What Is a Skin Blemish?

A blemish describes any discoloration, spot, or mark on the skin. There are different types of blemishes, and each has its own cause. Although most blemishes like acne scars aren’t a cause for concern and require no treatment, some may signal a more serious condition like skin cancer.

Acne Scarring

When acne breakouts penetrate the skin deeply, they damage the skin and the tissue beneath it. As the acne clears, the body tries to repair this damage. During the healing process, the body produces collagen, which gives the skin support. If the body produces too little or too much collagen, you will see a scar. 

The type of acne scar you have depends on how much collagen your body makes, such as:

• Depressed acne scars: If your body produces too little collagen, depressions or pits will form.
• Raised acne scars: Sometimes the body produces too much collagen as it tries to heal the skin. When this happens, you develop a raised acne scar.

There are many treatment options for acne scarring. It will depend on the severity and type of scarring you have. Your dermatologist may recommend more than one treatment to get the best result.

Treatments can include:

• Acne scar surgery: Dermatologists often perform this minor surgery to treat very noticeable acne scars and make them less prominent. The remaining scar should fade with time. During this procedure, your dermatologist may lift your scar to bring it closer to the surface and make it less noticeable. This can help people with a few depressed acne scars. Dermatologists can also perform acne scar surgery to reduce raised acne scars. 
• Resurfacing: Your doctor may recommend various resurfacing methods to diminish the appearance of widespread acne scarring. Methods include laser skin surfacing, chemical peels, dermabrasion, and microdermabrasion. Resurfacing works best for depressed acne scars that are nearly flat and not too deep.
• Fillers: Fillers can be used to safely and effectively plump a few depressed acne scars. Your dermatologist may fill acne scars with collagen, the patient’s own fat, or another substance. Many fillers give temporary results, which last between six and 18 months. Some fillers are permanent.
• Skin tightening: Dermatologists often use a technology called radiofrequency to tighten the skin. As the skin tightens, depressed acne scars become less noticeable. Radiofrequency requires repeat appointments and some at-home care after the procedure.
• Needling or microneedling: Also known as collagen induction therapy, needling encourages your body to make more collagen. Your dermatologist moves a sterile, handheld needle-studded roller across the depressed acne scars. This process punctures your skin. As your skin heals, it produces collagen. It takes about nine months to work, but many people begin to notice gradual changes before then. This treatment is recommended for depressed acne scars but not raised acne scars.
• Electrodessication: This treatment uses electrical probes to heat the tissue, which causes it to die. By itself, electrodessication is not an effective acne scar treatment, but it is recommended for depressed acne scars.
• Injections: Injecting medicine directly into raised acne scars can help soften and flatten these raised, thick scars. Getting the best results often requires repeat visits. Corticosteroids, the chemotherapy drug fluorouracil, the cancer treatment interferon, or a combination of medications may be used. If the scar does not respond or stops responding after the fourth injection, surgery may be recommended.
• Laser therapy: Lasers and other light treatments can treat raised scars safely and effectively. A pulsed-dye laser can help reduce the itch and pain, diminish color, and flatten a raised scar. For people with lighter skin, intense pulsed light may also be a treatment option. Laser therapy works for both depressed and raised acne scars.
• Cryosurgery: This approach freezes the scar tissue. Freezing the tissue causes it to die and gradually fall away. It can effectively diminish raised scars in people who have lighter skin, but it can cause permanent light spots to appear on treated skin.
• Topical treatments: Scar creams, gels, and silicone dressings for treating raised acne scars can be purchased over the counter (OTC). They can help reduce itch and discomfort, as well as shrink, flatten, and fade raised scars. These products must be used continuously for the best result. It's important to remember that none of these OTC treatments can eliminate raised acne scars completely.

Hyperpigmentation

Hyperpigmentation occurs when melanin, the pigment that gives skin its color, is produced excessively and forms deposits on the skin. In this condition, patches of skin become darker in color than the surrounding skin.

