What type of chemical peel would work best for hyperpigmentation? (Photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

From the photo, it appears that post-inflammatory hyperpigmentation (PIH), i..e. the "footprint" of prior inflammatory acne, is the major problem here. In general, so long as there is no accompanying scarring, most postinflammatory pigmentation, like post inflammatory erythema (PIE)--i.e. redness--will fade spontaneously with time. Usually this takes longer on the chest and back than on the face and longer in people of color than less deeply pigmented individuals. Several weeks to several months are usually required for complete fading (so long as no new acne or folliculitis breakouts occur to set the entire process back).To help speed this process, a series of a variety of in-office superficial peels may be employed, which include low-strength TCA, full strength salicylic acid, Jessners solution and full-strength glycolic acid--all of which I have used for this purpose, either alone or in various combinations. At-home bleaching preparations, which may include hydroquinone in varying concentrations, retinoic acid, arbutin, kojic acid and certain licorice extracts may be used in order to further enhance and expedite the process of fading.In general, I feel that bells and whistles lasers of various kinds and IPL, which are often hyped for treating these kinds of problems, do little more than add to the expense of treatment. Best to see a board certified aesthetic dermatologist who will be best be able to control any active acne, if present, and tailor a treatment regimen for you. Best of luck.

Hello Luxx4,I would recommend a combination of treatments for best results. The first step would be to set up a consultation with your provider. There are many ways to address PIH ( Post Inflammatory Hyper-pigmentation) and it is necessary to consult with a professional prior to treatment. It is not recommended to use chemical peels at home, you take a risk of causing irreparable damage to the skin, including hyper or hypo-pigmentation and even scarring. These deeper peels should only be performed by medical professionals or specially trained estheticians working in a medical office. There are many steps that go into these treatments besides applying the product.It is best to prepare the skin before you chemically peel with a 6 week regime using a system such as ZO Medical Products, which are prescription strength, medically dispensed skin health products. The ZO 3 Step Stimulation Peel is an excellent peel, along with RevePeel and VI.  Best, Dr Faraz

While hyperpigmentation from acne can be frustrating, we use the newest, cutting-edge technology to battle the marks left behind with really incredible results. If a chemical peel is what you are interested in trying, our retinol peel is a great option to noticeably lift hyperpigmentation. A retinol peel—which also goes by names vitamin A peel and retinoic acid peel—is a deeper peel that delivers a strong concentration of acid, followed by a high dose of retinol, or vitamin A, to maximize ingredient penetration and absorption of the anti-aging actives. Downtime ranges from 5-7 days during which time your skin will peel and sun-avoidance/protection will be critical. Our patients who have tried this peel have seen remarkable results and it is a great place to start when treating hyperpigmented skin.

Once your back acne is under control you can go ahead and treat with a combination of bleaching creams, V-Beam laser for redness, and TCA peels for pigmentation.  Strict sun avoidance is necessary to improve the skin as well.  Best, Dr. Green