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

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

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 at 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.

Results are seen within one session. Pico Lasers can speed up pigment resolution 10 times faster than creams.

 

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

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

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-

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

Pigment can also be removed via exfoliation, the ingredient list includes-

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

Pigment can be suppressed with antioxidants such as-

  • Ferulic acid, silimarin, tocopherol, green tea & ascorbic acid

The correct formulation will be prescribed to you by your clinical team at The Melasma Center.

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.

What are the common causes of post-inflammatory hyperpigmentation?

Any inflammation on the skin will cause PIH. The most common condition is acne, followed by insect bites, chicken pox, burns, trauma & eczema.

How to manage PIH due to acne?

For best results you must treat the cause of pigmentation. This means treating the source of acne. BHA washes, retinoids & skincare products can effectively treat 80% of acne. For resistant acne our clinical team at The Melasma Clinic can prescribe highly effective treatments to place acne into quick remission.

 

Why is my hyperpigmentation not going away?

Four primary reasons.

Firstly, you are getting too much sun. Learn to use the right formulation of sunscreen in the correct dose & frequency. If you don’t get this right, you will be spending alot of time, effort & money on trying to treat pigment with no success.

Secondly, apply the correct treatment combination of lasers, creams & peels.

Thirdly, treat the primary source of inflammation. The most common is acne as this leads to more post inflammatory hyperpigmentation. Acne is the most common cause.

Finally & most importantly, ensure that the diagnosis is correct. There are over 150 causes of pigmentation, finding the cause provides an avenue for treatment.

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-

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

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

If you are after a natural home remedy (after you get your sunscreen right) try two ingredients-

Vitamin C or ascorbic acid. Do not attempt lemon or citrus juice as this makes pigment worse. Look for vitamin C serum, 10-20%, apply under sunscreen in the morning & at night.

Azelaic acid. This is derived from wheat is a safe & somewhat effective treatment for pigment. Look for 10-20% gel formulations, apply up to twice a day. It combines well with vitamin C.

Other ‘natural’ ingredients include bearberries, green tea, & licorice root extract.

More of our mostFrequently asked questions

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

What if my pigment does not respond to pico lasers?

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), variabler 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.