum SPF 50+ is essential to delay progression of red marks to brown marks.
Conclusion
Treatment for brown acne marks (PIH)
You can check out the treatment for brown acne marks here.
References:
1. Connolly, D et al (2017). "Acne Scarring - Pathogenesis, Evaluation and Treatment Options." Journal of Clinical and Aesthetic Dermatology. 2017 Sep; 10(9): 12–23.
2. Fabrocinni, G et al (2010). "Acne Scars: Pathogenesis, Classification and Treatment." Journal of Dermatology Research and Practice. Published online 2010 Oct 14. Accessed June 4, 2023 at doi: 10.1155/2010/893080
3. Quignard, X et al (2017). "Silica nanoparticles as sources of silicic acid favouring wound healing in vitro." Colloids and Surfaces. 1 July 2017, Vol 155, Pages 530-537
4. Ludman, P (2023). Acne Scars. American Academy of Dermatology Association.
5. Mustoe TA, et al. (2002). International clinical recommendations on scar management. Plast Reconstr Surg. 110(2):560–571.
6. Shucheng, H et. al (2024). "Effects of 15% Azelaic Acid Gel in the Management of Post-Inflammatory Erythema and Post-Inflammatory Hyperpigmentation in Acne Vulgaris." J of Therapy and Dermatology. 2024 May;14(5):1293-1314. doi: 10.1007/s13555-024-01176-2.
