Post Inflammatory Pigmentation 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
- Cost$
Post Inflammatory Pigmentation
Post Inflammatory Pigmentation 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 Post Inflammatory Pigmentation
- 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?
Post Inflammatory Pigmentation
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.
View our Treatment Gallery
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%.
PIH or post inflammatory inflammation treated with pico laser. 3 sessions over 3 months using the 1064 Zoom of Picoway
.
👩🏽PIH/Grade 1 acne scars: 50% last 12 months or longer, of those 25% last 5 years. More prevalent in darker or ethnic skin types
.
🧴Topicals: give modest improvements; the usual HQ, arbutin, #cysteamine, licorice root extracts, botanicals ascorbic acid
.
🔫Pico lasers: are the game changer. Above all things, control or eliminate the source of inflammation. In the context of acne, aim for absolute control & remission
.
🎬Action: For PIH scars, book in with the nursing staff at Cutis Dermatology, if you have active acne, consult my dermatology colleagues
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
#acne #scars #pih #postinflammatorypigment #picolaser #picoway #picolasertreatment #skinlightening #skinbrightening #drdavinlim #brisbanedermatology
I still don’t understand how this laser is so much better than QSL - nano technology, for those who treat pigment truly is groundbreaking. I have not seen results like this after using 755 pico for over 5 years
.
.
👊🏻One session with Picoway using, believe it or not 532 & not the traditional 1064. B&A by Jean @cutis.dermatology dermatology
.
🤫A result like this is considered good (ish) after 8-10 sessions of Q switch using the 1064- after 8-12 months of therapy. The difficulty is compounded with the site (lower limb)
.
🔫💯👌🏻The pico is our go to for all things PIH - including acne, surgical scars, chemical peel PIH & iatrogenic laser induced causes, caused by yours truly 😜
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#skinscience #PIH #postinflammatoryhyperpigmentation #acnetips #picoway #dermatologist #dermatology #drdavinlim #davinlim #cutisdermatology
PIH secondary to erbium laser, treated with Picoway 1064 full beam 6 mm spot,
0.9 to 1.2 fluence by Alison @cliniccutis 3 sessions. If you are used to treating PIH, you know that pico is a game changer… Fear No Pigment 👊🏻
.
🔫Pico: Is awesome for post inflammatory hyperpigmentation from all causes including acne (grade 1 macular scars) through to iatrogenic pigmentation from peels, surgery or lasers. Pico laser, especially in the 1064 wavelength gives predictable treatments in 1-3 sessions. The best bit is that you don’t need to go hard to improve it
.
😎Davin Lim
@candelamedicalanz
Brisbane,
🇦🇺
.
#picoway #picolasser #melasma #pigmentation #laserrejuvenation #davinlim #dermatologist #picotoning #pigmentationtreatments #skinlightening
I cringe at the words ‘natural’ & ‘organic’. Guilty of throwing them around to get the job done. Hydroquinone is one of the best pigment correctors, however there are 3 main (proven) problems with it.
.
1️⃣Firstly it can be irritating to some, even in low concentrations. Hence why I prefer a stand alone as I can titrate
.
2️⃣It is not widely available in Asia, Africa & some European countries
.
3️⃣Long term use can lead to tachyphylaxis & exogenous ochronosis
.
🍊Natural’ pigment inhibitors are useful during the off phase of HQ, as part of rotational therapy, or adjunct in the am. An example is L-ascorbic acid in am which functions as an antioxidant & as a tyrosinase inhibitor
.
👉There are many novel ‘natural’ pigment inhibitor formulations including #Meladerm, #Melarase, #Melacream. Botanicals (technically lab made in some) such as liquorice root, citric acid, #arbutin, azelaic acid, kojic acid & bearberries are the main ingredients in these anti-pigment formulations
.
👍🏻Melasma patients: Be guided by the nurse I have assigned to your case. They will guide you as to how to titrate your topicals & when to integrate non-HQ ‘organic’ topicals into your routine. Rotate & titrate as per their instructions. Your actual program will depend on what stage you are at in your treatment program
.
.
😎Davin Lim
Dermatologist
Brisbane, Australia🇦🇺
.
#dermatologist #melasma #skinlighening #skinbrightening #pigmentationtreatment #skincare #organicskincare #naturalskincare
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 $490 with my nurses.
Pico lasers performed by me start from $1190.
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.
