I am being treated with 4% hydroquinone for the past 4 months for post-inflammatory hyperpigmentation (PIH) following Fraxel Repair. The hydroquinone does not seem to be working. Is PIH permanent? If not, will it eventually disappear on its own? Furthermore, if it ever gets resolved, is there a chance that it may come back?
Is PIH Following Fraxel Repair Permanent?
Doctor Answers (3)
PIH is a problem that can be permanent but the typical thing to worry about is the opposite
While it is possible that PIH can be permanent, it usually resolves with treatment. I put all my patients on the Obagi system prior to and after treatment. This reduces the chances for PIH dramatically. It is still not too late to try this and it will rev up the results of the Retin A significantly.
Most of the time the problem to watch for is actually post inflammatory hypopigmentation, the opposite of PIH. This can sometimes come after PIH, so it isn't a foregone conclusion that you are out of the woods even if the PIH starts to get better. This is why this procedure is so difficult.
There are so many skin issues to handle after these procedures that it is really important to go to someone who is expert in the skin and handling reactions after the laser as this is where problems and bad results occur.
PIH is usually not permanent
Occasionally, particular in darker skin people, PIH is possible after lasers. Usually it is easily controlled with Triluma. This should only be used for 4-6 weeks. It contains a 4% hydroquinone, Retin A, and a steroid. If having no success, your doctor can prescribe higher doses of hydroquinone. This is done from a compounding pharmacy. I have heard of doses of up to 12% but I don't have experience with that.
Once resolved, with proper sun precautions and skincare, it shouldn't come back. It's very important while you're healing to watch your sun exposure for several months, 3-4, or you can precipitate hyperpigmentation.
PIH is not permanent
PIH after repair occurs most commonly in people with more pigmented skin. If 4% hydroquinone does not work you may try a combination treatment such as TriLuma which has HQ, Retin-A and a steroid. The combination works well to eliminate PIH.