Most flat dark marks left by acne fade on their own, and you can help them fade faster with daily sunscreen and a fading cream such as a retinoid, azelaic acid or hydroquinone, usually over several months. Pitted acne scars are different: they form when healing skin makes too little collagen, so creams can only soften mild ones, and in-office procedures such as microneedling, lasers or scar surgery work far better. The first step is working out which one you have.

Is it a dark mark or a true acne scar?

A flat spot that is only a change in color is called post-inflammatory hyperpigmentation, or PIH. On lighter skin it often looks pink or red. On medium and darker skin it is usually brown, and sometimes bluish gray. These flat marks are usually not scars at all.

A true scar changes the texture of the skin. Most acne scars are pitted: narrow, deep “ice pick” scars, round or oval “boxcar” scars, or wide, shallow “rolling” scars that make the skin look wavy. Some scars are raised instead, often on the jawline, chest or back.

Tip: light the spot from one side. A visible dip means a scar; a change in color alone means a mark. Many people have both.

Why does sunscreen matter so much for dark marks?

Ultraviolet light can make dark marks darker. A review of PIH treatment calls sun protection an integral part of treatment and recommends a broad-spectrum sunscreen with SPF 30 every day. The American Academy of Dermatology (AAD) suggests SPF 30 or higher and a tinted sunscreen with iron oxide, which also helps protect against visible light, another cause of dark spots.

Apply it every morning and reapply every two hours outdoors, and after swimming or sweating. This matters even more during treatment: tretinoin and hydroquinone labels both stress sun protection.

Do retinoids fade acne scars and dark marks?

Retinoids, such as tretinoin, adapalene and tazarotene, speed up skin cell turnover, which helps pigmented cells shed sooner. They also treat the acne that keeps creating new marks. In a 40-week study of Black patients with PIH, tretinoin lightened dark marks significantly more than a plain cream, although about half had some skin irritation. For mild scarring, the AAD says a retinoid can make scars less noticeable, but creams cannot fill deep pits.

Irritation is the catch. Redness and peeling can trigger new dark marks, especially on darker skin, so dermatologists often start with a lower strength and build up. The Retin-A label says to apply tretinoin once a day at bedtime, using just enough to cover the area lightly, 20 to 30 minutes after washing. If irritation builds, it allows using it less often or pausing. A lower-strength cream such as Retino-A Cream 0.025% (from $10) is a gentler place to start, and our guide to tretinoin for acne explains each step. Ask your doctor before using a retinoid if you are pregnant, trying to get pregnant or breastfeeding.

How does azelaic acid help with dark marks?

Azelaic acid treats acne and also helps even out patchy pigment. The US prescribing information for Azelex (azelaic acid 20% cream) lists it for mild to moderate inflammatory acne, applied as a thin film twice a day to clean, dry skin. In a trial of darker-skinned adults with facial dark spots, including PIH, the 20% cream reduced pigmentation more than a plain cream over 24 weeks.

Side effects are usually mild and short-lived: the label lists itching, burning, stinging and tingling. It also asks people with darker complexions to watch for unusually light patches, which have been reported rarely. Aziderm 20% Cream (from $34) contains the same active ingredient as Azelex; it is made and licensed in India.

Is hydroquinone a good option for stubborn marks?

Hydroquinone lightens skin by reducing the melanin that pigment cells make. The same PIH review calls it the mainstay of treatment, usually at 2% to 4%. In the US, hydroquinone creams are available only with a prescription, as the FDA explains. A few rules matter:

• Labels advise testing a small amount on unbroken skin first and checking it after 24 hours. Do not continue if it itches, blisters or becomes very inflamed.
• Apply it only to the dark marks and keep it away from your eyes.
• Stop if nothing has improved after 2 months, as the label directs. Doctors often switch to a non-hydroquinone product after prolonged use.
• Hydroquinone can cause exogenous ochronosis, a gradual blue-black darkening of the skin that may be permanent. Stop and see your doctor if it appears.
• Ask your doctor first if you are pregnant or breastfeeding.

Eukroma Cream (hydroquinone, from $5) is one option. If dark patches sit evenly on both cheeks, the forehead or the upper lip without any acne, they may be melasma; our article on melasma treatment explains the difference.

