Post Inflammatory Erythema?

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Hey,

I've been doing a lot of research about post inflammatory hyperpigmentation (pih) recently, because like many of you, I have had red marks that vary from pink to purple to bright red, and have had them for almost 2 years. Upon doing some research, I came across various websites explaining that PIH tends to NOT actually be red or pink in colour, but actually light brown to black. I found several sites indicating that these red/pink marks are actually another inflammatory response of the skin called post inflammatory erythema. This makes a little more sense, because it's probably why my derm initially prescribed by hydroquinone, which is mostly for brown spots, and only seemed to make my red marks much worse (this was over a year ago).

Some of you may be aware that I have been getting V-Beam treatments for my red marks (just got my second one yesterday), because I believe it may be a more vascular issue (simply because they are faint when I take cold showers or red when slightly irritated). My derm that I am currently seeing even told me that PIH tends to be brown in colour, and seemed to agree that what gives redness to my marks is probably blood vessels.

Surprisingly enough, I can't seem to find much info about PIE online, so I was wondering what you guys know about it. Am I on the right track... am I making any sense? Does PIE have to be treated differently then PIH and is V-Beam any help? Kind of hoping to make this a good place for people to better understand the difference, including myself.

Thanks

Edited by jamesy90

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You're defo on the right track! PIH is very very different to PIE's (haha Pie! sorry) and is a result of melanin in the skin hence the dark brown-ish colour while erythemas are blood vessel-related to the best of my knowledge. I don't really know their exact mechanism but I'm working on that. There defo is a lack of info on post-inflammatory erythemas online. I'll be watching this thread - hopefully it'll result in a wealth of information :D

I'm sure they do have to be treated differently because it seems very illogical to reduce blood vessel dilations the same way as melanin. The PIHs are actually pigmented while the erythemas are just a result of dilated under the skin blood vessels wth the red blood cells showing their colour through the skin. Whenever I google treatments for erythemas the same treatments for PIH come up and that really doesn't seem right!

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Wow! Thanks for the quick response! That's why I love this site lol

Anyways I mean I don't want to jump to conclusions, but my derm said V-Beam is not used for PIH, so people on here getting V-Beam for their red marks (thinking it's PIH) and having it fade their marks are actually perhaps suffering from PIE instead. All I know for a fact is that some days, if I take an icy cold shower, hit my face with freezing water, and step out, my red marks look so faint (like super light pink/purple) that I feel good. Then, on the complete other extreme... if I shave, it irritates them, and I can litterally stand in front of the mirror and watch them get redder and redder, so it must be blood vessel related. Hoping this thread helps answer all our questions.


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That is exactly how my red marks are! I always blast myself with cold water right before I get out of the shower or splash my face at the sink so they're less obvious. And when I exfoliate they become more pronounced... I actually just mentioned in my log that I have a big cyst that looks blood-filled as far as I can tell and the erythemas around my cheek where it is are all but gone. It could just be coincidence, or that the cyst is so noticeable my red marks have just kind of faded into the background, or it could be that the cyst has drained blood from the surrounding area and lightened them! We shall see...

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Yep. I mean, melanin is one thing, but I know it doesn't change colour in an hour. If you have a brown spot on your skin, squeeze it and you'll see it doesn't get any fainter, so, I'm pretty sure our red marks have a lot to do with the blood flow under them. It all adds up, cold water, blood vessels shrink, spots fade, warm water, blood vessels expand, well you get it... also I think I remember asking my derm "can the skin make pink or red melanin?" and I'm pretty sure he said no, so as far as I know the only thing that can make skin look redder is blood underneath.

That's why I am going for V-beam. The first treatment didn't change much, but then right towards the end of a month later I noticed one my mark was fainter than ever and the other one maybe slightly better, but then I shaved and it went back to the way it was and didn't return to that good state even hours later and after a cold shower, so I really don't know what to expect. I had my second treatment monday, was more intense, try to follow my posts around here cause I'll let you know how it goes.


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All of the spots that I have left over from when my acne was moderate have faded very light, but are still noticeable, especially when I take a hot shower or exfoliate, or put anything semi-irritating on my face. Mine turn red- then light pink. I don't think I have ever had a brown or black spot left over, and have never heard of Post Inflammatory Erythema. But my marks seem to be fading and hopefully go away altogether. I don't think I have seen any white people with black or brown spots on their face, only ethnic peoples. Unless a spot turns into a scab, then I guess it's sort of brown?