The most common form of hyperpigmentation is age spots, also known as liver spots. Age spots occur due to sun damage and appear on parts of the body that are usually exposed to ultraviolet (UV) light from the sun or tanning beds. Hyperpigmentation can also be a result of hormonal changes during pregnancy or from taking birth control pills.

For the most part, hyperpigmentation is harmless and does not require treatment. Many people choose to treat their hyperpigmentation for cosmetic reasons. Treatment options can include:

• Topical treatments: Skin-lightening creams that contain hydroquinone may be used. They can lighten darkened skin patches by slowing the production of melanin so those dark spots gradually fade to match your natural skin coloration. Prescription formulations contain twice the amount of hydroquinone as OTC creams. In more severe cases, prescription creams with tretinoin and a cortisone cream may be used. 
• Laser therapy: The Q-switched ruby and other pigmented lesion lasers often remove pigment without scarring.

Melasma

Melasma causes brown or blue-gray patches or freckle-like spots on the skin, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.

The cause of melasma is not clear. It likely occurs when melanocytes, which are cells that make melanin, produce too much color. It is often triggered by UV ray exposure, hormonal changes like those that occur during pregnancy, and skin care products.

Melasma can sometimes fade on its own, especially when it's caused by pregnancy and birth control pills. If it does not go away, you can try different melasma treatments.

The first-line treatment for melasma is a skin-lightening cream that contains hydroquinone. To enhance the skin-lightening effects, your dermatologist may also prescribe tretinoin or a corticosteroid. Azelaic acid or kojic acid may also help lighten melasma.

If these medications don't help you get rid of your melasma, your doctor may recommend a chemical peel, microdermabrasion, dermabrasion, laser treatment, or light-based therapies.

Birthmarks

A birthmark is an abnormality of the skin that is present at birth. No one knows what causes many types of birthmarks, but some run in families.

There are different types of birthmarks. Vascular birthmarks are made up of blood vessels that haven't formed properly. They are often red or pink, and are typically found between the eyes or on the back of the neck. Another type called pigmented birthmarks are made of a cluster of pigment cells that cause color in skin. They can be many different colors, from tan to brown, gray to black, or even blue. Moles can be birthmarks, also.

Treatment isn’t always required since most birthmarks are harmless and some go away on their own. However, in some cases, moles can increase your risk of skin cancer, so those will need to be monitored to see if they need to be removed. If you want a birthmark removed, laser therapy or surgery can help. 

Skin Cancer

Skin cancer is the uncontrolled growth of cancerous cells in the skin. It can occur on any area of the body.

The main cause of skin cancer is overexposure to the sun's UV rays and from tanning beds, but it can also be caused by exposure to certain chemicals. People with weakened immune systems are at a greater risk of developing skin cancer. 

There are many types of skin cancer, with the three most common being:

• Basal cell carcinoma: Basal cell carcinoma is the most common type of skin cancer. It is a slow-growing cancer and rarely metastasizes (spreads to other areas of the body). 
• Squamous cell carcinoma: This type is less common, but accounts for the majority of skin cancers that spread that are not melanoma. Along with sun exposure and a weakened immune system, squamous cell carcinoma may also be brought on by immunosuppression caused by an organ transplant and chronic inflammation. 
• Melanoma: Melanoma is a deadly form of skin cancer, but it is also the least common type. It can recur, and roughly 1%–8% of people with a history of melanoma will develop multiple melanomas.

The signs of skin cancer differ between types. Basal cell carcinoma lesions are usually small and smooth, with a pearly or waxy bump or a flat lesion that can be light red or brown in color. The pearl-like type of basal cell carcinoma is typically found on the face, ears, and neck, while the flat lesion is most likely to appear on the arms, legs, or torso.

Squamous cell carcinoma lesions can present as firm red nodules or a scaly and rough flat patch, while melanoma lesions are typically brown in color and will be either a bump or a patch. Melanoma lesions can look like a regular mole but will have an irregular shape, have more than one color, and change over time.

