When acne clears, spots sometimes appear on the skin where the acne once was. These spots may be pink, red, or purplish in people with lighter skin and tan to dark brown in people with darker skin. Pigmented scars are usually the result of prolonged inflammation which may happen with all acne but most commonly seen with nodular or cystic acne (the painful ‘bumps’ lying under the skin). Hyperpigmentation is described as areas of abnormal darkening of the skin. This darkening can either be one spot or large patchy areas, depending on the cause. This condition is a result of inflammation and can be triggered by sun exposure, hormone fluctuations or skin injuries (acne lesions, a cut or a burn). Some skin types are more susceptible to hyperpigmentation than others. It can usually be avoided, simply by minimizing irritation or inflammation of the nodule or cyst and having timely and appropriate medical treatment. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although can last indefinitely if untreated. It is important to consult with our physicians at Boston Acne Specialists prior to using products to even skin discoloration, as high percentages of strong ingredients can cause further irritation and a worsening of the condition instead of improvement.
What is Post-Inflammatory Hyperpigmentation?
Post-inflammatory hyperpigmentation is abnormal darkening of the skin resulting from over production of melanin and spillage of melanin from melanocytes to surrounding tissue as a result of injury or inflammation of the skin. The residual spot from acne can take months to go away on it’s own and can be very disfiguring. People with certain genetic background such as Africans, Asians or South Americans and Mediterraneans tend to be more prone to post-inflammatory hyperpigmentation. The reason is that they have more melanin in their skin. So individuals with darker eyes, darker hair or darker skin tones are more prone to hyperpigmentation.
How does one prevent hyperpigmentation?
First, do not irritate or pick at the acne. Second, do not go to a salon or esthetician for non-medical extractions, Chemical Peels, dermabrasion or any other skin trauma. You can apply cool pack or ice if acutely tender and inflamed. Based on the appearance of the acne, you may need a short course of antibiotics, medical extraction, intralesional steroid or Isolaz treatment. One of the things you can do is to use sunscreen everyday, and I encourage anybody with post-inflammatory hyperpigmentation to use sunscreen every single day even in the winter and cloudy days and make certain that you’re using and SPF of 30 and a broad spectrum sunscreen as well that blocks UVA as well as UVB rays. For people with tendency to hyperpigment, Dr. Ishoo recommends a low dose topical Hydroquinone ointment applied sparingly at nights while undergoing treatment for acne or acne scars.
How Do we Treat Post-Inflammatory Hyperpigmentation?
If the spots do not resolve on their own, they can be treated with topical skin products containing hydroquinone, chemical or LASER peels with Fraxel Repair or Fraxel Dual using the 1927 nm wavelength as well as Clear & Brilliant treatments over several months.
How do we Lighten up Post-Inflammatory Hyper-Pigmentation with Prescription Products?
We may approach the acute pigmentation with exfoliation. Alpha hydroxy acid also known as glycolic acid can be used very effectively to help even the skin tone. Boston Acne Specialists may also start you on specially formulated product containing prescription strength hydroquinone, which is a bleaching agent in conjunction with a retinoid, topical steroid and exfoliating acid. These ingredients work very well to blend in the post-inflammatory hyper-pigmentation and restore healthy skin.
What kind of chemical peels do we use to treat hyperpigmentation?
In our practice, we have had great success with the Vi Peel and Kojic and Mandelic acid.
What if you need more aggressive treatment for persistent hyperpigmentation?
In with persistent skin discoloration, the staff at Boston Acne Center is able to utilize a wide rage of LASERS from the Clear and Brilliant, to IPL, LASER Facials to Fraxel Dual with protocols designed for treating a range of pigmentation issues including Post-inflammatory hyperpigmentation from Acne, Rosacea and Melasma.