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
- Chaowattanapanit et al. Postinflammatory hyperpigmentation: A comprehensive overview: Treatment options and prevention. J Am Acad Dermatol. 2017 Oct;77(4):607-621.
- 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.
- Katz et al. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation. Dermatol Surg. 2009;35:1844-1848.
- 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.
- 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.
- Kim et al. (2014). Treatment of acne vulgaris with fractional radiofrequency microneedling. The Journal of Dermatology, 41(7), 586–591.
