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How to get rid of dark scars on my legs after sand fly bites?

Skin, Hair & Nails Aesthetic Medicine

Hi I went to Taiwan 2 months ago, and was bitten by lots of sand flies, which became big bumps. I was given skin cream and anti-itch medication by a doctor for the bites. However, I'm now left with dark scars and marks all over my legs. How can I get rid of them?

DOCTOR’S ANSWER (4)

Sorry to hear that you have developed dark scars after sand fly bites.  It must be really frustrating for you to have to deal with all these marks after your holiday. I commonly treat patients with similar history and presentation. These marks are likely to be post-inflammatory hyperpigmentation (PIH). PIH is a common complication of any skin inflammation such as acne, allergic reactions, insect bites.

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

How to get rid of dark scars on your legs after sand fly bites? 

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.

Do speak with a doctor who will be able to explain to you in depth and share their experience treating such problems.

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.
322 views 31 Dec 2018

Sorry to hear about your condition, I really hope you can recover soon. Your question resonates with a lot of readers as I have many patients with the same issue, and most of them have a travel history to Taiwan too! Sand fly bites are notorious for leaving behind persistent itch and brown spots (pigmentation) after the acute bites settle. 

It is important to apply the anti-itch medication and do not scratch your spots as that will leave behind more brown marks. Use a ceramide-containing moisturiser to speed up skin healing and be concientious in applying a broad-spectrum sun screen (SPF50) to the affected areas, as excessive sun exposure will lead to darker marks. 

The marks will fade with time as your body absorbs the extra pigment. To speed up the process, you may want to consider using topical whitening creams where appropriate. Laser therapy for post-inflammatory hyperpigmentation may be tricky as there have been instances where pigmentation paradoxically darkens after laser treatment. An alternative to consider may be oral antioxidant supplements such as Heliocare Pure white radiance max, I have seen good results from patients.

Do consult an experienced dermatologist for assessment.

Take care!

Warm regards,

Dr Ker Khor Jia

423 views 3 Dec 2018

Your dark scars and marks are likely to be post-inflammatory hyper-pigmentation (PIH).

PIH can occur after any skin injury like insect bites, pimples/acne and eczema.

Post-inflammatory hyper pigmentation fades over months (2-4 months).

You should focus on preventing the PIH marks from worsening by applying sun block/moisturiser to keep your skin in good condition.

If you would like to get rid of the dark marks/brown marks due to post-inflammatory hyper pigmentation, there are several treatments for post-inflammatory hyper-pigmentation in Singapore:

1. Medical Skin-care

2. Pigment Lasers - Pico Lasers would be a good option.

Hope that this helps!

Warmest regards,

Dr Justin Boey 

534 views 16 Nov 2018

Those marks sound like post inflammatory hyperpigmentation marks. They can fade with time, but the process can be hastened with the use of some medical skincare as well as certain pigmentation lasers. The Qswitched lasers would be a good option usually.

Consult your dermatologist or aesthetic physician for that!

512 views 16 Nov 2018
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