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FAQ - Post Inflammatory Hyperpigmentation

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#1 frances

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Posted 10 November 2004 - 07:27 PM

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.
user posted image

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.

(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/...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/...=9443&hl=n-lite
· CoolTouch II: http://www.cooltouch.com/products.html
· IPL: http://www.intensepu.../equipment.html
V Beam Pulse Dyed Dye Laser
http://www.candelala...eam/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...rm/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...rm/topic876.htm

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

Treating PIH in darker skin tones
http://www.dermatolo...l.jsp?id=124881
http://www.freep.com...e5_20041005.htm
http://www.cosmetics...rticle2009.html

Understanding Exfoliants
http://www.cosmetics...rn/pf.asp?ID=27

Skin Lightening
http://www.emedicine...rm/topic528.htm
http://www.cosmetics...rn/pf.asp?ID=25

Lasers
http://www.emedicine...rm/topic517.htm
http://www.cosmetics...rn/pf.asp?ID=19

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#2 Dean

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Posted 11 November 2004 - 07:03 AM

Thanks frances, I was just about to start a thread asking if there was a clear difference between scarring and redmarks. Much apprech biggrin.gif

#3 frances

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Posted 12 November 2004 - 02:59 AM

Q: What is the Lemon & Vinegar Method?

A: This is a method that may improve the appearance of shallow, rolling scars. Drink either Robinson’s Lemon Barley Water or plain water with half a teaspoon of lemon juice to a full glass of water throughout the day. It is best to use fresh lemons if possible. Use any diluted vinegar (organic apple cider if possible, malt or white are also acceptable) in warm water to splash onto the face day and night. You may have to experiment to find the right combination of water to vinegar. Try diluting it 1 part vinegar to 4 parts water to start with. First wash your face with your normal cleanser, and then apply the vinegar (dab the solution on with cotton balls and leave on) before other topicals/moisturizers (apply topicals 20 minutes later). You should see an improvement within a week or two.

For more information, read this thread:
http://www.acne.org/...?showtopic=4885

#4 frances

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Posted 12 November 2004 - 03:01 AM

Q: What is the tape method of exfoliation?

A: This is a method whereby a piece of scotch/gift tape is applied to the surface of the skin and then gently removed. Once the tape is removed there may be pieces of dead skin that remain on the tape. Take care in using harsh topicals when this method is employed, as they will most likely irritate the skin moreso than if tape were not used.

For more information, check out this thread: http://www.acne.org/...?showtopic=1320

#5 winnie44

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Posted 01 May 2005 - 07:55 PM

2 years? thats a long time to wait. i dont think i can even wait another 6 months with this

#6 Mostly Spots

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Posted 22 April 2006 - 01:22 PM

what is the best treatment for PIH. Hdyroquinone, AHA, what. i keep hearing 4%hydroquinone. But i'm more interested in getting rid of PIH AND preventing pimples.

I have had proactiv since the end of january, and ever since i heard that BP worsens dark spots, i have stopped using it. I feel that was a bad idea, because now i have many new brown spots that i feel could have been prevented. I dont know whether i should continue using it, or try something else. The Proactiv DID HELP. Note that i want to prevent pimples, and get rid of dark spots. what if I use the proactiv and also add some extra glycolic acid before the toner. doesnt glycolic acid help with brown spots?
Please Help me.

#7 markymark

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Posted 01 May 2006 - 05:02 PM

QUOTE(Mostly Spots @ Apr 22 2006, 12:22 PM) View Post

what is the best treatment for PIH. Hdyroquinone, AHA, what. i keep hearing 4%hydroquinone. But i'm more interested in getting rid of PIH AND preventing pimples.

I have had proactiv since the end of january, and ever since i heard that BP worsens dark spots, i have stopped using it. I feel that was a bad idea, because now i have many new brown spots that i feel could have been prevented. I dont know whether i should continue using it, or try something else. The Proactiv DID HELP. Note that i want to prevent pimples, and get rid of dark spots. what if I use the proactiv and also add some extra glycolic acid before the toner. doesnt glycolic acid help with brown spots?
Please Help me.

ive heard about bp making red spots worse but the most important thing you can do is prevent pimples in teh first place and bp is the best thing for that. I'm not really sure if BP makes them worse or causes red marks, I seemed to get them before using bp anyway. My suggestion would be to use bp and once your clear of active pimples then you treat the red marks. Otherwise your active pimples will just leave tons of red marks anyway...

#8 fthea118

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Posted 31 May 2006 - 12:37 AM

I am pretty confident that BP does make red marks much worse. When I wasn't using as much BP that is suggestd by Dan (when I was on Proactiv), I was staying clear and I hardly ever had any red marks, they would only be there for maybe a week or two at the most and then they would go away. Since I have been on BP, I have had the same mark for over a month and a half without much fading. Can someone tell me the costs for the different laser treatments?

#9 markymark

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Posted 01 July 2006 - 02:04 PM

QUOTE(fthea118 @ May 30 2006, 11:37 PM) View Post

I am pretty confident that BP does make red marks much worse. When I wasn't using as much BP that is suggestd by Dan (when I was on Proactiv), I was staying clear and I hardly ever had any red marks, they would only be there for maybe a week or two at the most and then they would go away. Since I have been on BP, I have had the same mark for over a month and a half without much fading. Can someone tell me the costs for the different laser treatments?

proactiv's main ingredient is BP. it has bp in it's cleanser and it's repairing lotion. Proactiv is all about BP. There's no evidence at all that bp makes red marks last longer...I'd like to see some

#10 tikvica

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Posted 22 July 2006 - 02:25 AM

i haven't used bp earlier, and i have say that i do notice more red and brown spots on my face than before
but i don't care, as long as i'm clear
at least redmarks can be covered

#11 Jrod16

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Posted 07 August 2006 - 03:17 PM

what if its a deep scar hyperpigmentation are the 18 months included in this>? thanks...

