Which is the best laser for post-inflammatory erythema and redness?
Dear Doctors, I have a lot of post-inflammatory erythema (PIE) due to previous acne. I understand that long pulse visible light laser is good for PIE. What about BBL (BroadBand Light laser) or Pico? Which laser is the best for my post-inflammatory erythema, in terms of safety and efficacy?
PIE from previous acne can be treated by a wide range of lasers. This very recent review paper (Light-based devices in the treatment of cutaneous vascularlesions: An updated review) shows a compilation of more than 50 clinical papers of the options to treat vascular skin lesions. I shall summarize their findings below.
Long pulse visible light options like KTP (green) or CB/PDL (yellow) are extremely useful, with the yellow light options having most affinity to "redness" and more suitable for darker Asian skin types - still the GOLD STANDARD for treatment. Additionally, certain infrared wavelengths and even fractional technology can help with undulating scars together with the PIE.
IPL can be useful too, but is less suitable for darker Asian skin types because of range of wavelengths used in each filter encompasses wavelengths that are very readily absorbed by melanin. BBLs are an upgraded version of IPL, but are still less efficacious than the gold standard of vascular lasers. IPLs/BBL have a fair amount of literature supporting their use (5 clinical papers in the above mentioned article) and should be considered in the more budget conscious and fairer skin type patient.
Picosecond lasers are useless for this (nano and sub-nanosecond pulse durations have very minimal absorption in blood and redness). In the above systematic review which looks carefully at all the evidence available, there is zero mention of any pico or nano second lasers that can help with post inflammatory erythema. The lasers and light (IPL) options stated in the paper all have pulse durations in the millisecond duration for a good reason.
The Fotona Starwalker is an exception because it has a true Long-pulse and true Picosecond function within its platform.
Make sure you use sunblock well over the PIE spots. That can lessen the subsequent UV damage and PIH to those areas. Sunblock is also very important while doing your laser treatments!
Thank you for your question. Post-inflammatory erythema (PIE) due to acne is very common and troubling for many patients.
To treat PIE, we need lasers that emit wavelengths to target Haemoglobin specifically.
This family of lasers are called Vascular Lasers.
Examples of Vascular lasers that are commonly used in Singapore to treat PIE include:
1. Pulsed dye lasers (VBeam, 595nm wavelength)
2. Gold-toning Q-switched Nd:YAG lasers (Lutronic Spectra XT, 595nm)
3. Copper Bromide laser (Pro Yellow, 577nm)
Apart from Vascular lasers, Fractional microneedling Radiofrequency (eg Infini/Intracel) is also shown to work for PIE by its anti-inflammatory and anti-angiogenetic properties.
As you can see, there are many different Vascular Lasers available in Singapore. All of them are safe and effective when used appropriately.
I personally use the "Gold toning" Q-switch Nd:YAG lasers for PIE. It is effective with minimal side-effects. Several sessions are encouraged for good results.
Hope that this helps!
Dr Justin Boey
Thank you for your query.
As my colleagues have expertly shared with you, allow me to summarise.
For red marks, stick to a vascular laser. Example is the V Beam.
Hope this helps.
Dr Daniel Chang