The following scar treatments are frequently recommended for dark scars and other forms of hyper-pigmentation:
1) Hydroquinone
2) Kojic acid
3) Vitamin C (like ascorbic acid)
4) Natural scar treatments like licorice extract
Hydroquinone is probably the most frequently recommended lightening agent because it is generally very effective. It comes in different strengths, typically 2% and 4%. One uncommon but significant potential complication from using hydroquinone is a condition known as Ochronosis. This consists of delayed wound healing, loss of skin elasticity, and ironically, permanent hyper-pigmentation.
Hydroquinone can also occasionally cause skin allergy and a change in nail color. Because of these potential complications many European countries allow hydroquinone use only by prescription and it is also highly regulated throughout Asia. Hydroquinone does not address any other aspects of an unsightly scar other than the dark pigment. Interestingly, it’s effectiveness also decreases with repeated use.
Kojic acid also helps lighten the dark pigment seen in dark scars and other skin lesions like melasma and brown spots. While it is not as effective as hydroquinone, the popularity of kojic acid has increased over the years as people have become more fearful of hydroquinone’s potential side effects. Kojic acid is also more “natural” as it is produced by several different types of fungi. Once again, there is no improvement in scar healing except for lightening of hyper-pigmentation.
Various forms of vitamin C have been shown to fade hyper-pigmentation effectively without the side effects associated with hydroquinone or kojic acid. L-ascorbic acid and other vitamin C esters also normalize collagen production after skin injury, leading to more organized collagen formation closer to that seen in normal, uninjured skin. This makes vitamin C a very good scar treatment in general.
Brown or dark yellow vitamin C skin care products should be avoided. The coloring is used to disguise the fact that the vitamin C becomes unstable over time, oxidizes and becomes completely ineffective (vitamin C turns brown as it oxidizes). Products using STABLE vitamin C are typically white as there is no fear of the vitamin C becoming oxidized and ineffective.
Some natural scar treatments like licorice extract have potent anti-inflammatory and skin-renewal properties. Like ascorbic acid, licorice also helps fade hyper-pigmentation by decreasing activity of the enzyme tyrosinase which is responsible for melanin production. Licorice has also been shown to boost the lightening actions of vitamin C so the 2 should be combined for best results.
Regardless of the treatment you choose, be patient. It takes time to get rid of dark scars. Improvement does not happen overnight. Also keep applying sun block (over the scar treatment) as prolonged sun exposure will only make dark scars even darker.
Dr Chrysopoulo is a board certified plastic surgeon with a special interest in scar healing therapies and safe scar treatments. He is also Chief Science Officer of C&H Scientific, makers of InviCible Scars Advanced Scar Therapy.
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