Edited by Trae Michael

It is better to keep your mouth shut and appear stupid...than to open it and remove all doubt.---Mark Twain


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Err why you making it more confusing than it already is maann lol

I don't have spots really.....Like i can't go into the mirror and point out each little mark like some can. I have more of like patches of discolored skin , I wouldn't even say it's red...More light pinkish. In the worst lighting or mirror it looks horrible , Like the light from the sun or wherever makes it look shiny :ninja: Add to the fact that i'm pale as **** don't really help the cause.

But i don't want to get a tan and prolong the problem...Have to see if it can be fixed somewhat first.

Should i still look into the V Beam treatment ?

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Kraven...a tan will not "prolong" your problem. I have a gradual tanning lotion with SPF that moisturizes without clogging pores and protects me from the sun, and every time I put it on I slowly get tanner, it's great :D I still do it even after my pink spots disappeared


It is better to keep your mouth shut and appear stupid...than to open it and remove all doubt.---Mark Twain


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I don't have time to really research this right now but google "Fractional Photothermolysis" as it seems to be the only treatment that comes up for post-inflammatory erythemas!

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Interesting responses so far.

I find that the WORST thing about red marks is how often they change. If they just gradually lightened, but never got worse, like after shaving, then that would be fine. On days they look good you'd be happy because you'd find them acceptable and know it can only get better.

I hate never really knowing if you are free of them because I've had days where they are so light I feel they are just a few shades darker than the surrounding skin... like a very light pink, almost light brown in certain light, and then I will shave or something and it will get bright red. What depresses me even more is when they stay that way for hours after wards or even days. You wonder if you're red marks are actually improving or if you are just stuck in place.


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ive had red marks for about 2 years now and just this year realized that acv will get rid of new marks but only completey on areas other than my cheeks. the majority of my marks are on my cheeks and really havent changed much in years, but i never used sun screen or acv back then either. i have noticed to that after i sweat my marks seem less red. and they will gradually get pinkish or normal color.

i bought an aha gel though and i really hope itll help cause almost every month i get an addition to the collection even though my acnes definetely under control. the acv does seem to help newer marks though.

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Excerpt from wikipedia article:

start here:

http://en.wikipedia.org/wiki/Erythema

Erythema disappears on finger pressure (blanching), while purpura or bleeding in the skin and pigmentation do not.

does yours dissappear temporarily on finger pressure?

if so, you have Erythema so moving forward....

Erythema is caused by Hyperemia of the capillaries..

ok now we are almost there..

Hyperemia is a regulatory response, allowing change in blood supply to different tissues through Vasodilation.

one more...

Vasodilation refers to the widening of blood vessels. The process is essentially the opposite of Vasoconstriction, or the narrowing of blood vessels.

ah there we have it..the cause of the redness is Vasodilation due to your body reacting to some kind of trauma, your body will begin to Vasoconstrict as soon as it thinks the the healing is done!! The fact that your skin is still red after that long just tells me that your are a very strong healer and your body wont stop until all that is repaired. The fluctuations you see are this:

the cold water vasocontricts

the warm water vasodilates

look at this image here:

http://fitness.appstate.edu/images/filecab...er1/VasTone.jpg

want more specific? the redness you see is the "ends" of thousands of capillaries, the ends expand and contract and are known as "sphincters" you have them all over you skin it's just that in the presence of trauma your body will open up the ends (vasodilate) to allow more blood in for better healing..

there now you can stop wondering what the hell is going on

The razor making them redder is simply your bodies response of vasodilation due to what it perceives as "trauma" maybe try using a dry shaver instead of razors

Now, it is possible to induce Vasoconstriction temporarily as you have noticed through cold water, but we want the Vasoconstriction to be permanent.

If you read some of my posts, i have been doing experiments with saliva and skin scraped off the inside of my cheek with some success, but i have been in a battle to solve this problem for years as well even though my marks have long since faded i possess a smouldering anger for them for what they put me through and will not stop until i figure it out.


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Dude... that was... the BEST... most COMPLETE answer I've ever gotten on these boards.

Thank you so much

I always knew it was related to blood vessels because a) they we're pinkish/red and b) they changed so often. The word hyperpigmentation didn't make sense because my marks we're not brown and if you shave over a brown spot it does not turn darker brown lol.

This is why I have been getting V-Beam, because it's suppose to remove damaged blood vessels. Though I am two weeks into the healing from my second treatment and right now they look red and I'm just praying they return to ''normal'', I can't even pray for improvement right now.

So you're saying my body is having all this crazy blood vessel action in these spots because it is healing? I had the laser like 2 years ago... it's still healing? I find that hard to believe lol. Well more importantly, does this ever stop? I mean 2 years is quite awhile, do they ever gradually fade more?


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I had v-beam done about 4 years ago, that mark was exactly the same as what you describe on yourself. That mark is totally gone now and i can't see it even in direct sunlight and there is no scarring.

You must not take that scab off prematurely, if it takes 3 months to fall off on it's own than so be it

I know what you mean about the psychological aspect of it, always wondering whether its better or not. I noticed you said you check them everyday, you should really just check them like once a week because you will never notice 24 hrs of improvement anyways, and you are clearly driving yourself mad.


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i have a big mark like that which came from 3 cyst on the same spot so you can image the kind of trauma, anyways likewise my mark lightens and gets darker, ive noticed it gets darker when im flushing, washed my face or had a bath etc. though it returns tio somewhat normal pinkish colour again and even turns a kind of purple colour. though when i touch it its still there you know? whats this do you think? isit just normal hyperpigmentation? do you think the descriptions similar to yours?

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@ kamran

Yes man exactly the same. If I take a freezing cold shower the marks will be a light pink almost purple, and if I shave they will turn dark pink/red. After about an hour they return to normal, sometimes more sometimes less. Sometimes they stay like that for a bit or till I take another shower. And if I were to press down on my marks they would probably get a bit lighter but still be visible, and some days they seem lighter than others.

@bio_nerd

So you had V-Beam for your red marks? How long did you have them before you decided to get treatment? And is V-Beam what completely removed them (if so, after how many treatments)? I'm depressed now b/c it's hard to tell if these marks are fading (not just now after V-Beam, but in general, because they seem to change day to day). How many years did you deal with your red marks in total till they no longer bothered you anymore?

P.s. Sorry for the million questions lol


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i know theyre sooo frustrating and decieiving when i think its going it kind of comes back! :( anywaya ama be looking at diff treatments too. let me know how yours goes for you..

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I will. Today was a fuckin' shitty day, I had my first day of classes and obviously my red marks looked like shit (still red + very noticeable) so I had to slap on some make up to cover it. It looked fuckin' bad since the marks were red and though the make up covers the redness it didn't quite blend and I was afraid everyone could tell. I just wanted to be completely avoided today and I get there and one of my good friends is in the class so I had to talk but barely looked at them since they were to my left and that's where all my red marks are. I was fuckin' sweating cause I was nervous/uncomfortable and it was hot in there and since I walked in with like 2 minutes till class started everyone was already sitting and I felt they were staring at me. Horrible, horrible first day.

I look at some pics I took just before I got my second V-Beam treatment, and at the time I thought the redness was bad, but I compare it to now and I'm just like shit what have a done, I healed completely after the first one in like 2 weeks. I'm just praying it gets better day by day, but I'm really nervous.


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dw hopefully itl get better, sometime they need there time. the one that ive got is really big but not compared to what it was before trust me ive got pictures to prove it. i need to somehow upload my pics when i get my phone to get working again. but i just put emu oil on it throughout the day whenever i can and it has improved but still there if u know what i mean? like it has its good and bad days but NOTHING compared to what it was!! it still gets me down though.

hopefully your treatments will work for you. im scared to use any kind of lasers or anything because of any risks im a wimp when it comes to that, plus i have brown skin...

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@bio_nerd

So you had V-Beam for your red marks? How long did you have them before you decided to get treatment? And is V-Beam what completely removed them (if so, after how many treatments)? I'm depressed now b/c it's hard to tell if these marks are fading (not just now after V-Beam, but in general, because they seem to change day to day). How many years did you deal with your red marks in total till they no longer bothered you anymore?

P.s. Sorry for the million questions lol

I had it for about 2 years. I only got one treatment.

I have some suggestions for you:

1. Sea salt. Buy a bag of sea salt from a pharmacy and put about 2 cups in a cold or warm bath (you can try both) then just get in and dunk your head under and soak for a few hours. You can also try epsom salts as well. This is probably your best bet as sea salt has AMAZING healing properties and is a very overlooked remedy.

2. Evening primrose oil, Buy it from pharmacy it's about 11.99. Break the capsules open and let them drain over your marks, then just leave it for a while. If you have lots of active acne then maybe not do this as it might aggravate it a bit. Again evening primrose oil is overlooked but is one of the very few "dry" oils on this earth and has skin regeneration properties. You can also just try taking it internally if you are worried about it irritating your skin.

