Post Inflammatory Hyperpigmentation
(aka red marks, brown marks, purplish marks, macules, psuedo scars, fake scars, inflammatory pigmentation)

Disclaimer: The information below is provided as a courtesy to address general questions. As we are not medical professionals, we cannot be held responsible for the accuracy of this information. By reading this information, you agree not to hold us liable for any damages that may result in your use of this information. This information should not replace information that your Doctor, Dermatologist or Plastic Surgeon provides you.


Q: Are red/brown/purple marks scars?

No. Red marks left on the site of old acne lesions are usually temporary (see picture below). Red marks are simply a normal remnant of the skin’s inflammatory process - Post Inflammatory Hyperpigmentation (PIH). Pigmented areas will fade unassisted, though they can take up to 2 years to disappear.


A quote from SkincarePhysicians.com


(Please note - If treating acne scarring is of concern please also read FAQ on Scar Treatments)


Q: What causes PIH?

Inflammatory Acne lesions. 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.


Q: What can I do to prevent PIH?

Manage and prevent acne from forming. Do not touch or pick acne lesions as this can worsen infection and inflammation.


Q: What can I do to hasten the fading of PIH?

With all topical and laser treatments for PIH there is a some risk of causing new outbreaks, new pigmentation problems and possibly even new scarring. Risk of these occurences 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. You should investigate and weigh possible side effects against possible benefits. And discuss with your derm or doctor. There is no single treatment that works for everyone. The effectiveness of each treatments varies and treatments may have to be used in conjunction with each other.

If you are on Accutane you should not be using any topicals treatments except under the supervivion of your dermatologist.

Firstly - avoid sun exposure. 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+.


Topical Treatments for PIH

Typically treatments for PIH bleach pigment OR block pigment formation OR accelerate the rate of exfoliation OR a combination.

Bleachs pigment OR block pigment formation
Hydroquinone - works by inhibiting the enzyme (tyrosinase) which causes tanning/pigmentation
Kojic Acid – i.e. Vita K for Blotchy skin
Topical Retinoids – Tretinoin i.e: Retin A, Renova (It also stimulates faster cell proliferation and has been clinically proven to be an effective acne treatment)
Azeliac Acid (It also stimulates faster cell proliferation and has been clinically proven to be an effective acne treatment)

Accelerate the rate of exfoliation.
The Tape Method of Exfoliation
The Vinegar Method of Exfoliation
Alpha Hydroxy Acid (i.e. Lactic Acid, Malic Acid, Fruit Enzyme etc.)
TCA (Trichloroacetic acid)
Beta Hydroxy Acid
Mandelic Acid

Many new generation topical treatments combine several agents from the list above in a single topical preparation i.e. TriLuma, Paula's Choice Clearly Remarkable Skin Lightening.

A topical approach usually prescribed by dermatologists is a Retinoid (i.e. Retin-A) & Hydroquinone.

If you want to research other peoples opinions or recommendations about topical PIH treatments and suppliers you could try the following links
http://www.acne.org/messageboard/Recommended-Products-R-t14887.html
http://www.acne.org/rate.php
http://www.makeupalley.com (registration required.)

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 recommed that you research options throughly and discuss with your Doctor or Dermatologist.

Here are examples and links to information about them:
· N-Lite: http://www.wrinklereduction.com
thread on acne.org: http://www.acne.org/messageboard/forums.html...=9443
· CoolTouch II: http://www.cooltouch.com/products.html
· IPL: http://www.intensepulselight.com/equipment.html
V Beam Pulse Dyed Dye Laser
http://www.candelalaser.com/vbeam/vb_home.asp


Q: How long does it take to see results from treatment?

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 ....
From: Post Inflammatory Hyperpigmentation http://www.emedicine.com/derm/topic876.htm

In the case of peels (i.e: lactic acid) visible improvement may occur within 4-6 applications (spaced at least a week apart).


Q: Who should be cautious about treating PIH?

PIH and active acne?
If you are on Accutane you should not be using any topicals treatments except under the supervision of your dermatologist.

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) Research otc topicals thoroughly and discuss your use/planned use of all prescription and otc topicals with your dermatologist or doctor. Generally invasive peels or procudures are NOT appropriate for people who still have active acne.

PIH and darker skin colours?
People with darker skin tones have a greater prediposition 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, combination topicals like TriLuma.

