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Post-Inflammatory Hyperpigmentation Caused By Acne

Get Rid of Acne Post-Inflammatory Hyper-Pigmentation Effectively Now!

Dr Justin Boey reviews the causes and treatments for post-inflammatory hyper-pigmentation in Singapore.

What is Post-Inflammatory Hyperpigmentation (PIH)?

Post-inflammatory hyper-pigmentation (PIH) acne scars are brown dark spots on your skin due to inflamed skin wounds like acne or pimple spots. 

Other causes of post-inflammatory hyper-pigmentation include eczema, surgical scars and skin injury like scratching.

Another cause of PIH is unsuitable cosmetic procedures for your skin type (such as IPL).

Such treatments may worsen your skin condition and lead to post-inflammatory hyper-pigmentation.

What causes PIH?

Post Inflammatory Hyper-pigmentation is formed by alterations in normal pigmentation caused by skin inflammation, such as acne, dermatitis, insect bites, and such. Lesions also cause hyperpigmentation due to the fact that overproduction of melanin (skin’s natural pigment) is part of the healing process.

The appearance of these marks can be different depending on what caused it and on what area it is on. The pigmentation is usually darker than the normal skin tone. It may come out as a darker shade of brown, blue, and even grey. Commonly, they are flat, brown or black spots on the skin. It is because there is an increased production of melanin pigment due to an injury or inflammation to the skin.

Hyperpigmentation comes in different sizes – it may be rounded or patchy. What remains consistent is the differentiation of Post Inflammatory hyper-pigmentation from your normal skin color. 

hyperpigmentation melanin singapore

Acne Scars vs PIH vs PIE

Discuss the differences between acne scars, PIH, and post-inflammatory erythema (PIE)

There are two types of post-acne pigmentation. 

Post-inflammatory erythema: These are marks which are reddish in colour. They are caused by broken blood capillaries (small blood vessels) that have yet to heal at the site of acne lesion. 

Post-inflammatory hyperpigmentation: These are marks which are dark brown in colour. They are caused by an overproduction of melanin. The over-production of melanin is a reaction to skin inflammation at the affected area.

Does PIH go away over time?

Yes, PIH fades over several months, especially if there is no future breakouts or cystic acne. For patient with darker skin tones, PIH can take longer to fade.

How to prevent PIH?

The best way to prevent post inflammatory hyperpigmentation (PIH) is to minimise active acne so that you can achieve more even toned skin.

How to Treat PIH?

There are Home treatments and Clinic treatment options for PIH

At-Home

Salicylic Acid

Inflammation, like acne, can produce large amounts of melanin, which leads to pigmentation. Salicylic acid is a beta-hydroxy acid that is commonly used to treat acne but is also a pigmentation fighter. It has an exfoliating effect to get rid of pigmented dead skin cells as well as renew old skin.

This also has antibacterial properties. This also has the ability to slow down or stop the formation of melanin. Patients with lighter skin types can also benefit.

Glycolic Acid

This alpha hydroxy acid is found in sugarcane, which helps breakdown melanin and promotes collagen production. It’s included in several cosmetic products from over the counter creams to medical-grade facial peels.

The chemical reacts by penetrating the skin’s outer layers, breaking apart dead cells, and allowing new, healthier skin to come to the surface.

Glycolic acid simply helps with peeling off dark marks and in revealing lighter skin. Being an all-natural chemical exfoliant, it is considered safe even for dark-skinned individuals to help get rid of hyperpigmentation.

Azelaic Acid

Azelaic Acid is a natural skin brightener that is comparable to the activity of 4% hydroquinone when it’s in a 20% concentration. It is originally used for treating acne; however, it is also used nowadays to fight post inflammatory hyperpigmentation because of its skin lightening pigmentation side effect.

Azelaic works by stopping melanocytes growth that leads to or worsens pigmentations. It is also an antibacterial and anti-inflammatory ingredient, which is why it’s effective for acne and rosacea.

Other useful topical medications include kojic acid, topical retinoids, hyaluronic acid, vitamin c serum, alpha hydroxy acids, licorice root extract, green tea and lactic acid.

Hydroquinone

This ingredient found in effective Pigmentation Topical Creams acts as a bleaching agent which lightens any dark spots to achieve lighter skin tones. It works by reducing the number of melanocytes which are responsible for the production of melanin (skin’s natural pigment). Tri-Luma is one topical cream that contains potent ingredients and 4% of hydroquinone.

When using these creams to reduce melanin production as part of your skincare routine, remember to wear sunscreen and use daily sun protection to minimise UV radiation (UV rays).

Clinical

Chemical Peels

This treatment usually use glycolic acid or salicylic acid. This helps resurface the upper layers of the skin to reveal healthier, lighter skin. It is effective for cell turnover and improving the appearance of the skin.

There are different types of chemical peels: superficial, medium, and deep. Superficial peels only target the outermost layer of the skin, which is the epidermis. Medium-depth peels are effective for age spots, actinic keratoses, and freckles while deep peels are the aggressive type and can penetrate deep into the skin.

 This treatment works by reacting to the upper layers of the skin and dissolving damaged or pigmented skin cells, revealing healthier skin from underneath. Patients may experience a tingling sensation during the treatment but will subside once the solution has been neutralized. Deeper peels may require some numbing cream as it works deeper into the skin and is more active. 

Chemical peels for hyperpigmentation in Singapore is priced from $150.

Microneedling

Microneedling with Radiofrequency improves cell renewal. It improves skin tones, strengthens the skin barrier and helps to treat post inflammatory erythema (also known as post inflammatory erythema pie) and postinflammatory hyperpigmentation (PIH).

PIE and PIH are commonly acne marks that are a result of acne breakouts (medically known as acne vulgaris). This can be worsened by sun exposure as the skin damage will result in brown marks (brown spots) and red marks that persist.

This laser therapy can also be used with Pico Laser treatments to treat acne induced pih, treat PIE, improve atrophic scarring and smoothen skin texture.

Picolaser

Pico Laser works by breaking down excess melanin so the skin would easily absorb and clear away pigmented areas. It is a safer procedure compared to traditional lasers as it uses ultra-short 450 picoseconds, which means the skin is exposed to less heat. 

The high power and ultrashort pulse duration used is what breaks pigments into smaller fragments. This means fewer treatments sessions as the procedure makes it faster for pigmentations to clear up compared to other treatments.

Pico Laser works 90% better and more effectively with treatments mentioned above. 5-10 treatments may be required to help you get rid of your targeted pigmentation.

As with any treatments, Pico Laser comes with minimal side effects such as mild itchiness or a pinkish flush, but this goes away within a few hours. During the procedure, tiny warm pricks may be felt, but most patients can tolerate it.

After a Pico Laser Treatment, you can immediately get back to work – but it is advised not to stay under the sun for too long to avoid hyperpigmentation.

traditional lasers vs picoplus

When Pico Laser is combined with the other treatments mentioned above, more than 90% improvement of your dark spots can be expected.

Price of Pico Laser for Hyperpigmentation in Singapore: From $150.

As non-invasive in office treatments, this anti-inflammatory treatment with minimal downtime is suitable for asian patients who have PIE and PIH as well as patients who have darker skin types.

Conclusion

There are many options for treating PIH caused by Acne. For best results, it is essential to speak to an expert.

Author

Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.