Post Inflammatory Hyperpigmentation At A Glance
- Best Results2-6 treatments
- Treatment RecoveryImmediate
- Procedure Time5 to 10 minutes
- Skin SpecialistDermal therapist, nurse, dermatologist
- Duration of ResultsPermanent if controlled
- AnaestheticNot required
- Back to WorkImmediately
Post Inflammatory Hyperpigmentation
Post Inflammatory Hyperpigmentation is darkening of skin due to inflammation. The most common cause is acne. With adequate sun protection, control of inflammation together with pigment reduction creams & lasers, the vast majority of PIH can be treated. Even with the very latest pico lasers, it takes 3-6 months for optional results.
FactsFacts on Hyperpigmentation
- The most common cause of PIH is acne
- Effectively treating the cause will prevent recurrence
- Sunscreens form the basis of management
- Fading creams such as ascorbic, azelaic & Kojic acids may help
- Lasers such as Spectra & Pico lasers can speed up pigment resolution
- Peels can also improve pigmentation
What is PIH or Post Inflammatory Hyperpigmentation?
PIH is a medical term to describe darkening of skin secondary to inflammation. The most common cause by far is acne. Other causes include eczema, dermatitis, chicken pox as burns from chemicals, lasers & IPL. The cause of PIH is over production of a compound called melanin by the pigment producing cells in your skin.
How long will it take pigmentation to go away?
About 6-12 months, however 50% will last longer than 12 months. 25% of these will take 5 years to resolve. The biggest mistake dermatologists see is the delay in achieving absolute control of the cause of pigmentation. In the vast majority of patients, the primary culprit is active acne.
Why does acne cause post inflammatory pigmentation?
Inflammation from any cause can lead to PIH. In susceptible individuals that produce an exaggerated melanin response (usually ethnic – Asian skin types), PIH can be a sequelae.
The most important concept to understand is that you must prevent new lesions of acne, otherwise you will be frustrated (& broke) chasing your pigment. With lasers & topicals, my team will definitely fade PIH, what is beyond our control is the amount of new acne spots you may get in the future. For patients with PIH, control of acne must be absolute. Even if you get 5 spots per month & only 3 will lead to PIH, over a course of a year you will get 36 new spots. Get it?
Who is prone to PIH or post inflammatory pigmentation?
Darker skin types including ethnicities such as Asians, South Americans, & Middle Easterners are more prone to pigmentation changes. This is because the pigment producing cell, called the melanocyte is more active. Additionally patients who love the sun or do not sun protect are more prone to pigment.
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What can I do at home to treat PIH?
Apart from controlling inflammation, sunscreen forms the absolute cornerstone of treating any form of pigmentation. Use a SPF 50+ sunscreen at least twice a day, regardless of sun exposure. Things to try at home include-
Superfade cream (2% HQ), this is a mild bleaching cream. Use at night to spots. You can try either azelaic acid or ascorbic acid (vitamin C) in the morning.
Does vitamin C help with post inflammatory hyperpigmentation?
Yes, vitamin C can both decrease hyperpigmentation AND help with collagen regeneration. Ascorbic acid (Vitamin C) is best used in the morning. Start with a 10% L- Ascorbic formulation before graduating to 15 or 20%.
How do Dermatologists treat pigmentation?
Specialist manage this condition by looking at the cause of pigmentation. Prevention is the most critical step to prevent further PIH. We then proceed by prescribing sunscreen & skin lightening agents. In some cases tablets can help. To accelerate pigment resolution, lasers can be used. As a guide-
QSL or Spectra lasers: can reduce pigment over a period of months. They are side effect free. We space treatments 2-3 weeks apart. 5-10 required over 3-6 months.
Pico lasers can be used to speed up pigment clearance. I now use third generation pico lasers over first generation Picoway. This laser can give faster results than Spectra lasers (in most cases).
Can dark underarm hyperpigmentation be treated?
Depending on the cause of pigmentation some can be improved. The hardest form of underarm hyperpigmentation to reliably fade is acanthosis nigricans.
This is a medical condition that should be managed by medical dermatologists. Treatments include topicals such as tretinoin, AHA buffered creams & tablets such as metformin & anti-hormones. Please see a general dermatologist BEFORE seeking laser treatment. Laser can marginally improve this condition, at best.
What is the quickest way to lighten my skin?
PIH can not be treated in one session (as high laser settings often worsen pigment). Control of inflammation, creams, SPF & pico lasers are the fastest way to treat unwanted pigment.
What is better; chemical peels or lasers?
Though AHA chemical peels such as lactic or glycolic acid can be effective, lasers give faster & safer clearance. Lasers work by decreasing the activity of the pigment cell (melanocyte) whilst chemical peels work by exfoliation.
How much do treatments cost?
Treatments are more affordable than you think !
Lasers start from $150 per treatment with my dermal therapists or nurses.
Pico lasers (Picoway & Picosure) start from $450 with my nurses.
If you have straight forward PIH from acne, book in to see my nurses. They can assess & guide you accordingly.
Davin’s Viewpoint on PIH and treatments
8 out of 10 patients I see will still have active background inflammation. Control MUST be absolute. Take acne for example, if you have 3 pimples per month but 2 ‘pigments’, over a year you will have 24 spots & in two years you will have nearly 50. Hence in darker skin types, control must be almost 100%. A medical dermatologist can help treat the cause of inflammation.
For PIH I normally start patients on a routing of pigment correctors such as HQ, or ascorbic, azelaic, Kojic mixed with arbutin & AHAs, in addition to tranexamic acid. My laser of choice is either Nano Spectra or the newer generation three Pico lasers (over older generation one Picosure). Regardless, most patients will require several treatments over 3-6 months.
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