PIH and sensitive skin?
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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Before posting a new thread, please go to the top of this page try doing a Board Search it is very possible information you want is already here.
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Useful Links

Post Inflammatory Hyperpigmentation
http://www.emedicine.com/derm/topic876.htm

Acne Scarring - (Overview which explains the differences of PIH and Acne scars)
http://www.skincarephysicians.com/acnenet/scarring.html

Treating PIH in darker skin tones
http://www.dermatologytimes.com/dermatolog...l.jsp?id=124881
http://www.freep.com/news/health/mcare5_20041005.htm
http://www.cosmeticsurgery-news.com/article2009.html

Understanding Exfoliants
http://www.cosmeticscop.com/learn/pf.asp?ID=27

Skin Lightening
http://www.emedicine.com/derm/topic528.htm
http://www.cosmeticscop.com/learn/pf.asp?ID=25

Lasers
http://www.emedicine.com/derm/topic517.htm
http://www.cosmeticscop.com/learn/pf.asp?ID=19
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(Last edited by Rossignol, 6th February 2006 - updating content and editing information)
(Last edited by Rossignol, 5th August 2004 - pinned thread and added information.)
(Last edited by Rossignol, 8th August 2004 - added links for top products.)
(Last edited by Rossignol, 12th November 2004 - moved thread to red marks forum - I feel it is more appropriate here, as the products are typically more effective on red marks than actual scars)


This Thread details the (mainly topical) products that members of the board have found most effective in helping to reduce their red marks and improve overall skin condition. The list is not exhaustive, but most of the people posting have tried a huge amount of products, therefore these have been tried and tested!!!
To view people's actual product ratings, please look at the product rating section of acne.org - here is the link: http://www.acne.org/rate.php

To sum up, here are brief summaries of the top 5 products mentioned:

1.Puredeming Intense gel - a serum that is applied daily for approx. 1 hour, contains high quality natural ingredients that will improve skin condition and help with healing, in particular alpha lipoic acid and DMAE which have been cited as helping to reduce red marks and very shallow scarring. Available here: Puredeming
Here is a thread containing info about the intense gel: http://www.acne.org/messageboard/forums.html...topic=15937
2. Lactic acid peels - a relatively gentle form of AHA acid peel, which helps remove dead skin cells, thereby improving skin tone. They may, over time, help reduce very shallow scarring, and can be extremely effective on diminishing red marks. Available here Puredeming, and, for stronger versions, here: Logan wood skincare
Here is a thread containing useful info:http://www.acne.org/messageboard/forums.html...
3. Copper peptides products - help with skin healing and promote collagen production. Especially useful when combined with a procedure such as skin needling or microdermabrasion. There are several different varieties that vary in intensity, although the more intense versions can be more likely to cause acne breakouts. Available here: Skin Biology
Here is a thread containing more info: http://www.acne.org/messageboard/forums.html...copper+peptides
4= Emu oil - a natural oil extracted from the fat glands of emus that have been killed for their meat. It is, therefore a by product - emus are not killed to produce the oil. It contains high amounts of essential fatty acids and vitamin E and is therefore beneficial for skin healing. It is good as an overall moisturiser as it is very non-comedogenic. Has reduced redness in scars for some people. Also, it is a carrier oil and may increase efficiacy of other products such as BP and manuka oil when applied after these. - Available here: Ebay
Here is a thread: http://www.acne.org/messageboard/forums.html...topic=19181
4= Manuka Honey products - again, helps with skin healing and is very antibacterial and antifungal, therefore guarding against future breakouts. Manuka OIL is even more potent. Manuka honey and oil are both available in a variety of products but the one most highly recommended is Living nature's Manuka oil and honey gel. Available here: Living Nature and here: Comvita
5= Smoothbeam - not technically a 'product', it is a form of non-ablative laser which many members have undergone with moderate to excellent success. There is more information in the FAQ.
5= jojoba oil - like emu oil, a non-comedogenic natural moisturiser derived from the liquid wax of the jojoba nut. Contains high amounts of vitamin E, thereby beneficial for skin healing. It may help with healing red marks, but has very little effect on scarring, however.
5= C+C blackhead clearing scrub - helps exfoliate skin thereby improving skin texture and red marks. May, over time, help reduce some very shallow scarring.
5= TCA complex products - a more intense form of acid peel, TCA peels come with a significant downtime, unlike lactic acid or glycolic acid peels. However, they can be much more effective on red marks and shallow scarring. For deeper scarring, the CROSS method of applying 100% TCA can be effective. However, it is recommended that this is performed by a doctor. More information is contained in the FAQ.