Treatment for skin cancer depends on the type and progression of the disease. Common treatments include either surgical removal of the lesions and surrounding tissue, topical chemotherapy, standard chemotherapy, radiation therapy, or immunotherapy if the cancer has spread to other areas.

Scars

A scar is typically the result of an injury to the skin, but it can also be caused by infections, surgery, or tissue inflammation. Scars can appear anywhere on the body. Some scars are flat, while others are raised. A scar could also appear lumpy, discolored, or sunken into the skin.

There are different types of scars, including:

• Keloid scars: Keloid scars are rounded and irregular groupings of scar tissue that form at the location of a skin wound. The color varies but is typically red or darker than the skin surrounding it. When the body tries to repair itself, it creates collagen, and keloid scars are typically formed from that collagen. They can form anywhere on the body, but they are most commonly found on the back, shoulders, earlobes, or chest.
• Hypertrophic scars: These scars are similar to keloid scars but are more localized to the wound area. The scars are red, raised, and thick.
• Contracture scars: These types of scars occur over a large section of skin when it becomes damaged, such as from a bad burn. They develop when the surrounding skin thickens and tightens, pulling the skin surrounding it together. These scars limit muscle and joint movement in the area.

Treatment for scars will depend on the type, location, size, how it’s affecting you, and your age. Common treatments for scars include:

• Dermabrasion
• Corticosteroid injections
• Laser treatments
• Pressure therapy
• Massage therapy to help break up scar tissue
• Scar revision surgery
• Ointments or creams designed to reduce the appearance of a scar

Rashes

A rash refers to an area of irritated or inflamed skin. Many rashes are itchy, red, painful, and irritated. Some rashes can lead to blisters or patches of raw skin. Rashes are a symptom of many different medical problems. 

A common type of rash is contact dermatitis. You can get a rash when your skin is exposed to an irritant, such as chemicals, poison ivy or poison oak, or something that you are allergic to.

Other causes of rashes can include:

• Eczema: Eczema is a common skin condition. It causes red, raised, and extremely itchy patches of skin. Eczema typically develops on the hands and feet, behind the elbows and knees, and on the scalp.
• Seborrheic dermatitis: This type of dermatitis occurs on the scalp, face, upper chest, and back. It may be caused by an overgrowth of fungus on the skin.
• Hives: Hives can occur randomly, but they also can be triggered by allergens such as foods, cold or heat, medications, and stress. They are often pink, red, or the same color as your skin and can vary in both size and shape. They also are itchy and can show as patches on the skin.
• Shingles: Shingles causes a painful rash that develops from the virus responsible for chicken pox. The virus stays in the body after you get the disease and can be reactivated years later. Shingles typically appears on the torso, wrapping around one side, although it can be elsewhere.

Some rashes may clear up on their own, while others require treatment. The treatment is tailored to what causes the rash. If the rash is caused by an allergic reaction, an antihistamine may be needed. Calamine lotion can also relieve the itch. If the itching is severe, as is typically the case with eczema, a hydrocortisone cream may be used.

Summary

Blemishes refer to any discoloration, spot, or mark on your skin. They have many different causes, including acne scarring, hyperpigmentation, melasma, and birthmarks. Some may be a sign of a serious condition like skin cancer. If you notice any blemishes that are changing in shape or color, talk to your dermatologist because these changes can be a sign of skin cancer.

A Word From Verywell

Skin blemishes can be irritating and embarrassing, but remember that most are not harmful to your health. Some like birthmarks may even go away on their own with treatment. Even for those that persist, the good news is there are plenty of options to choose from that remove or diminish the appearance of the blemishes.

Some procedures like dermabrasion and chemical peeling need to be performed by a dermatologist. If you have any concern about skin blemishes, speak to your dermatologist about the best option for your specific case.