We have many techniques to deal with postinflammatory hyperpigmentation (PIH). The most important treatment for PIH is prevention and treatment of the underlying inflammatory skin condition (e.g. ‘Treatment of melisma using kojic acid in a gel containing hydroquinone and glycolic acid’. … Jimbow, K., Obata, H., Pathak, M. & Fitzpatrick, T. (1974). That brings us on to our next topical treatment for PIH – retinoids. She has experience in plastic and reconstructive surgery, dermatology, and aesthetics and has received training in laser treatments. In fact, it is well known that daily sunscreen use prevents hyperpigmentation from worsening and it is included in the treatment protocols for most hyperpigmentation disorders, While hydroquinone is an effective treatment on its own with good to excellent results, The most extensively used hydroquinone combination therapy for PIH and melasma is known as the Kligman formula – a combination of 5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone (a corticosteroid). What are the treatment options for post-inflammatory hyperpigmentation? For example, 0.1% adapalene gel improved PIH after 12 weeks of use in a study of 65 acne patients [15]. Espinal-Perez, L., Moncada, B. ‘Post inflammatory hyperpigmentation: etiologic and therapeutic considerations’. Adverse events from all treatments tend to be mild, and mainly consist of skin irritation, dryness, burning, erythema, and post-inflammatory hyperpigmentation. (2004). Hydroquinone is a widely used treatment for PIH. Research also suggests that niacinamide interferes with the cell signaling pathways between keratinocytes and melanocytes [23]. Hydroquinone can potentially be irritating if applied to fragile skin. PIE is in the process of becoming the new terminology used to describe pink to red discoloration after an inflammatory … … This website is intended for informational and/or educational purposes only. In other studies, 20% azelaic acid was as effective as [21]or better than [22]2% hydroquinone at reducing hyperpigmentation. However, postinflammatory erythema (PIE), the erythematous scars often seen in acne and other inflammatory skin conditions, is not well understood. Others like Hydroquinone or other Tyrosinase-Inhibitors and Licorice Root Extract are aimed at treating PIH and will not help much with the erythema aspect. ‘A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma’. Lacz, N., Vafaie, J., Kihiczak, N. et al. : How … laser treatments and chemical peels) [1][2]. "I have post inflammatory erythema from healed acne (red marks). ‘A multicentre, 12-week, phase 3b trial: A combination solution of mequinol 2%/tretinoin 0.01% vs hydroquinone 4% cream in the treatment of mild to moderate postinflammatory hyperpigmentation’. There are treatments for PIH in our armamentarium – such as microdermabrasion, chemical peels, hydroquinone, and vitamin C – that inhibit melanogenesis and blend the skin discoloration. to describe erythema often seen after the resolution of inflammatory acne or other inflammatory skin conditions.1 It is not to be confused with the erythema and telangiectasias seen in erythematotelangiectatic rosacea, which is a separate entity. https://www.ncbi.nlm.nih.gov/pubmed/21348540?dopt=Abstract, https://www.ncbi.nlm.nih.gov/pubmed/20725554?dopt=Abstract, https://www.ncbi.nlm.nih.gov/pubmed/15117368?dopt=Abstract, https://www.ncbi.nlm.nih.gov/pubmed/17075653, https://www.ncbi.nlm.nih.gov/pubmed/19706225, https://www.ncbi.nlm.nih.gov/pubmed/9125764, https://www.sciencedirect.com/science/article/pii/S0022202X15442642, https://www.tandfonline.com/doi/abs/10.1080/09546630050517333, https://link.springer.com/article/10.2165/00044011-199500102-00008, https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-4632.2004.02134.x, https://www.ncbi.nlm.nih.gov/pubmed/18491487, https://www.researchgate.net/publication/22035454_A_new_formula_for_depigmenting_skin, https://pdfs.semanticscholar.org/993b/e26e161fbda07b0e256e4281950295f9a661.pdf, https://www.nejm.org/doi/full/10.1056/NEJM199305203282002, https://www.ncbi.nlm.nih.gov/pubmed/11845948, https://pdfs.semanticscholar.org/5336/b801312e1862b22df52c682c5f7ed97db1be.pdf, https://www.ncbi.nlm.nih.gov/pubmed/26578346, https://www.skintherapyletter.com/hyperpigmentation/topical-agents/, https://www.ncbi.nlm.nih.gov/pubmed/9829446, https://www.ncbi.nlm.nih.gov/pubmed/9829447, https://www.ncbi.nlm.nih.gov/pubmed/1816137, https://www.ncbi.nlm.nih.gov/pubmed/2528260, https://www.ncbi.nlm.nih.gov/pubmed/12100180, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-2494.2004.00228.x, https://www.hindawi.com/journals/drp/2011/379173/cta/, https://www.ncbi.nlm.nih.gov/pubmed/8543691/, https://www.ncbi.nlm.nih.gov/pubmed/15304189/, https://www.ncbi.nlm.nih.gov/pubmed/18045355/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605218/#B3, https://www.ncbi.nlm.nih.gov/pubmed/17348991, https://www.researchgate.net/publication/292812801_A_multicenter_12-week_phase_3b_trial_A_combination_solution_of_mequinol_2tretinoin_001_vs_hydroquinone_4_cream_in_the_treatment_of_mild_to_moderate_postinflammatory_hyperpigmentation, https://www.ncbi.nlm.nih.gov/pubmed/10417583, https://www.ncbi.nlm.nih.gov/pubmed/16026582, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412432/, https://www.ncbi.nlm.nih.gov/pubmed/29734525, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047947/, https://www.sciencedirect.com/science/article/pii/S0923181104000982, https://www.ncbi.nlm.nih.gov/pubmed/14756523/, https://jamanetwork.com/journals/jamadermatology/article-abstract/557798, https://www.ncbi.nlm.nih.gov/pubmed/9145958, https://www.ncbi.nlm.nih.gov/pubmed/26859648, https://www.ncbi.nlm.nih.gov/pubmed/29663438, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-4725.1996.tb00345.x, https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1524-4725.1999.08236.x. Sunscreen that is SPF 30 or higher, broad spectrum and ideally mineral is … Lim, J. Post Inflammatory Hyper-pigmentation, or PIH, is the medical term given to discoloration of the skin that follows an inflammatory wound. However, retinoids can also be effective when used on their own. ‘An open-label study of the efficacy and tolerability of microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants for the treatment of hyperpigmentation’. This prevents the conversion of dihydroxyphenylalanine (DOPA) to melanin [1]. This process would usually take approximately 4 weeks [38]. & Willis, I. And because it has a larger molecular size than most AHAs, it’s absorbed more slowly by the skin and won’t trigger post-inflammatory … Is Post-Inflammatory Hyperpigmentation Permanent Or Does Post Inflammatory Hyperpigmentation Go Away? As azelaic acid inhibits tyrosinase, as well as inhibiting DNA synthesis of abnormal melanocytes, it can also be an effective treatment for PIH [18]. In human (in vivo) studies, niacinamide has demonstrated effectiveness at preventing pigmentation and reducing existing pigmentation. Niacinamide and Hyaluronic Acid Together = Super Skin Hydration. This study concluded that 0.1% tretinoin can speed up the resolution of PIH and, once cleared, this PIH did not return once treatment was stopped [14]. Halder, R. & Richards, G. (2004). ‘Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin’. 1 It is not to be confused with the erythema … But are topical products enough to treat PIE? Dr. Talakoub and Dr. Wesley are co-contributors to this column. All subjects were supplied with SPF15 sunscreen to be applied daily and were instructed to avoid excessive exposure to sunlight, wind, and cold. In order to provide stability and permeability, L-ascorbic acid should have a pH of less than 3.5 and works best at concentrations of 8-20%, Mequinol is a derivative of hydroquinone that may inhibit tyrosinase and melanin production, Kojic Acid is a potent tyrosinase inhibitor that is effective at reducing pigmentation when combined with glycolic acid and/or hydroquinone, Arbutin is a naturally occurring derivative of hydroquinone that is extracted from the dried leaves of various fruit plants. Hydroquinone is a fading cream that treats brown discoloration. The first step toward getting rid of PIH involves treating the underlying inflammation (e.g. PIH predominantly affects darker skin types (Fitzpatrick III-VI) in the same location that the inflammation occurred. For example, one study found that 5% niacinamide prevented seasonal-induced increases in pigmentation when used twice daily for 12 weeks [24]. ‘Comparative evaluation of efficacy and tolerability of glycolic acid, mandelic acid, and phytic acid combination peels in melasma’. PIH occurs as a result of injury to the skin or inflammation causing an increase in the production of pigment. As well as inhibiting tyrosinase, some research suggests that hydroquinone may interfere with DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) synthesis, destroy melanocytes, and degrade melanosomes [7]. Bisset, D., Miyamoto, K., Sun, P., Li, J. This study concluded that 0.1% tretinoin can speed up the resolution of PIH and, once cleared, this PIH did not return once treatment was stopped, Synthetic retinoids, such as adapalene and tazarotene, have also demonstrated effectiveness as treatments for PIH. In this installation of our Summer Skin Care Series, we are covering the other type of hyperpigmentation: post-inflammatory erythema, otherwise known as PIE. (2001). I look forward to reading more of your articles. Garcia, B.   It's available over the counter in 1 percent to 2 percent strengths, and in 3 percent to 4 percent prescription creams. Research has demonstrated that vitamin C can also inhibit tyrosinase, thereby decreasing melanin production and reducing PIH [26]. In addition, at the end of the 8-week treatment period, 70% of patients in the ‘triple-combination’ group saw a reduction in their pigmentation of at least 75%. Hydroxy acids generally fall into three main categories; alpha-hydroxy acids (AHAs; e.g. You can do this by applying cold compresses or smoothing over … It acts as a tyrosinase inhibitor and prevents the maturation of melanosomes, Licorice Extract contains several active agents that inhibit tyrosinase, including glabridin and licochalone, as well as liquiritin which reduces pigmentation by dispersing melanin, Soy proteins can reduce pigmentation by inhibiting the transfer of melanosomes from melanocytes to keratinocytes. Some other conditions can cause disruption to the basement membrane and allow melanin to fall into the dermis where it resides within macrophages, Although the exact mechanism behind this reaction to inflammation is unknown, it is thought that the melanocytes are responding to the inflammatory mediators and reactive oxygen species (ROS) that are released during the inflammatory process, While post inflammatory hyperpigmentation can eventually resolve on its own, it can take months to years to fade when its limited to the epidermis and can be permanent if present in the deeper dermis, The most important treatment for PIH is prevention and treatment of the underlying inflammatory skin condition (e.g. Stiller, M., Bartolone, J., Stern, R. et al. Hydroxy acids can speed-up the resolution of PIH and other pigmentary disorders by increasing skin cell turnover [37]. (2002). It’s a melanin inhibitor and natural brightener. Basically, retinol is less irritating and less likely to cause irritation, but it’s going to take longer to see the effects. J Clin Aesthet Dermatol. For example, by avoiding picking, scratching, and rubbing at the skin and, For epidermal hyperpigmentation, such as PIH after acne, there are a variety of topical lightening treatments available as well as chemical peeling and laser treatments. 2012;92(3):232–235. More recently, the hydroquinone + retinoid + steroid formula has been adapted with different concentrations of ingredients and different steroids. Hyperpigmentation is the term most people would use to describe their post-pimple marks, but there are actually two different types of spots: Post-inflammatory Hyperpigmentation (PIH) and Post-inflammatory Erythema … & Castanedo-Cazares, J. Erythema was the most common side effect, occurring only with hydroquinone. Copyright  © 2020 Frontline Medical Communications Inc., Parsippany, NJ, USA. 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