Anyone else, feel free to add your favourite products to the thread!

It is unlikely that these products will completely clear your scarring, but they may help improve your skin condition and your overall complexion, helping with skin healing, reduction of inflammation and minimization of light scarring.

/ EDIT







As the year draws to a close i thought we could type down what products we have found this year and rate the best ones.

Here's my small list:

1. PureDeming Intense Gel
2. Bio Oil. Here is some more info about this product: http://www.acne.org/messageboard/forums.html...topic=19108
3. PEL Super Rich Moisturizer
4. Cetaphil cleansing wash
5. Calendulis Plus cream

Hey guys and girls,

This article has a good summary of what really works for red marks. I advise each one of you to read it for more information: http://www.associatedcontent.com/article/2...gmentation.html

I've had these red marks for several months and they aren't fading at all. I'm very concerned and I'm afraid they'll be like this forever. I have been applying aloe vera gel daily to them and have seen no progress. At this point I don't even know what to do, but I feel so depressed about the fact that my skin doesn't even heal normally for some reason. Leaving it alone isn't going to do anything, trust me, I've tried it. So, what am I supposed to do? They look awful and I want them gone...

http://img94.imageshack.us/img94/8742/042km.jpg

So yeah, I had a pimple right in the middle of my face, about 5 inches under my left eye a couple weeks ago. It went away, but now I have a mark there. This is an annoying place, as its right in the spot where people look at you. So, My body pretty much heals HORRIBLY and will take like 6 months for the reddish-brownish spot to even begin to go away. I have two questions:

I'm a male with a pretty ligh skin tone. Not white, but not that dark either, fairly white but tanned a little bit. This mark is hurting my self-esteem. Do you guys know of any of the best kind of makeups or whatever to cover this mark without interacting with regimen? Basically something I can just put to hide the red-brown mark even a little!

My 2nd part is what would you guys reccomend to take or to put on the mark to make it go away a little faster. Keep in mind I do the regimen everyday to prevent new ones from forming.

THANKS GUYS

Does anyone know if the marks i have are gonna be permanent? i had these before around 3 years ago and i took antibiotics and they all went away. Now they came back stronger and i still have active acne on my face along with tons of red marks. I have no indentions in my skin when i look at it with light, but just alot alot of red tiny marks and big ones. I am out in the sun alot cause im in sports does anyone know if it is permanent or will go away with time? thank you so much.

can anybody tell from the pictures if i have actual scarring or just post-inflammatory hyperpigmentation?


as well, in the morning after i wake up, my face looks a lot less red and the tone matches far more than it does in the photo (taken about an hour after the night's face wash), why is this?

the second i wash my face (day or night), my cheeks are red as if i was slapping myself. i do not scrub or apply lots of pressure, i gently massage the soap into my face.. i use the same amount of pressure on my forehead as i do my cheeks, but my forehead is NEVER red.

most of my acne is on my cheeks. i do get the occasional zit on my forehead, but not very often.

ive been using desert essence tea tree oil for about 4 days now in clearing up my acne. i put a few drops in my cleanser and moisturizer and dab some on active acne. it seems to have dried up some of the active bumps i have and since ive been suffering from moderate acne for a few months now (something im not used to) i obviously have some hyperpigmentation. its worse on my right side than my left and i know with time itll eventually fade, but does anyone know if TTO helps speed up the process?

I'd just like to let you guys know about something I tried for red marks and minor scarring that did not work for me in any way whatsoever. I purchased a 15% TCA peel kit from Makeup Artist's Choice and did the peel 8 days ago. When I did the peel, I had one tiny pimple, due to hormones. I took Accutane 5 years ago, so I generally have a clear face. However, 8 days after the peel I have 14 pimples on my face.

After the peel, my skin looked like an 80 year olds for about 3 days. During that 3 day period, I could see some new red marks underneath the layer of dead skin on my face. It was gross. Those red marks turned into bumps and as the skin finally sloughed off, I ended up with worse skin than I've had in years. It's embarrassing. The pimples are bright red and scattered all over my face. There are about 6 on my left cheek, 3 on my right cheek, 3 on my chin, and 2 on my forehead. My forehead NEVER breaks out. Even when I had very bad acne, I did not have anything on my forehead. I can't believe this peel has made me breakout so bad. For the record, this is the only new thing I've done to my face. All of my skincare and makeup has stayed the same, so I cannot attribute the breakouts to anything else.

