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How is post-inflammatory pigmentation treated?

Q: I am a 38 years old woman having dark facial skin as compared to the neck. I underwent treatment for the same for 6 months. The doctor said it was hyperpigmentation and acne problem as I developed black spots after pimples. The treatment was going well with some positive results but then I developed allergic reactions. Earlier, my skin was extra oily for which, I took treatment but then lots of rashes developed with burning and itching followed by acne and the skin again started becoming dark. The doctor stopped treatment saying that I was allergic. Is there any solution? I am using Sunban Forte with SPF 50. I was undergoing Microderma treatment of skin whitening with AHA.

A:Your entire problem is Post-inflammatory pigmentation (PIH), which is discoloration of the skin at the site of a healed or healing inflamed acne lesion. It occurs more frequently in darker-skinned people, but occasionally is seen in people with white skin. Early treatment by a dermatologist may minimize the development of post-inflammatory pigmentation. Some post-inflammatory pigmentation may persist for up to 18 months, especially with excessive sun exposure. Chemical peeling may hasten the disappearance of post-inflammatory pigmentation. Generally the deeper the original acne lesion or more prolonged the infection, the darker the resulting PIH. The darker the PIH the longer it will take to fade. Manage and prevent acne from forming. Do not touch or pick acne lesions as this can worsen infection and inflammation. Topical treatment for PIH With all topical and laser treatments for PIH there is some risk of causing new outbreaks, new pigmentation problems and possibly even new scarring. Risk of these occurrences will probably grow with increasing strength or invasiveness of topical or laser procedures. Some treatments are NOT suitable for people with active acne, sensitive skin or darker skin tones. One should investigate and weigh possible side effects against possible benefits. And discuss with your dermatologist or doctor. There is no single treatment that works for everyone. The effectiveness of each treatment varies and treatments may have to be used in conjunction with each other. Ultra Violet light can cause hyper-pigmented areas to darken further and thus prolong them. Use non-comedogenic facial moisturisers or facial sunscreens, which contain a high SPF of at least 15+. Typically treatments for PIH are bleach pigment or block pigment formation or accelerate the rate of exfoliation or a combination. Many new generation topical treatments combine several agents from the list above in a single topical preparation i.e. Triluma, Paulas Choice Clearly Remarkable Skin Lightening. A topical approach usually prescribed by dermatologists is a Retinoid (i.e. Retin-A) & Hydroquinone. Non-topical treatments for PIH Some non-ablative lasers are being marketed specifically for treating pigmentation problems. These treatments may be unsuitable for people who suffer from active acne. Be aware that laser treatment is generally expensive and carries a risk of causing new acne, PIH and scarring. We recommend that you research options through and discuss with your doctor or dermatologist. Results and times will vary widely from one person to the next and from one treatment type to the next. As a very general guide for topical PIH treatments. Preventing the formation of inflammatory acne will prevent the formation of PIH. Some topical treatments have attributes, which mean they can help active acne and PIH...particularly topical retinoids, Azelaic Acid, BHA (aka salicylic acid), and some AHAs. There are some potential negative interactions between PIH treatments and other conventional Acne medications (e.g. Retinoids and Benzoyl Peroxide, Hydroquinone and Benzoyl Peroxide). Generally invasive peels or procedures are NOT appropriate for people who still have active acne. People with darker skin tones have a greater predisposition to experience PIH. They are also at a greater risk of reacting adversely to agressive treatments with further pigmentation problems. Treatments typically sited by users and dermatologists as being well tolerated are Mandelic Acid, Lactic Acid, Hydroquinone, and combination topicals like Triluma. Some topicals for PIH can be irritating for people with sensitive skin typically those sited by users as causing irritation are Topical Retinoids, Glycolic acid, TCA. Some topicals for PIH typically sited by users as less irritating are Lactic Acid, Salicylic Acid.

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