First of all, I would advise you to return to your treating physician for a follow-up review session to diagnose your current skin condition post skin resurfacing treatment.
My following answer will be based on your possible “at-risk” post-INFINI (Fractional RF with micro-needling) causing PIH. Melanocytes are the cells responsible for pigmentations in the skin. Their activity can be increased due to inflammation. When skin becomes hyperpigmented from an injury, it is named post-inflammatory hyperpigmentation or PIH. This is particularly prevalent in darker skin patients.
For the patient at a higher risk of PIH, I will always start them on preventive measures before any thermal-based device skin procedures such as lasers (ablative and semi-ablative). First-line preventive therapy typically consists of topical depigmenting agents in addition to photoprotection including a sunscreen which should be started at least 3 weeks before the procedure.
It should be continued at least a month after the treatment. Topical creams that I typically prescribed include:
- hydroquinone,
- retinoids and
- corticosteroids.
The management of PIH should begin first with addressing the underlying inflammatory dermatosis if any. Initiating treatment early for PIH may help hasten its resolution and prevent further darkening. However, it is important to always be mindful of potential the treatment itself has to cause or exacerbate PIH by causing irritation. The timing of PIH is very predictable. It almost always occurs about 3 weeks after an “at-risk” procedure is performed. Extreme skin redness should alert a physician if an infection is suspected, antibiotics will be needed.
If there is already PIH formed, my approach will be:
- Topical depigmenting agents, such as hydroquinone, azelaic acid, kojic acid, and retinoids
- Photodynamic therapy (blue light)
- Low fluence laser toning with picosecond laser or Q-switched Yag laser
- Chemical exfoliation
Last but not least, an integral part of the treatment of PIH that should not be overlooked or underestimated is the importance of photoprotection to prevent the worsening of PIH. My patients will be educated on the use of daily broad-spectrum mineral sunscreen SPF of 30 above and sun-protective measures such as:
- avoidance and
- protective clothing.
For further information, please also read my complete guide to fractional lasers in Singapore.
