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(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
QUOTE
Before talking about scars, a word about spots that may look like scars but are not scars in the sense that a permanent change has occurred. Even though they are not true scars and disappear in time, they are visible and can cause embarrassment.
Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to "mark the spot" for up to 6 months. When the macule eventually disappears, no trace of it will remain—unlike a scar.
Post-inflammatory pigmentation 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.
Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to "mark the spot" for up to 6 months. When the macule eventually disappears, no trace of it will remain—unlike a scar.
Post-inflammatory pigmentation 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.
(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/index.php?showtopic=14887
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/index.php...=9443&hl=n-lite
· 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 ....
QUOTE
The treatment of PIH tends to be a difficult and prolonged process that often takes 6-12 months to achieve the desired results of depigmentation. Daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 15 or greater) is an essential part of any therapeutic regimen.
From: Post Inflammatory Hyperpigmentation http://www.emedicine.com/derm/topic876.htmIn 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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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
