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Lynette
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from Singapore asked a question

What are effective topical treatments to speed up the fading of Post Acne Erythema?

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Acne & Scars Skin, Hair & Nails Medication & Prescriptions

I've had a series of breakouts, leaving me with red marks throughout my face. My acne has now cleared up, but the red erythema marks take a really long time to fade, with some 1 year old red marks still fairly obvious. I understand that the most efficient way to fade the marks is through laser treatment, but I was wondering if there are any effective topical treatments to help speed up the fading process for these red marks? Thank you!

DOCTOR’S ANSWER (2)

Dear Lynette,

Good to hear that your acne has cleared up. Sorry to hear that you are still suffering from obvious red marks which must be quite distressing for you.

These red marks are known as Post Inflammatory Erythema (PIE). They present as localized skin redness following any type of skin inflammation, and may progress to scarring. Facial PIE improves with time, but very slowly, and in some cases, complete clearance of PIE cannot be achieved. Acne erythema should be understood as a scar with erythematous components and not as a simple erythematous or vascular lesion.

What are effective topical treatments to speed up the fading of Post Acne Erythema?

Unfortunately, acne-induced PIEs are generally resistant to available topical medications. There is no evidence supporting the effectiveness of topical treatments for Post Inflammatory Erythema. The following topical off-label treatments could possibly help:

  • Silicone gel - This has been shown to improve erythema in keloids and hypertrophic scars and may help with PIE as well. It increases hydration of stratum corneum facilitating regulation of fibroblast production and reduction in collagen production. Silicone also modulates the expression of growth factors, fibroblast growth factor β (FGF β) and tumor growth factor β (TGF β) 
  • Topical vasoconstrictors such as Brimonidine or Oxymetazoline - These are used mainly in rosacea and have great albeit temporary effect on redness. Thus, they are probably only suitable for sporadic usage such as during important events 

The mainstay of treatment for Post Inflammatory Erythema remains energy based devices such as:

  1. Long pulsed light or laser therapy such as Intense Pulsed Light (IPL) with vascular filters, or vascular lasers such as Yellow Laser, Pulsed Dye Laser, Quasi / Long Pulsed Nd:YAG Laser, 940nm Diode Laser, long pulsed KTP Laser - these work by targeting the haemoglobin inside skin blood vessels. The laser energy is absorbed and converted into heat causing the vessels to shrink and close up, improving the redness. 
  2. Fractional Resurfacing treatments such as Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency. These target water and can produce photothermal damage to deeper dermal vasculature as well as potential anti-inflammatory and anti-angiogenetic properties. 

Clinical photographs showing improvement in post-inflammatory erythema (PIE). The treated group showed improvement in redness 8 weeks after the second session of treatment (B) compared with baseline (A), whereas the control group showed no improvement (D) compared with baseline (C).

Clinical photographs showing improvement in post-inflammatory erythema (PIE) after Fractional Microneedling Radiofrequency. The treated group showed improvement in redness 8 weeks after the second session of treatment (B) compared with baseline (A), whereas the control group showed no improvement (D) compared with baseline (C). (source)

I own and use both Long Pulsed and Fractional devices. Personally, I prefer to use Fractional Resurfacing treatments as they improve concomitant scarring or active acne often present in patients with PIE. Long Pulsed Lasers do however have advantages in having less downtime. 

Needless to say, it is important to control active acne and reduce sun exposure to prevent further skin damage and development of marks.


Do speak to your doctor to find out how best to manage your red marks.

Hope this helps! 


Warmest regards,

Dr Wan Chee Kwang


References: 

  1. Minu L. Mathew et al. Intense Pulsed Light Therapy for Acne-induced Post-inflammatory Erythema. Indian Dermatol Online J. 2018 May-Jun; 9(3): 159–164. 
  2. Neerja Puri et al. The Efficacy of Silicone Gel for the Treatment of Hypertrophic Scars and Keloids. J Cutan Aesthet Surg. 2009 Jul-Dec; 2(2): 104–106. 
  3. Chernoff WG et al. The efficacy of topical silicone gel elastomers in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic Plast Surg. 2007 Sep-Oct;31(5):495-500. 
  4. Andrew William Johnson et al. The Role of Topical Brimonidine Tartrate Gel as a Novel Therapeutic Option for Persistent Facial Erythema Associated with Rosacea. Dermatol Ther (Heidelb). 2015 Sep; 5(3): 171–181. 
  5. Yoon-Soo Cindy Bae-Harboe et al. Easy as PIE (Postinflammatory Erythema). J Clin Aesthet Dermatol. 2013 Sep; 6(9): 46–47. 
  6. Park KY et al. Comparison of fractional, nonablative, 1550-nm laser and 595-nm pulsed dye laser for the treatment of facial erythema resulting from acne: a split-face, evaluator-blinded, randomized pilot study. J Cosmet Laser Ther. 2014 Jun;16(3):120-3.  
  7. Glaich, A. S. et al. Fractional Photothermolysis for the Treatment of Postinflammatory Erythema Resulting from Acne Vulgaris. Dermatologic Surgery, 33(7), 842–846. 
  8. Min S et al. Fractional Microneedling Radiofrequency Treatment for Acne-related Post-inflammatory Erythema. Acta Derm Venereol. 2016 Jan;96(1):87-91. 
Consult Doctor
0 524 views 0 Doctors agree 17 Sep 2018

Dear Lynette

Sorry to hear that you are troubled with post acne red marks. Laser is indeed the best way of removing these marks.

We usually use the pulsed dye laser (VBEAM) as it is excellent in shutting down the blood vessels and resulting in fading even after 1-3 sessions.

In terms of topicals, we usually advise patients to practice strict sun protection and apply sunscreen daily as well as to reduce sun exposure as much as possible. As long as there are no new active acne forming, these marks will usually fade gradually over time. 

Hope this helps!

Warm regards

Dr Stephanie Ho, Dermatologist 

Consult Doctor
0 540 views 0 Doctors agree 17 Sep 2018
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