Whether it be from an injury, a medical condition, or some sort of surgical procedure, developing a scar or two over the course of our lives is more or less inevitable.
But while most scars tend to fade over time, on skin of color, they tend to appear much darker than the surrounding skin for a longer period of time—and may even form a keloid.
“Scars are generally the result of preceding trauma or a surgical procedure,” explains New York City-based board-certified dermatologist Dr. Rose Ingleton. “These conditions lead to a stimulation of melanocytes—the pigment producing cells—in the area as part of the healing process. The increased melanin production is what leads to hyperpigmentation within the scar.”
On the other hand, keloid scars are not only darker in color, but are also raised above the skin’s surface. “A keloid occurs when there is an overproduction of collagen, which is more typical in darker skin types,” says Dr. Michelle Henry, board-certified dermatologist and founder of Skin & Aesthetic Surgery of Manhattan.
“The cell that makes collagen is a fibroblast and in people of color, fibroblasts can be bigger and more active. This is a double-edged sword as it leads to a slower onset of the appearance of aging from the excess collagen, but it can also put you at risk for keloid scarring.”
Regardless of the type of scar you have, treatment options look different for those of us with skin of color—as many lasers, for example, were not developed with us in mind. That’s why it’s vital to consult with a dermatologist who has vast experience working with darker skin tones. This ensures you’ll develop an effective treatment plan—whether you want to opt for in-office procedures, at-home remedies, or a combination of both.
Here, we spoke to a wide-range of professionals on how to combat the look of scarring and discover which treatments actually work.
Are scars more difficult to treat on darker skin?
It depends on the type of scar you are trying to treat. But generally speaking, not necessarily—so long as you’re working with a dermatologist who is well-versed in skin of color. However, there are certain factors you’ll need to keep in mind.
“When we look at the differences between skin of color and white skin, we see that all have melanocytes, but skin of color has more melanosomes,” says Dr. Henry. “Melanosomes are packets of color and are more evenly distributed around the skin on skin of color.
Because of this, they are more readily stimulated to release pigment whenever there is any type of inflammation, such as acne or a cut to the skin. The darker the skin—because there are more melanosomes everywhere—the more likely it’ll stimulate longer-lasting pigment.”
That said, while it may not necessarily be harder to diminish the look of scars on darker skin tones, it may take longer. Typically, most doctors will suggest moving at a slower pace to ensure treatment does not worsen the scar.
I’m going to get surgery, what should I know about scarring?
First and foremost, it’s important to understand that if you get any form of surgery that requires an incision, there is going to be a scar left behind. But how well that scar heals is largely based on your doctor’s suturing technique. “This impacts your scar greatly,” says Dr. Grace Ayensu-Danquah, Borghese Roma’s skin expert and fellow of American College of Surgeons. “The kind of suture they use, the fineness of the suture—that all makes a difference.”
You should also be honest with your doctor about how previous scars you’ve had have healed, and whether or not you’re prone to keloids to ensure they’re able to provide the best care.
What are the best treatment options for hyperpigmented scars?
In-Office Treatments
Dr. Henry has a variety of treatment options that she tailors to a patient’s specific needs. “In-office, I often use laser treatments such as the Picosure laser,” she shares. “It’s a secondary laser, meaning that the laser shatters the pigment of the scar to help the immune system clear it out, and it doesn’t cause much damage to the skin.” She also suggests chemical peels for some patients if the scar is superficial to medium depth.
Leading board-certified cosmetic, medical and surgical dermatologist Dr. Blair Murphy-Rose, FAAD is a fan of radio-frequency micro-needling treatments, like Morpheus8 or Lutronic Genius, especially for flat and atrophic scars, as these energy-based devices can help to stimulate collagen production to not only even out the skin tone, but also help the skin look more renewed.
At-Home Treatments
Red light therapy is a great option to use at home, as it can help to stimulate collagen production, reduce inflammation, enhance cellular repair, and regulate melanin production—all of which can be effective for minimizing the look of scars.
