How do I get rid of my PIH once and for all? (photo)

Doctor's Answers 3

Sorry to hear about your recurrent acne, red marks and post-inflammatory hyperpigmentation (PIH). It must be really frustrating for you to have to deal with all these marks. PIH is a common complication of skin inflammation such as acne.

How do you get rid of PIH once and for all?

There are two parts in your question to address:

  • how to get rid of PIH
  • how to prevent it from coming back

Post inflammatory hyperpigmentation develops in the area of the preceding inflammation and may range from light brown to slate-grey or black. PIH often fades away slowly, sometimes persisting for years and can cause significant anxiety and lowered self-esteem.

PIH usually responds well to q-switched laser and topical pigmentation medications. Nanosecond pulse duration Nd:YAG lasers such as Spectra XT or Fotona Starwalker can be used, however newer picosecond pulse duration lasers (especially those with more melanin specific wavelengths such as ruby) such as Discovery Pico Plus produce faster, more predictable results in my experience. Generally, the PIH would start lightening within the first few sessions, particularly the darker ones.

Other options include fractional thulium and/or erbium YAG lasers, chemical peels which can be used too. I find that Discovery Pico Plus generally gives good results.

Patients with existing PIH are prone to developing more PIH, perhaps even in response to treatment for PIH, hence care must be taken before, during and after treatment. Topical pigmentation medications (such as hydroquinone, tretinoin, tranexamic acid, etc) lighten the PIH and reduce any further pigment production. Sometimes oral medication is necessary. Sunblock and UV protection are imperative to avoid further worsening of the PIH.

To prevent PIH from coming back, we need to address the source of skin inflammation. Judging from the photo you sent, you have active inflammatory acne together with red marks and PIH. These need to be controlled, otherwise new PIH would just keep developing.

I would recommend fractional energy devices such as fractional laser, fractional radiofrequency or fractional microneedling radiofrequency, depending on the severity of the active acne and scarring. These have the added benefit of helping with the red marks, otherwise known as post-inflammatory erythema.

Skin care and topical medications (such as antibiotics, retinoids) should be started as well. Depending on the severity of your acne and scarring, oral medications such as antibiotics, oral contraceptives or low dose isotretinoin may be necessary.

Do speak with a doctor who will be able to explain to you in depth.

Hope this helps!

Warmest regards,
Dr Wan Chee Kwang

References

  1. Chaowattanapanit et al. Postinflammatory hyperpigmentation: A comprehensive overview: Treatment options and prevention. J Am Acad Dermatol. 2017 Oct;77(4):607-621.
  2. Eimpunth et al. A focused review on acne-induced and aesthetic procedure-related postinflammatory hyperpigmentation in Asians. J Eur Acad Dermatol Venereol. 2013;27(suppl 1):7-18.
  3. Katz et al. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation. Dermatol Surg. 2009;35:1844-1848.
  4. Kwon et al. Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study. J Eur Acad Dermatol Venereol. 2018 Apr;32(4):639-644.
  5. Moneib et al. Randomized split-face controlled study to evaluate 1550-nm fractionated erbium glass laser for treatment of acne vulgaris--an image analysis evaluation. Dermatol Surg. 2014 Nov;40(11):1191-200.
  6. Kim et al. (2014). Treatment of acne vulgaris with fractional radiofrequency microneedling. The Journal of Dermatology, 41(7), 586–591.

Based on what I observed from the photos, your face looked red and inflamed. There is new active acne as well as brown marks caused by previous acne.

I will advise you to treat your acne and redness soon so that it won't get worse. I would recommend the combination below to treat your condition effectively:

1) Oral medications to control acne

You should get your acne under control so that your skin is allowed to heal and no new acne scars develop. You can start with oral medications such as antibiotics or roaccutane to control your acne.

2) Light treatments to reduce redness and pigmentation

Personally I like to use light treatment like the Sciton Forever Clear BBL or the yellow lasers as they are gentle to the skin and suitable to treat sensitive, acne-prone skin.

Both Sciton Forever Young BBL and Pro Yellow Laser are able to reduce redness, acne, and pigmentation at the same time. Most patients experience minimal discomfort and downtime with both treatments mentioned above. Several treatments are required in order to achieve maximum effect.

As the name suggests, Post-Inflammatory Hyperpigmentation(PIH) may occur whenever there is an insult/inflammation to the skin, and the skin reacts by producing more melanin. It is temporary, but may take a long time to heal and resolve without treatment. Unfortunately, it also happens more commonly in darker-skinned individuals.

Treating PIH is not easy and takes time and patience. In my practice, I adopt a combination therapy approach to treat PIH when it happens. The most important "treatment" in my opinion, is to prevent them from happening. In your case, it would be to prevent and treat the acne first to prevent new outbreak from causing more acne PIH marks.

To treat existing PIH marks, the following can be used:

1. Topical therapy - Topical products containing ingredients like tretinoin which increase cell turn over and hence removal of pigmentation, lighteners like hydroquinone, anti-oxidants like vitamin C, as well as cysteamine cream which inhibit melanin production all help with reducing the appearance of PIH marks.

2. Oral supplements like sublingual glutathione, oral carotenoids that can help to inhibit existing melanin synthesis and lighten PIH marks and even out skin tone, as well as oral polypodium leucomotos supplements that can help prevent further damage and darkening of marks from UV radiation.

3. LED light and Laser therapy - In your case, blue LED light will help with your acne, yellow LED light is useful to reduce redness and the Near-Infrared wavelength LED light is iseful for melanin pigment destruction and pigment suppression and hence useful to treat PIH. Lasers like the Dual Yellow Copper Bromide laser, Nd-Yag laser toning and Picolaser toning have all been shown to be useful in the treatment of PIH as well.

As I mentioned, in my practice, often a combination therapy approach gives very good results in the treatment of PIH. You should get a proper assessment by a certified and experienced doctor who will be able to come up with a customised treatment plan for you.

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