Can chemical peels fade acne scars?

A chemical peel uses an acid to remove the top layers of skin in a controlled way, in strengths from mild to strong. According to the American Academy of Dermatology, peels help the skin make more collagen and elastin, which can make depressed acne scars less noticeable. A mild peel often takes 3 to 5 sessions spaced 2 to 4 weeks apart. Light glycolic or salicylic acid peels are also used for brown marks, although study results are mixed.

Peels can cause irritation and new dark marks, a bigger concern on medium and darker skin, so choose a provider who regularly treats your skin tone.

What treatments work for pitted acne scars?

Dermatologists usually start once acne is under control, since stopping breakouts helps prevent new scars. The main options are:

• Microneedling: tiny needles puncture the skin to trigger new collagen. It is often combined with radiofrequency, a chemical peel or platelet-rich plasma (PRP), and the AAD says it is safe for all skin tones.
• Laser resurfacing: lasers resurface scarred skin so new collagen can form. Settings need extra care on darker skin to avoid new dark marks or blistering.
• Scar surgery: a dermatologist can lift a scar from the tissue beneath it, or remove a deep scar and close the area with stitches or a small skin graft.
• Fillers: injected under a depressed scar to lift it. Most give temporary results lasting from 3 months to 2 years, and some are permanent.

Raised scars are treated differently, often with corticosteroid injections, laser, surgery or freezing. Combining treatments, such as microneedling with radiofrequency, can work better than either one alone. Tell your dermatologist about every acne treatment you have used in the past two years, including pills.

How long does it take to fade acne scars?

• Flat marks a few shades darker than your skin: usually fade within 6 to 12 months on their own. Treatment can clear them more quickly.
• Fading creams: results build slowly; the tretinoin and azelaic acid studies for dark marks ran for 24 to 40 weeks.
• Deep slate-blue or gray pigment: can take years to fade and may not clear fully.
• Pitted scars: do not fade on their own and can look more noticeable with age as skin loses firmness. Most procedures take several sessions, and they make scars less noticeable rather than erasing them.

When to see a doctor

• Your acne keeps leaving new scars, or you get deep, painful lumps or cysts. Treating acne early can prevent more scarring.
• A scar is raised and keeps growing beyond the original spot, which can be a sign of a keloid.
• Dark patches appear without any acne, or spread evenly across the cheeks and forehead.
• A spot changes in size, shape or color, bleeds, or will not heal; get it checked to rule out skin cancer.
• A cream causes blistering, strong burning, unusually light patches, or blue-black darkening where you apply it.

Frequently asked questions

Can acne scars go away on their own?

Flat dark or red marks usually fade with time, often within a year. Pitted scars do not; procedures are the main way to improve them.

Does picking or squeezing pimples cause scars?

It can. The NHS advises against picking or squeezing spots because this can cause scars. Picking also adds inflammation, which can make dark marks worse.

Should I choose hydroquinone or azelaic acid for dark marks?

Hydroquinone is a mainstay for stubborn brown marks, but it is meant for limited courses and needs a prescription in the US. Azelaic acid also treats active acne, and its side effects are usually mild. A dermatologist can help you decide.

Why are my acne marks red instead of brown?

It mostly depends on your skin tone: marks tend to look pink or red on lighter skin and brown or bluish gray on medium and darker skin. Either way, treating the acne and protecting your skin from the sun help, and most of these flat marks fade with time.

This article gives general information and does not replace advice from your doctor or pharmacist. Prescription medicines, including tretinoin, azelaic acid and hydroquinone creams, should be used under a doctor’s care.

Tretinoin, adapalene and retinol all belong to the retinoid family, the vitamin A ingredients used on skin, but they differ a lot in strength and in how you get them. In the US, tretinoin is the strongest and needs a prescription, adapalene 0.1% gel is sold over the counter for acne, and retinol is a milder cosmetic ingredient aimed at early signs of aging. For acne, adapalene or tretinoin are the usual picks; for fine wrinkles, tretinoin has the strongest evidence and retinol is the gentlest place to start.

How are tretinoin, adapalene and retinol different?

