Post-Inflammatory Hyperpigmentation

Post inflammatory hyperpigmentation or PIH is commonly encountered after acne, insect bites, burns, eczema & trauma to the skin. It is universally encountered in darker skin types. With appropriate skincare & lasers, PIH can be effectively treated & the duration of pigment shortened. 

Recovery

0 days (no downtime)

Results

3-8 weeks

Treatment Time

5 minutes

Aftercare

SPF, pigment correctors

Treatment science score:    (with accurate treatments)

The science of treating post inflammatory hyperpigmentation

  • Always address the primary cause of skin inflammation to prevent recurrence
  • Pico lasers provide the fastest resolution of pigment
  • Lasers are combined with pigment correctors
  • Without sunscreen, PIH will be infinitely harder to treat

The Picosure Pro has revolutionized the treatment of post inflammatory hyperpigmentation. This treatment accelerates pigment clearance by over 10 times the normal speed. Treatments are quick, painless & effective. 

Who is prone to pigmentation?

Darker skin types including Asian, Middle Eastern, Islanders & Africans are more prone to PIH pigmentation. Persistent pigment also runs in families. Other risks include those who receive a significant amount of UV & those with active skin conditions like acne & eczema.

What happens to post inflammatory pigmentation if not treated?

Pigmentation can take up to 5 years to fade. A recent paper has shown that PIH persists for longer than one year in 50% of patients, & beyond 5 years in a quarter of cases. 

What is the fastest way to treat post-inflammatory hyperpigmentation?

Picosecond lasers employ ultrashort pulses of light to safely shatter unwanted pigment without heating the skin. They offer the fastest way to effectively & safely treat post inflammatory hyperpigmentation. 

Pico Lasers can speed up pigment resolution 10 times faster than creams. 

  • Painless
  • Zero downtime
  • Highly effective
  • Fast removal of all types of pigment

 

This concept is grasped by only a handful of patients as most melasma patients can not see beyond pigmentation itself. Those who get it will have a much higher probability of long term remission 💯
.
👉Rate limiting factors: ability to understand the cause of melasma beyond pigment, the time required to remodel the dermis, especially in skin of colour, financial constraints as dermal remodelling goes far beyond ‘retinol-retinoids’, RFM, lasers & EBDs or the ubiquitous & over-rated Cosmelan peel
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #photoaging #melasmaclinic #celluaraging #drdavinlim

This concept is grasped by only a handful of patients as most melasma patients can not see beyond pigmentation itself. Those who get it will have a much higher probability of long term remission 💯
.
👉Rate limiting factors: ability to understand the cause of melasma beyond pigment, the time required to remodel the dermis, especially in skin of colour, financial constraints as dermal remodelling goes far beyond ‘retinol-retinoids’, RFM, lasers & EBDs or the ubiquitous & over-rated Cosmelan peel
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #photoaging #melasmaclinic #celluaraging #drdavinlim
...

204 4
The use of antioxidants such as glutathione can lighten & brighten skin. Glutathione can be a useful adjunct in some cases of #melasma
.
🔫Pico lasers: can safely be used to treat various types of pigmentation. A series of 3-5 sessions produce the best results, however in this patient only one treatment was performed. Settings matter
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #picolaser #picosurepro #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #glutathione #skinlightening

The use of antioxidants such as glutathione can lighten & brighten skin. Glutathione can be a useful adjunct in some cases of #melasma
.
🔫Pico lasers: can safely be used to treat various types of pigmentation. A series of 3-5 sessions produce the best results, however in this patient only one treatment was performed. Settings matter
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #picolaser #picosurepro #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #glutathione #skinlightening
...

69 4
If the proper amount of sunscreen is used, anything over an SPF of 40 is fine (in the context of melasma). Other than SPF factor (a measure of UVB), UVA ratings & attenuation of visible light is super important in the management of pigmentary disorders such as melasma & post-inflammatory hyperpigmentation, especially in skin of colour
.
👉Cosmetic elegance & colour matching: is often the rate limiting factor
.
👉Why tint? Iron oxides protect against visible light, this band of light stimulates pigment
.
👉How to use? Two fingerlengths, twice daily, regardless of exposure💯
.
👉Our pick? Elta MD, acknowledging there are many good brands with a wider range of colour matching
.
Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #melasmatips #bestsunscreen #spf #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #elta #eltaMD #eltasunscreens

If the proper amount of sunscreen is used, anything over an SPF of 40 is fine (in the context of melasma). Other than SPF factor (a measure of UVB), UVA ratings & attenuation of visible light is super important in the management of pigmentary disorders such as melasma & post-inflammatory hyperpigmentation, especially in skin of colour
.
👉Cosmetic elegance & colour matching: is often the rate limiting factor
.
👉Why tint? Iron oxides protect against visible light, this band of light stimulates pigment
.
👉How to use? Two fingerlengths, twice daily, regardless of exposure💯
.
👉Our pick? Elta MD, acknowledging there are many good brands with a wider range of colour matching
.
Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #melasmatips #bestsunscreen #spf #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #elta #eltaMD #eltasunscreens
...

45 2

How many laser sessions will I require & when will I see results?

Results can be seen within one treatment session, however a series of 4 treatments will yield optimal outcomes. 

