Treating Red Acne Scars at a glance
- Best Results2-5 sessions
- Treatment Recovery1-4 days
- Procedure Time5 minutes
- Skin SpecialistDavin Lim, nurses, dermal therapists
- Duration of ResultsPermanent
- AnaestheticSkin Cooling
- Back to Work1 day
Red Acne Scars
Red acne scars are termed PIE or post inflammatory erythema. Macular erythema refers to the same condition. By definition these scars have not contour changes. The majority of PIE will fade within 3 to 6 months. 20% can linger on for many years. Simple vascular lasers can treat redness associated with old acne spots.
FactsFacts on Red Acne Scars
- Vascular lasers give the best results
- Fractional & Pico lasers can give added clearance
- Most cases require 2-5 sessions
- The prognosis for PIE is excellent- if acne is controlled
What causes post inflammatory erythema?
The most common cause is acne. PIE or post inflammatory erythema is a term used to describe red acne scars that linger after pimples. Redness is due to both increased blood vessels & in some cases pigment. By definition PIE is flat, unlike true scarring which has contour changes.
How do I treat PIE?
For true cases of PIE, the stand out treatment is vascular laser. This laser targets red marks, without breaking the surface of the skin. For mixed pigmentation, addition of a nano Q switch laser or better still a Pico laser can give faster clearance.
This type of scarring is classed as grade one, or ‘mild scars’. Book a consultation with my nurses for laser options. As a guide, I manage objectively severe forms of acne scars. Fortunately PIE can fade with a series of simple laser sessions. On average 3-4 sessions are required, spaced 2-4 weeks apart.
Does post inflammatory erythema go away?
In some situations, PIE can fade within 3 to 6 months. If inflammation is severe it can take up to 2 years to resolve. In some cases it can be permanent.
What skin products can treat PIE?
If you would like to try to fade PIE with over the counter products & skin care, try the following-
- The foundation of management is a good sunscreen. Use twice a day.
- Vitamin C in the AM, along with anti-oxidants such as vitamin E & ferulic acid.
- Niacinamide or Vitamin B3 is a good, low irritant anti inflammatory topical.
- Option for retinol or prescribed retinoid
Find the correct combination for your skin type, as this is dependent on your skin irritant threshold as well as the extent of active acne.
Disclaimer: I am a procedural dermatologist, I do not prescribe skin care. My work is focused on lasers, surgery & injectables. For information on products please discuss with your treating therapist, nurse or dermatologist.
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Why is sunscreen the most important step in skin care?
UV adds to redness & skin pigmentation following inflammation of the skin. Without adequate sun protection, your PIE will not fade – even with the best products & lasers! Use a high factor SPF 50+ at least twice a day. Brands like Invisible Zinc or La Roche Posay Anthelios are best.
Why is acne control vital in the management of post inflammatory erythema?
Without absolute control you will not be able to clear up PIE. Even if you have 2-3 pimples a month, after one year you may have over 20 new spots. If you have a tendency to PIE, you must get acne under control.
For cases that can not be controlled with home remedies & over the counter creams, I suggest you see one of my medical colleagues to discuss treatment options.
Can Vitamin C treat PIE?
Yes. Ascorbic acid can reduce both red & brown scars. It is a potent inhibitor of tyrosinase & can reduce dark pigmentation. It can also treat post inflammatory erythema though it’s anti-oxidant & collagen stimulating properties.
The caveat is that ascorbic acid can also cause skin irritation in some patients, hence careful titration is required, especially if you have sensitive skin.
Does aloe vera treat post inflammatory hyperpigmentation?
In some cases, aloe vera application can reduce redness as it has anti-inflammatory properties. You can use the gel like substance from the aloe leaf. Note that there are many reported cases of allergic contact dermatitis following aloe application. Needless to say, medically prescribed creams & lasers work best.
What are the differences in facial aesthetics- Asian vs Caucasian patients. How do you prevent post inflammatory erythema? ?
There are two things that you can do to reduce PIE. Firstly is to have absolute control over your acne. Secondly is to consistently use sunscreen.
Can microneedling treat PIE?
PIE can improve with microneedling, however lasers including vascular & pico give better results. If you would like to try microneedling, you can safely do it at home (alternatively you can have it done by one of our dermal therapists at Clinic Cutis). For home use, start with a 0.2 to 0.25 mm DermaRoller.
As a guide-
- Microneedling can be done every 2-4 weeks.
- 3-5 sessions over 4 months
- Depth ranges between 0.25 (home use) to 1.0 mm (clinic use)
- Adjunctive sunscreen is critical
- Lasers offer better results with less side effects & downtime
What types of lasers do I use to treat post inflammatory erythema?
True cases of PIE do not have any contour changes, meaning they are absolutely flat.
For flat scars, our team at Clinic Cutis primarily employs vascular lasers including the V Beam Perfect, V Beam Prima, or even BBL-IPL.
Pico lasers, including third generation Picos have replaced the first generation Picosure. These lasers can also be used to treat early & mild depressed scars that have pigment mixed in with inflammation.
Tixel & gentle fractional lasers such as LaseMD, Clear & Brilliant as well as Fraxel can improve mild contour changes as well as PIE.
Davin’s Viewpoint on treating PIE
Fortunately the majority of cases can be managed with simple vascular lasers. I prefer a bruising setting with the V Beam as it can accelerate treatments & reduce visits. Simple cases of acne scarring can be managed by my clinical team. For associated contour changes (depressed scars), simple fractional energy devices such as Tixel, RFM, nano-RF (eMatrix), pico lasers, Fraxel, C and B, LaseMD, & other devices can markedly improve outcomes.
I am not a fan of microneedling in the context of PIE, as other treatments are more effective & less invasive. (I do use microneedling for dermal drug delivery in cases of hypertrophic scarring)
By far the biggest mistake I see is active acne prior or during the course of PIE treatments, if you do not treat the source of PIE, you will never be cleared. For cases of active acne, my medical colleagues at Clinic Cutis can discuss treatment options with you.
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