All three speed up skin cell turnover, which helps keep pores clear and, over months, can make skin look smoother. The difference is how directly each one works.

• Tretinoin is retinoic acid, the active form of vitamin A that skin cells respond to. It needs no conversion, so it acts directly and strongly.
• Adapalene is a lab-made, retinoid-like drug developed for acne. It targets retinoid receptors more selectively than tretinoin and tends to be gentler on the skin.
• Retinol is a form of vitamin A that your skin must convert in two steps, first to retinaldehyde and then to retinoic acid, before it does anything. A review of retinoids for skin aging describes retinol as about 20 times less potent than tretinoin and much less irritating.

Which ones need a prescription in the US?

Tretinoin is prescription-only in every strength and form. US brands include Retin-A, Retin-A Micro and Renova, plus generics.

Adapalene is split. Adapalene 0.1% gel is sold over the counter: the Drug Facts label for Differin Gel 0.1% notes it was previously available only by prescription, and it covers acne in adults and children 12 and older. The stronger 0.3% gel and the cream, lotion and other forms remain prescription products.

Retinol is sold as a cosmetic ingredient in serums, creams and night moisturizers. Cosmetics do not go through drug approval, and the American Academy of Dermatology points out that labels often do not say how much retinol a product contains.

If your doctor prescribes tretinoin, Retino A Cream 0.025% contains the same active ingredient as Retin-A cream; made and licensed in India. Adaferin Gel contains adapalene, the same active ingredient as Differin; made and licensed in India. Prescription medicines like these should be used under a doctor’s care.

Which retinoid is strongest, and which irritates the most?

From strongest to mildest, the usual order is tretinoin, then adapalene, then retinol. You cannot compare percentages across ingredients: 0.1% adapalene is not the same as 0.1% tretinoin.

Stronger usually means more irritation. Expect some dryness, redness, peeling, burning or stinging at first. The Differin label says this irritation is most likely in the first few weeks and usually eases with continued use. In older head-to-head trials, adapalene 0.1% gel cleared acne about as well as tretinoin 0.025% gel with less irritation, although in one trial tretinoin 0.1% microsphere gel reduced blackheads and whiteheads faster.

If you have darker skin, go slowly: irritation can trigger dark marks (hyperpigmentation).

Which is better for acne, and which for wrinkles?

For acne

Adapalene and tretinoin are both proven acne medicines; retinol is not an acne treatment. They help clear blackheads, whiteheads and small pimples and help prevent new ones. For red, inflamed acne, doctors often pair a retinoid with benzoyl peroxide or a topical antibiotic such as clindamycin.

Adapalene 0.1% is a sensible first step for mild acne. Tretinoin is the stronger option when that is not enough. The Retin-A label says early results may show in two to three weeks, but more than six weeks may be needed for a clear benefit; the Differin label allows up to three months. Our guide to tretinoin for acne covers strengths and what to expect in more detail, and you can compare creams and gels in our acne treatment section.

For fine lines and sun damage

Of these three, only tretinoin has US prescription labeling for wrinkles. The Renova (tretinoin 0.02%) label describes it as an add-on for softening fine facial wrinkles in people who also follow a full skin care and sun-avoidance plan. It does not erase wrinkles or repair sun damage, and up to six months of use may be needed before effects show. Adapalene is labeled for acne only.

Retinol has smaller studies behind it, including a controlled trial that found improved fine wrinkles after 12 weeks, but far less data than tretinoin. It breaks down in light and air, so choose an opaque, airtight container. It suits sensitive skin or a mild first step.

How do you start a retinoid without irritating your skin?

1. Pick one. Using more than one retinoid product at a time makes irritation more likely.
2. Start slowly. Use it every other night at first, then build up to once nightly as your skin allows. Never use it more than once a day.
3. Use a small amount. A pearl-sized dab, about 1/4 inch across, is enough for the whole face. Apply a thin layer at night to clean, fully dry skin, over the whole area rather than single spots, and away from your eyes, mouth and the corners of your nose.
4. Moisturize. A plain, fragrance-free moisturizer that will not clog pores helps with dryness.
5. Skip harsh extras. Avoid scrubs, alcohol-based toners and other drying products such as salicylic acid, sulfur or resorcinol unless your doctor suggests them. Do not wax treated skin.
6. Ask about timing. If you also use benzoyl peroxide, ask your doctor or pharmacist how to time the two products.
7. Be patient. Acne may look worse in the first few weeks before it improves. Give acne treatment about three months and wrinkle treatment three to six months.