“Increased collagen helps improve skin texture and elasticity, while the anti-inflammatory effects minimize the risk of post-inflammatory hyperpigmentation (PIH),” shares New York-based board-certified dermatologist Dr. Nicole Ruth.
“Enhanced cellular repair and improved blood circulation accelerate the healing of scar tissue, and melanin regulation aids in evening out skin tone. Together, these effects contribute to a smoother, more uniform appearance of scars.”
If red light therapy is right for you, Dr. Ruth recommends CurrentBody’s range of at-home devices. The brand has a variety made specifically to treat hyperpigmentation—whether it be on the neck, face, hands, or anywhere else on the body.
Dr. Murphy-Rose recommends looking for products “with potent tyrosinase inhibitors like tranexamic acid, cetyl tranexamic mesylate, kojic acid, cysteine and vitamin C,” she shares. These ingredients help by inhibiting the process of pigment formation, which can lighten the appearance of the scar over time.
She recommends products like Skincare Junkie’s Discoloration Fade Wand, which she shares helps fade hyperpigmented scars as well as post-acne marks. “This is thanks to a proprietary powerhouse combination of clinically-proven kojic acid, tranexamic acid, and vitamin C in their most penetrable, potent, and yet well-tolerated forms,” she says.
She also likes Skinceuticals Discoloration Defense, Dr. Idriss Major Fade Hyper Serum, and RescueMD’s DNA Repair Complex. Some other great options are Alastin’s A-Luminate Brightening Serum, Bio-Oil Skincare Oil, and Tronque’s Scar Concentrate.
While all of these treatments can technically be used in-between any in-office procedures, it’s best to check in with your dermatologist first to ensure there won’t be any negative side effects.
How do you get rid of keloid scars—and can you avoid them in the first place?
Treatment for keloid scars vary, but a good rule of thumb is to start treatment as soon as possible. Dr. Ingleton suggests using silicone sheets or gels as soon as you notice one starting to form. “These help suppress the scar from getting bigger and thicker,” she explains. “The silicone creates a moist environment and exerts pressure on the surface of the scar.”
However, if you’ve been using silicone and have found it to be ineffective, you can always opt for in-office treatments.
Most dermatologists will commonly treat keloids by injecting the area with corticosteroid medication like Kenalog, says Dr. Murphy-Rose. However, sometimes a combination of treatments is needed depending on the patient. “Keloids can also be treated by excision, shave removal, laser treatment, and radiation therapy,” she shares.
As for whether or not keloids can be avoided in the first place? Unfortunately, the answer is no. “Some people are just genetically prone to keloids,” says Dr. Ayensu-Danquah.
What factors can worsen the appearance of scars?
While there are many factors that can worsen scars, all the experts ESSENCE spoke with agree that sun exposure should be avoided at all costs. “It’s important to be very serious about sun protection,” says Dr. Henry. “Sun exposure will worsen the appearance of scars as it will further traumatize the skin.”
“If you’re prone to keloids, it’s important to have a hands-off approach and avoid unnecessary trauma like tattoos or piercings,” she continues.
Dr. Ruth adds in the early stages of healing, proper wound care is vital. “Inadequate cleaning, protection, or moisturization can all lead to worse scarring, as can infections that hinder proper healing,” she explains.
“On top of that, I always tell patients that picking or scratching a wound interferes with the healing process, leading to more significant scars, as well as prolonged or excessive inflammation that can cause post-inflammatory hyperpigmentation, particularly in skin of color.”
Should I consider scar revision?
It really depends on how you feel about the scar itself. If you decide to opt for the procedure, Dr. Ayensu-Danquah recommends keeping a few things in mind.
“Patients should consider how they have scarred previously,” she says. “What happened to the last surgical incision, was it fine post-surgery and once they went home they applied certain things to it—did they scar easily, do they have keloids? If all of those are not true, then you are a good candidate for a scar revision, because most likely it’s the technique of the last surgeon.”