Treatments are spaced 2-4 weeks apart. Above all, it is important to stop further pigmentation by treating the source of inflammation, most commonly acne.

The Melasma Clinic difference

Our specialist clinic is overseen by dermatologists who provide a comprehensive & bespoke approach to skin care. We take into account the complexity and individuality of your skin. Our pigment solutions include preventing future recurrences of melasma. Our ethos is to improve & maintain your skin’s health & vitality as an ongoing commitment to our patients.

Dr Davin Lim

645K subscribers

How to treat PIGMENTATION

If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination…

What skin care ingredients are there to reduce pigmentation?

PIH pigment can be improved treated with key ingredients designed to reduce the production of melanin they include-

Ingredients to reduce melanin production

Kojic acid, hydroquinone, arbutin, azelaic acid, botanicals & vitamin C

Ingredients to exfoliate the skin, removing excess pigment

Citric acid, salicylic, lactic, glycolic & mandelic acids.

Ingredients with antioxidants 

Ferulic acid, tocopherol, green tea & ascorbic acid

The ideal formulation will be prescribed to you by your clinician at The Melasma Clinic.

What is a simple skin care routine to treat PIH pigment?

AM: Antioxidants incl. Vitamin C & E, SPF 50+ Iron oxide 

PM: Azelaic acid (option for vitamin C, arbutin, kojic acid, HQ)

The biggest traction you will receive is to get your sunscreen application correct. This means using the right amount of sunscreen (2.5 to 5 mls), twice daily, regardless of sun exposure.

Why is sunscreen essential in managing PIH pigment?

UV & visible light stimulates your cells to produce pigment. Without sunscreen your PIH journey will be slow & frustrating. Tinted sunscreen is essential as visible light stimulates pigment production.

Here is how to effectively employ sunscreens; apply two fingerlengths of sunscreen, twice daily, SPF 40 & above, tinted.

What are the best lasers to cure post inflammatory hyperpigmentation?

Picosecond lasers are the most effective way to remove pigmentation, including cases of PIH. We employ both Picoway & Picosure Pro. Our pico program consists of –

  • 4 sessions of laser, spaced 2-4 weeks apart
  • Treatments are painless & take 5 minutes to perform
  • Laser have no recovery period

Can microneedling treat post-inflammatory hyperpigmentation?

Yes, if done correctly. Here is how to safely perform microneedling at home– 

  1. Use a 0.1 to 0.2 mm roller or stamper. eBay or Amazon. Do NOT go deeper than this. 
  2. Roll the affected areas with 3-5 passes, apply traction to the skin, or stamp 2-4 times to the affected areas.
  3. Add your pigment corrector of choice after microneedling (vitamin C, azelaic acid, arbutin). 
  4. Repeat 1-2 times a week. 

The aim of microneedling is to increase the absorption of topicals in addition to increasing the shedding of pigment in the upper layers of skin. With microneedling you can expect some pigment to shift within 4 to 12 months; much slower than with lasers, but faster than just creams alone. 

*Caution: do not go deeper than 0.2 mm or you will push pigment deeper into your skin, making the condition worse. 

More of our mostFrequently asked questions

What are some natural remedies to treat post-inflammatory pigmentation?

What are the best products to treat post inflammatory hyperpigmentation?

How to manage PIH due to acne?

How does Picosure Pro compare to Fraxel for post inflammatory pigment?

What if my pigment does not respond to pico lasers?

Can Rejuran treat post-inflammatory hyperpigmentation? 

How much better are pico lasers compared to older Q switch lasers?

How to treat post inflammatory hypopigmentation?

 Can I lighten pigmentation with supplements?

Can exosomes treat post inflammatory pigmentation?

Why is my hyperpigmentation not going away?

A SummaryTreating post-inflammatory hyperpigmentation

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

PIH treatment requires a two stage approach. Firstly absolute termination of the inflammatory process. The first stage is done via the help of a medical dermatologist (the subspecialty of dermatology that looks into prescribed medication to treat skin conditions). Depending on the type of inflammation, your dermatologist may elect to use-

  • Steroids: oral, intralesional or potent topical corticosteroids. 
  • Non-steroidal topicals: tacrolimus, pimecrolimus, other agents
  • Tablets: plaquenil, isotretinoin, oral anti-inflammatories & immune modulators

Special cases of PIH as they have vastly different rates of success. PIH due to acne has the highest hit rate, whilst PIH due to trauma or lichenoid conditions have a much lower chance of resolution, despite advances in picosecond lasers.

PIH due to lichenoid cases (lupus, lichen planus, PPD,)

  • Lupus PIH: hard to treat, can be treated (see or before & after), variable results
  • Lichen planus PIH including Ash Dermatosis: very hard to treat. 
  • PIH due to lichen aureus, pigmented purpuric dermatosis: variable responses

PIH due to surgical scars: hard to treat if scars are thick, easier in thinner scars. 

PIH due to non-lichenoid inflammatory causes (eczema, insect bites): variable responses, good with eczema & insect bites.

In our experience the use of pico lasers provides the best clearance of PIH pigment- somewhere in the order of 80% with 2-5 sessions, depending on the depth of pigment.