If your skin gets very red or sore, ask your doctor about using it less often rather than giving up. Stop and call your doctor if irritation is severe.

Do you really need sunscreen with a retinoid?

Yes. Retinoids make skin more sensitive to sunlight, and the tretinoin and adapalene labels tell you to limit exposure to sun, sunlamps and tanning beds and not to apply them to sunburned skin. Every morning, use a broad-spectrum sunscreen with SPF 30 or higher on all exposed skin, plus a wide-brimmed hat and shade when you can. Wind and cold can also irritate treated skin.

Can you use a retinoid while pregnant or breastfeeding?

Talk to your doctor first. The Renova label says not to use it if you are pregnant or trying to become pregnant, and the Retin-A label says tretinoin should be used in pregnancy only if the benefit justifies the risk. The Differin label says to ask a doctor before use if you are pregnant or breastfeeding, and to stop and ask a doctor if you become pregnant or plan to. The American Academy of Dermatology states that retinoids should not be used during pregnancy, and it counts retinol as a type of retinoid. Retinoid pills such as isotretinoin are known to cause serious birth defects. If you are pregnant or planning a pregnancy, ask your doctor which acne options suit you.

When to see a doctor

• Deep, painful lumps or cysts, or acne that is leaving scars
• No improvement after three months of once-daily adapalene
• Severe burning, swelling or blistering where you applied the product
• Signs of an allergic reaction, such as hives, swelling of the lips or eyelids, or trouble breathing (get emergency care)
• Acne along with irregular periods or new facial or body hair, which can point to a hormone problem
• Constant facial redness or flushing, which may be rosacea rather than acne
• You are pregnant, trying to conceive or breastfeeding

Frequently asked questions

Is adapalene the same as retinol?

No. Adapalene is a retinoid-like medicine made to treat acne, while retinol is a cosmetic form of vitamin A that skin must convert before it works. Adapalene is stronger and has drug labeling for acne.

Is tretinoin stronger than adapalene?

Generally, yes, and it tends to cause more irritation. In acne trials, adapalene 0.1% worked about as well as low-strength tretinoin with less irritation.

Can I use retinol and tretinoin together?

There is usually no reason to. Tretinoin already does what retinol does, more strongly, and using both raises the chance of dryness and peeling.

Should I put a retinoid on in the morning or at night?

At night. The labels call for once-daily use, and the tretinoin labels specify the evening or bedtime. Wear sunscreen the next morning.

Why does my acne look worse after starting a retinoid?

The Differin label notes that acne may seem to get worse in the early weeks before it improves, and calls this normal. Severe irritation, swelling or pain is not, so stop and call your doctor if that happens.

This article gives general information only and is not medical advice. Prescription medicines such as tretinoin should be used under a doctor’s care; check the leaflet and ask your doctor or pharmacist before starting, stopping or combining any skin treatment.

Melasma causes brown or grayish-brown patches, most often on the cheeks, forehead, nose and upper lip. It isn’t harmful, but it can be frustrating: it tends to be stubborn, and it often returns after treatment. The good news is that with the right combination of sun protection and proven topical treatments, most people can significantly lighten their patches. This guide explains what causes melasma and how the most effective melasma treatment creams work.

What Causes Melasma?

Melasma happens when the pigment-producing cells in the skin (melanocytes) become overactive. The main triggers are:

• Sun exposure: ultraviolet (UV) and visible light are the biggest drivers, and even short daily exposure counts.
• Hormones: pregnancy (melasma is sometimes called “the mask of pregnancy”), the contraceptive pill and hormone therapy.
• Genetics: it often runs in families.
• Skin type: it is more common in women and in people with medium to darker skin tones.
• Heat and some cosmetics, which can make it worse.

