Post inflammatory hyper-pigmentation scars on face, neck and breasts not responding to Tretinoin (0.05%)

I'm a biracial women with brown PIH scars on my face, neck and breasts (around the nipples) from acne, ingrown hairs and compulsive skin picking. I've been using Tretinoin (0.05% strength), as prescribed by my dermatologists for three months. My acne has improved, but the PIH scars remain the same. I want a second opinion. I need a more effective treatment for the PIH/discolorations, that has minimal risks and yields faster results. What are my options?

Doctor Answers 2

PIH treatment with Melarase creams

I would recommend a combination of Plato's Scar Serum, Melarase PM, and Melapads to help with the PIH> 


Dr. Karamanoukian

Los Angeles

Los Angeles Plastic Surgeon
4.8 out of 5 stars 93 reviews

Treatment of postinflammatory hyperpigmentation

Thanks for your question. Retin A can certainly be helpful for this condition, but it would work better if combined with other agents which improve the distribution of pigment and melanocyte function. In the ZO SKin Health line, Melamix (containing 4% Hydroquinone) is combined with Retin A at night and Melamin (also 4% Hydroquinone) is used in the daytime. 4% Hydroquinone products should be used for a maximum of 18 weeks consecutive, at which point you should switch to non hydroquinone brighteners such as ZO Skin Health Brightenex (facial lightening) and Brightamax (non facial/body skin lightening). Medical grade vitamin C can also be helpful- concentration should be 10% or more.

Procedures such as microneedling with platelet rich plasma "Vampire facial" can help also. 

Intense pulse light ("photofacials") can coagulate existing pigment to get it to shed faster, but given your tendency towards PIH, you should be on a skin conditioning program (hydroquinone) for a good 6 to 12 weeks before any energy based intervention, and even before microneedling, to ensure that the healing phase after your procedure does not lead to unwanted pigment response. 


Lisa Vuich, MD

Lisa Vuich, MD
Nashua Physician
4.7 out of 5 stars 9 reviews

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