I'm so mad at myself for doing the peel at home, but I had read so many other good reviews about people who have had much success with the home peel and I thought it would be safe. I honestly think it's an allergic reaction, because I did take Accutane (which has kept my blemishes away very nicely) and because I exfoliate regularly, and I use a Clarisonic nightly. I told my nurse friend about this over the phone (she lives across the country, so I couldn't show her my problem face) and she said that she too thought it was an allergic reaction due to the fact that I exfoliate regularly so there shouldn't have been a lot "to bring to the surface," as most skin usually purges.

I just wanted to throw in my 2 cents about this. It might work for older women and men who are looking to even their skin out (I'm only 28), but for me, it was too harsh for my skin and did more damage than good. Now, I have to figure out how to rid myself of all these pimples again. It's so terrible to look in the mirror and know you caused the acne you're seeing. I'm so angry with myself!!

I've been struggling with acne marks for FOREVER and a day. No matter what I do, I seem to get marks. I broke out quite badly a few months ago for some reason, and now have even more than usual that are very red. It's hard to cover them up with makeup. I'm currently using vitamin e on them at night, but I'm not seeing great results. I might try Bio Oil again, although I didn't think that worked great either.

I have never been to a dermatologist. I have combination skin - sensitive, dry, quite oily. And I break out quite frequently mo matter what I do. Even mild pimples seem to be leaving marks these days.

I'm wondering if it's worth going to a dermatologist. I've heard mixed opinions. Some people say they can't really do much - that you're better off just getting over the counter products. I certainly don't want to be put on any pills. I have a number of health problems, and I'm already on a bunch of pills...

What do you think?

Also, what's a really good face cleanser for acne marks? Should I look for something with salicylic acid in it? I'm currently using eucerin redness relief cleanser, but it doesn't seem to be helping a lot with either my acne or my marks.

i thought i'd just throw my opinion out there, i suffered for red marks for 2-3yrs - only finished accutane in 2008 which worked well, but left me with some nasty hyperpigmentation.

i looked everywhere, got advice from everyone, and tried loads of things:

- olive oil
- urine
- aqua glycolic
- lemon juice
- aha/bha
- green cream
- gamma hydroxy
- apple c vinegar
- various dermabrasion stuff
- baking soda
- lots of pills

last week i went for my 2nd (and last) chemical peel
all of my redness is 100% gone

i just want to let people like me know just dont waste your time
get out there and get a real treatment.

good luck to all

here are pics of my acne scars, i have a lot, all of them are a brown color.. the really dark one is a new scar that is like a week old. I think the pimple popped while I was sleeping and turned on it.. not sure.. I didn't know how it got that big though. The only red mark I have is from a pimple I put toothpaste on overnight and i guess the toothpaste got on my skin and burned it.. not using that stuff again..

But anyways, What kind of treatment is best for these kind of scars.. they are not red, but are brown.. Is bio oil worth giving a shot?

Also I am desperately in need of a new daily face wash and moisturizer, and some people say a toner is very good too. I figure that if I want to stop scars, I gotta have a daily regiment that I can use to prevent pimples. Currently I am using an Estee Lauder exfoliator followed by my Bump Fighter moisturizer. First, I rinse my face in lukewarm water, than rub the exfoliator on my face in gentle circles for a minute, then I rinse it off with lukewarm water, pat it dry with a towel and then apply the moisturizer. I do this in the morning and before I go to bed, but I am looking to buy a new and better mosturizer as well as a daily face wash.. does anyone have any recommendations for a good daily face cleanser + mostuirizer combo?

But at the same time I want to treat these acne scars!! Also, i should note that I just started using exfoliater and moisturizer, the exfoliater seems to work good but I think I should really get a better moisturizer..

Last night I decided to put toothpaste on 3 pimples that were emerging overnight. I woke up in the morning and rinsed my face and noticed 2 of the spots where the pimples were had these red burn marks. It sucks!!! I learned my lesson, toothpaste doesn't really help overnight and might only work if you only use it for maybe 10 minutes. When I applied I felt a little burning sensation but I didn't think it'd leave a ugly red mark.

Does anyone have any suggestions on how to get rid of the red marks, and also, is toothpaste safe to use on pimples if I only leave it on them for 10 minutes or so they dry up? This is how I did it before and I never got red marks like I did with leaving them overnight..