Step 1: Sun Protection (The Non-Negotiable)

No cream will work well without strict sun protection. Even brief sun exposure can undo weeks of progress.

• Use a broad-spectrum sunscreen, SPF 30–50, every morning, all year round, indoors and out.
• Choose a tinted sunscreen containing iron oxides where possible. It also blocks visible light, which ordinary sunscreens don’t.
• Reapply every 2 hours when outdoors.
• Wear a wide-brimmed hat and seek shade between 10am and 4pm.

Step 2: Hydroquinone Creams

Hydroquinone has long been one of the most widely used topical treatments for melasma. It works by blocking tyrosinase, the enzyme the skin needs to make melanin, which gradually lightens dark patches.

• Common strengths are 2% and 4%.
• Improvement usually becomes visible after 4–12 weeks.
• It is typically used for about 3–4 months, followed by a break. Long-term continuous use can, rarely, cause a bluish-black darkening called exogenous ochronosis.
• Mild redness, dryness or stinging can occur. Do a patch test on a small area first.

Hydroquinone creams include Melalite Forte Cream, Eukroma Cream and Melanorm Cream.

Step 3: Triple Combination Creams

For moderate to stubborn melasma, dermatologists often prescribe a triple combination cream. It combines three ingredients that work together:

1. Hydroquinone: reduces melanin production
2. Tretinoin: speeds up skin cell turnover, so pigmented cells are shed faster and hydroquinone penetrates better
3. A mild corticosteroid (such as mometasone or fluocinolone): calms the irritation the other two can cause

Triple combination therapy is considered one of the most effective topical treatments for melasma. An example is Melacare Cream (hydroquinone, tretinoin and mometasone).

Because these creams contain a steroid, they are usually used for a limited period, often up to 8 weeks, as directed by a doctor. Longer use can cause skin thinning, visible blood vessels, acne-like breakouts or stretch marks.

How to Apply Melasma Creams

1. Cleanse gently and pat the skin completely dry.
2. Apply a thin layer only to the dark patches, once daily at night, unless told otherwise.
3. Avoid the eyes, lips and corners of the nose.
4. Wash your hands afterwards.
5. Apply sunscreen every morning without exception.

Gentler Options and Maintenance

Melasma often comes back, especially after sun exposure or hormonal changes. Once your patches have improved, a doctor may switch you to a gentler maintenance routine, such as:

• Azelaic acid (for example Aziderm 20% cream): lightens pigment and is often considered suitable in pregnancy
• Niacinamide, vitamin C, kojic acid or tranexamic acid serums
• Continued daily tinted sunscreen

In-clinic treatments such as chemical peels may also help, but some lasers can make melasma worse, so choose an experienced dermatologist.

Who Should Be Careful

Avoid hydroquinone and tretinoin if you are pregnant or breastfeeding. Melasma that appears during pregnancy often fades on its own after delivery. See a doctor first if you are unsure whether a patch is melasma. Other conditions, including some skin cancers, can look similar and should be checked.

Frequently Asked Questions

Can melasma be cured permanently?

Melasma can be greatly improved and sometimes cleared, but it tends to recur. Long-term sun protection and a maintenance routine are the best ways to keep it away.

How long does it take for melasma creams to work?

Most people notice lightening within 4–8 weeks, with more significant results by around 12 weeks.

Why is my melasma getting darker during treatment?

Usually this is due to sun or heat exposure, or irritation from the cream. Review your sunscreen routine and speak to your doctor if the skin becomes very red or inflamed.

Browse our full range of melasma treatments, or read our guide to using tretinoin for tips on reducing irritation.

This article is for general information only and is not a substitute for professional medical advice. Consult a doctor or dermatologist for diagnosis and before using prescription skin-lightening treatments.

Tretinoin is one of the most effective and well-studied topical treatments for acne. Dermatologists have prescribed it for over 50 years. It can clear blackheads and whiteheads, reduce breakouts, and even improve post-acne marks and fine lines. It also has a reputation for causing dryness and peeling in the first few weeks, which is why so many people give up too early. This guide explains how tretinoin for acne works, which strength to start with, and how to use it for the best results with the least irritation.

What Is Tretinoin?