#12 koreankid

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Posted 08 August 2006 - 10:19 PM

Will all red marks go away? I heard if you go in the sun then they can get darker and never go away. Is this true?

#13 markymark

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Posted 09 August 2006 - 08:34 PM

thats what the dermatologists say...

#14 VocStu

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Posted 25 August 2006 - 05:54 PM

Hi if I picked at this one lesion (currently in the healing process), when the brown spot appears, is this considered PIH? And whether it is or not, would creams/lemon juice/whatever have any affect on reducing the hyperpigmentation?

So I guess I'm trying to ask, is picking at a lesion (whitehead in this case), causing it to open, the same as PIH? treated the same way?

any help is greatly appreciated

#15 Lexia

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Posted 08 October 2006 - 07:32 AM

Hoping someone can answer this for me.
Ive been on roaccutane for a month now and during this month it has made 97% of my pimples go down, so i have all these small red spots ALL over my cheeks and chin. I'm not seeing the derm for a while so im wondering if i should take it apon myself to find a good redspot treatment whilst still on roacc. Is this a bad idea? I want to start treating the spots asap but im not sure if i should let roacc do all the work (i still dont know if tane helps with red spots). What do you guys think???

#16 jasonng

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Posted 11 October 2006 - 06:25 PM

QUOTE(jasmina @ Jul 22 2006, 02:25 AM) View Post

i haven't used bp earlier, and i have say that i do notice more red and brown spots on my face than before
but i don't care, as long as i'm clear
at least redmarks can be covered




What the fuck! yeah maybe for girls, but what about the rest of us.

#17 calla lily

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Posted 18 November 2006 - 02:40 PM

QUOTE(frances @ Nov 12 2004, 12:59 AM) View Post

Q: What is the Lemon & Vinegar Method?

A: This is a method that may improve the appearance of shallow, rolling scars. Drink either Robinson’s Lemon Barley Water or plain water with half a teaspoon of lemon juice to a full glass of water throughout the day. It is best to use fresh lemons if possible. Use any diluted vinegar (organic apple cider if possible, malt or white are also acceptable) in warm water to splash onto the face day and night. You may have to experiment to find the right combination of water to vinegar. Try diluting it 1 part vinegar to 4 parts water to start with. First wash your face with your normal cleanser, and then apply the vinegar (dab the solution on with cotton balls and leave on) before other topicals/moisturizers (apply topicals 20 minutes later). You should see an improvement within a week or two.

For more information, read this thread:
http://www.acne.org/...?showtopic=4885


Is it okay to use lime in place of the lemon?

#18 Spades

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Posted 25 January 2007 - 01:46 AM

Thx ^^

#19 reOowSEXtasy

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Posted 13 February 2007 - 03:10 PM

QUOTE(Lexia @ Oct 9 2006, 12:32 AM) View Post
Hoping someone can answer this for me.
Ive been on roaccutane for a month now and during this month it has made 97% of my pimples go down, so i have all these small red spots ALL over my cheeks and chin. I'm not seeing the derm for a while so im wondering if i should take it apon myself to find a good redspot treatment whilst still on roacc. Is this a bad idea? I want to start treating the spots asap but im not sure if i should let roacc do all the work (i still dont know if tane helps with red spots). What do you guys think???


heyy Lexia I also havve tha same problem and want to treat my my pigmentation red mark thingys man are they pissing me off yerr i was on roaccutane for 3-4 monthz then got taken off it coz of depression and im not seeing my derm 4 a whiile either I also want a spot treatment I heard 100% aloe vera gell is supposed to be good havnt tried it myself yett .. any suggestions any one ??

` ªмуу ьαььίί_.˚




#20 SummerLuv

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Posted 07 May 2007 - 08:45 AM

QUOTE(reOowSEXtasy @ Feb 13 2007, 03:10 PM) View Post
QUOTE(Lexia @ Oct 9 2006, 12:32 AM) View Post
Hoping someone can answer this for me.
Ive been on roaccutane for a month now and during this month it has made 97% of my pimples go down, so i have all these small red spots ALL over my cheeks and chin. I'm not seeing the derm for a while so im wondering if i should take it apon myself to find a good redspot treatment whilst still on roacc. Is this a bad idea? I want to start treating the spots asap but im not sure if i should let roacc do all the work (i still dont know if tane helps with red spots). What do you guys think???


heyy Lexia I also havve tha same problem and want to treat my my pigmentation red mark thingys man are they pissing me off yerr i was on roaccutane for 3-4 monthz then got taken off it coz of depression and im not seeing my derm 4 a whiile either I also want a spot treatment I heard 100% aloe vera gell is supposed to be good havnt tried it myself yett .. any suggestions any one ??

` ªмуу ьαььίί_.˚






hey guys..
first of all, I'm in my 3rd month of Accutane .. and my derm gave me two products (AHA-CONCEPT AHA CREME 5% pH 3.5) & (Remederm Face Cream) They're both 'Louis Widmer' .. and wat i have to do is mix both creams on my hand and apply them on my red spots, scars, etc .. before i go to bed .. i've been doin that for about 2 weeks and the red spots didnt seem to fade... its a shame cuz i spent around $45 for those two creams!! ..... any sucess stories in gettin rid of rep spots anyone?? ;/