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

Doctor's Answer

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.

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