Besides using acv can i use normal white vinager or any other natural toner for red marks?

Hey!
I just wanted to let you all know... after you start using the acne.org system and your skin starts to clear you notice that a lot of the scarring starts to fade as well... Although it doesnt all go away. I tried using the Clinique Even Better Skin Tone Corrector and My face is almost back to not having any dark spots or scarring....
I would definitely suggest it and i have only been using it for about 3 weeks.
Give it a try! Ps if you use it and it doesnt work... you can return it!!!!!

Hi, I Have bought the Khiel's acne corrector and have been using it for a while but it doesn't work. I have the occasional acne and the best product if anyone is interested is the Dermalogica clearing gel worth $58.00 and is really worth it. The khiel is rubbish.

Ok well the only product that i've been using to help out with the pigmentation for my back and face is Alpha Hydroxy 8% which is the Wal-Greens brand....

BUT i just ordered AHA from acne.org which seems it has alot more benefits and is a much higher concentration...

So my question is....Should I expect the marks to fade faster by using Dans AHA product?

AND/OR what other products or natural remedies will aid in a FASTER healthy complexion??

Reason being I wanna be able to take off my shirt at the beach when spring break comes rolling in

If you have got red marks from acne scars or watever scars, even pitted scars try using 'Bio Oil' it has got the breakthrough ingredient 'Purcellin Oil'. I have been using this for about 2 months and have seen heaps of result, i had very red scars from large pimples and acne for years, now there fading very quickly, which is great! TRY IT!!
its only about $15 too!

www.bio-oil.info

i got this done about 4 days ago and only now am i experiencing the peeling and flaking, i have a big event coming up in about 3 days, will the flaking subside by then? sorry if this is the wrong forum

Im looking to buy one of those at home glycolic acid peels and looking for the best brand?

so ive been using stievamycin forte for a few months my acne
has cleared but ive been left with these red marks, should i continue using
my stievamycin or use something else?

does using potatoes on your skin really work to get rid of red marks or discoloration?

I was wondering if there were any store bought items that may reduce and heal red marks or scars that's reasonably priced and work well. Any suggestions?

I have nothing but red marks left, with only the occasional blemish. I will be doing a series of peels, but wonder what type of peels I should do? I am not going to be performing these myself, as I just don't trust myself enough and am willing to pay to have them done at a plastic surgery office I trust. My question though is should I do Glycolic Acid peels, or Salicylic Acid peels. The question is essentially AHA versus BHA peels. Which peel is better for red marks?

Right I have these persistant red marks that cover all of my cheeks, they have been there since I got off Roactatane back in June 2008.

I have tried nearly everything apart from Retin-A (I know I should try that, but I wont be able to take another major breakout, which happens in most cases), well anyways my mum is a beauty specialist and shes being giving me peels over the years etc.

Atm my mum has the Crystal Clear machine, which is the same as Microdermobrasion, so my question is does is get rid of the red marks (especially when flushing:().

1: I know that it leaves your face red for a couple of days, but helps it in the long run since it takes the top layers of your skin off.

2: How long about does your skin take to heal back to the way it was/or better than it was?

Thx 4 reading,

So I've been drinking Apple Cider everyday for the past two weeks. I'm not sure if it's because of this, but my marks have started fading and skin has started looking healthier.

I know a lot of people have had great results with ACV, so my question is - how different is ACV from Apple Cider? I read that people don't like drinking ACV - but just Apple Cider tastes great and I love drinking it.

Another question I have, which I've posted here before but got no response to, is regarding Salicylic acid. I've been using a Salicylic 2% wash morning/night for the past 4-5 months. I want to know if using it for so long might be bad for the skin in the long run? I want to switch to a regular milder face wash and would like some recommendations?

Thank you very much.

I've been using ACV as a toner at night but I think it's too strong. I'm thinking about trying Green Tea as I have a lot of it around anyway (I live off the stuff lol).

I'm reluctant to try anything which could clog pores as I've recently stopped getting any new spots.

So Ive had severe, dark red marks all over my face for about two years now with no signs of improvement and was looking at glycolic acid. My derm said the red marks were "vascular" whatever that means?? So would the glycolic acid still help me?

I stopped getting acne around 3 months ago. and i have been left with red marks.
Do you know how long it will take to get rid of it?

i somtiems use bio oil.

im currently taking half a tablet of sulfameth and using clindamycin phosphate.