Tretinoin (also known as all-trans retinoic acid) is a topical retinoid, a form of vitamin A applied directly to the skin. It is available as a cream or gel on prescription, and is sold under brand names such as Retin-A, as well as generics like Tretinoin cream and Tretoin gel.

How Tretinoin Treats Acne

Acne starts when dead skin cells and oil block a pore, forming a microcomedone that can become a blackhead, whitehead or inflamed spot. Tretinoin works on this root cause:

• Speeds up skin cell turnover, so dead cells don’t build up and clog pores
• Unblocks existing comedones (blackheads and whiteheads)
• Prevents new blockages from forming
• Reduces inflammation and helps other acne treatments penetrate better
• Fades dark marks left by old spots and improves skin texture over time

Which Tretinoin Strength Should You Use?

Creams are generally more moisturizing and gentler. Gels suit oilier skin but can feel more drying. Most dermatologists recommend starting low and increasing gradually. A higher strength isn’t necessarily better if it leaves your skin too irritated to use consistently.

How to Use Tretinoin: Step by Step

1. Apply at night only. Tretinoin breaks down in sunlight and makes skin more sun-sensitive.
2. Cleanse gently with a mild, non-foaming cleanser and pat dry.
3. Wait 20–30 minutes until your skin is completely dry. Applying to damp skin increases irritation.
4. Use a pea-sized amount for your whole face. Dot it on the forehead, cheeks and chin, then spread thinly. More is not better.
5. Avoid sensitive areas: the corners of the nose, the eyes and the lips.
6. Moisturize with a simple, fragrance-free moisturizer, before or after tretinoin.
7. Use sunscreen every morning: broad-spectrum SPF 30 or higher, even on cloudy days.

Start with two or three nights a week, then increase to every other night and eventually nightly as your skin adjusts.

What to Expect: The Tretinoin Timeline

• Weeks 1–4: Dryness, flaking, redness and mild stinging are common while the skin adjusts (sometimes called “retinisation”). Some people get a temporary flare of breakouts as clogged pores come to the surface (“purging”).
• Weeks 6–8: Irritation usually settles and fewer new spots appear.
• Weeks 12 and beyond: Clearer skin, fewer blackheads and faded marks. Full results can take 3–6 months.

Patience is the key to success. Most people who say tretinoin “didn’t work” stopped before the 12-week mark.

What Not to Combine With Tretinoin

• Harsh scrubs, exfoliating acids (AHA/BHA) and toners with alcohol. These can seriously increase irritation.
• Benzoyl peroxide at the same time. It can break down some tretinoin formulas. If both are prescribed, use benzoyl peroxide in the morning and tretinoin at night.
• Waxing on treated skin. It can lift the skin.

Who Should Not Use Tretinoin

Avoid tretinoin if you are pregnant, trying to conceive or breastfeeding, unless a doctor specifically advises otherwise. Don’t apply it to sunburned, broken or eczema-affected skin. Other prescription retinoids such as tazarotene (Tazret gel) must also be avoided in pregnancy.

What If Tretinoin Isn’t Enough?

For moderate acne, doctors often combine tretinoin with a topical antibiotic or benzoyl peroxide. Azelaic acid (such as Aziderm 20% cream) is a gentler alternative that also helps with dark marks. Severe, scarring or cystic acne may need oral treatment such as isotretinoin. That medicine requires specialist supervision, regular monitoring and strict pregnancy prevention, so it should only be started by a dermatologist.

Frequently Asked Questions

Can I use tretinoin every night from the start?

Most people can’t without significant irritation. Starting two or three nights a week and building up is far more sustainable.

Does tretinoin help acne scars?

It can fade dark marks (post-inflammatory hyperpigmentation) and mildly improve texture over months. Deep, pitted scars usually need procedures such as microneedling or laser treatment.

Is tretinoin the same as retinol?

No. Retinol is a weaker, over-the-counter ingredient that the skin must convert into retinoic acid. Tretinoin is already the active form, making it considerably stronger and more effective for acne.

Explore our complete acne treatment range and other skin care products.

This article is for general information only and is not a substitute for professional medical advice. Speak to a doctor or dermatologist before starting a prescription skin treatment.