3. Avoid acids/peels/AHA/BP and such as they will do the opposite of what you are trying to achieve.

4. Instead of shaving around the spots, pluck the hairs near the spots out with tweezers, that way you won't have to shave there for a month or so. Or like i said before use a dry shaver.

Basically what your dealing with here are flat scars, some people say red marks are different but i disagree i believe they are just flat scars. So you goal is to heal those scars so your body will move on to other things.

You can beat these things, trust me.

As for the v-beam stuff you are worrying about, don't. Worst case scenario they go back to exactly what they were before.

I think you are totally right about tons of people thinking they have PIH, when really they have PIE. I will also take this one step further and say that red marks are really just a flat scar.

3 types of scars:

raised

depressed

flat

all of which may or may not have the redness from PIE.


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Thanks man

I remember last summer I went on vacation, and being in the ocean and stuff and getting SOME sun seemed to make my red marks better. And I'll probably get an electric shaver if it really helps to reduce irritation. It's weird though, you'd think it would cause MORE irritation because it's like a million little blades moving fast.

As for the V-Beam, you are so lucky that it worked in one treatment. I can't help but worry. I am a worrier by nature, and right now they look so shitty, much worse than before treatment. I mean why do you say worse case scenario they return to normal, how do you know that's the worst thing that can happen?

Edited by jamesy90

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Wow very interesting, you say not to put BP and AHA, which I use on my face, and especially on my forehead where I have some leftover pink spots. They seem to be getting better with time though, and they are flat pink spots, the SA and exfoliating every 2 days seems to be helping :eh: Now I can't help but wonder if these spots would be gone already if I hadn't put BP and AHA on them for months and months....Will other kinds of salts work? Like Rock salt or even regular salt?? :think:


It is better to keep your mouth shut and appear stupid...than to open it and remove all doubt.---Mark Twain


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@Trae Michael

Well i think it depends on the stage of healing that the scars are at, since yours are pink they are in the advanced stages of healing and the collagen/keratin/elastin matrix is fully formed so in your case i think using peels would be effective. Of course, don't let that stop you from trying sea salt.

In jamesy90's case he still has alot of healing to do and i don't think peeling back layers of skin is in his best interest, not yet at least.

Table salt is fine it's just that table salt is highly refined which removes alot of the beneficial naturally occurring minerals. Not sure about rock salt. Another benefit of soaking in sea salt is that it purges any active acne,

if you stay under water long enough the infection will just be sapped right out.

The advice I'm giving is that of which i have gained through trial and error and personal experience so of course - everyone is different - and i don't claim them to work on everyone.

@jamesy90

The reason i say that is because it doesn't make any sense for the v-beam to make them worse, it either helps or it doesn't - end of story. You are getting into a panic for no reason and i think you need to just not look at those things for a while to bring you back down to reality. When you study and analyze things for that long your brain gets delusional and your eyes will play tricks on you.

If you absolutely must look at it, maybe try taking a picture of it in the same light every single day that way you can get a accurate sense of it instead of relying on your memory.

Most electric shavers have smooth metal shields with holes over top of the cutters so they never directly contact your skin.

Edited by bio_nerd

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There's also reactive hyperemia, which is in crease in blood flow due to a previous state of ischemia, which is blood flow restriction.

The reason i mention this is because there has to be reason why some pimples heal as PIH and others as PIE. It's fine to understand both processes, but why are two different processes happening in the first place?

When i was a teen I remember how even my worst pimples would immediately scab and turn into PIH. They were hardly noticeable because I was often playing sports outside, so i had a good tan. Now mos tof my acne is gone, but i still get some spots. Some turn to PIH, like before, but i've started to get a lot more that heal as PIE, which i dont remember ever having as a teen. So what's the difference?

It seems to me that it's reactive hyperemia. Prior to this event, ischemia cuases a lack of oxygen (promotes acne bacteria growth/infection) and an increase of metabolic wastes, which i think promote acne in a way, either directly or indirectly, by overloading the immune system......so instead of pimples becoming PIH, which heals faster, the rush of blood and pro-acce enviroment cause a much more trauma within a pimple that necessary, opening/dilating vessels in the process.

What causes the ischemia in the first place? My guess is muscle issues. Muscle imbalances, body misaligment, etc....I actually started a thread focusing on this and received zero feedback. I'm not sure if people think it's a far reach or what, but i'm 100% certain there's a connection here and i hope some research can begin in this area.

Here's the thread:

http://www.acne.org/messageboard/Acne-caus...ri-t267943.html

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