Have there been any statistics released on the percentage of patients that end up with PIH after Fraxel Restore or Fraxel Repair? Is there anything that can be done either prior to Fraxel or after that can reduce PIH? Does PIH occur more in patients getting restore versus repair? I know that there are creams that can be used if PIH occurs but what if anything can be done to prevent it in the first place?
Preventing PIH After Fraxel Restore or Repair
Doctor Answers 4
Prevention of Post-inflammatory Hyperpigmentation or PIH
Post-inflammatory hyperpigmentation or PIH is a darkening of the skin which can potentially follow any injury to the skin. Scratching a mosquito bite, getting burned with a curling iron, waxing the eyebrow are minor injuries which can result in long lasting darkening of the pigment. How much more the possibility of PIH when more intense medical treatments are applied!
Prevention of PIH starts with matching the patient and their goals to an appropriate treatment. For instance a very dark complected brunette patient might not be the best candidate for a deeper Fraxel Restore treatment at all. Once the patient and treatment have been matched pre-treating the patient with tretinoin, hydroquinone, and sunscreen a month before treatment would be beneficial in preventing unwanted color.
The best thing to do is to prevent with Retin A and Obagi program prior to procedure
While there are many reasons for post inflammatory hyperpigmentation, the easiest way to prevent it is to pre-treat with Retin A and the Obagi System. The Obagi system has hydroquinone in it, which alone can help, but doesn't help as much as when it is in the Obagi program.
The Retin A is always a help and is incorporated within the Obagi system if you purchase that.
Additionally, it is really important to make sure you are the right person for these types of treatments. If you are darker than average or if you are a sunlover, then neither of these treatments are probably right for you as you will probably have problems after them.
Post-inflammatory hyperpigmentation (PIH) can occur when any type of inflammation is delivered to the skin: laser, peels, dermabrasion, etc. With lasers it is more common with ablative (Fraxel Repair) than nonablative (Fraxel Restore). It is also much more common with Fitzpatrick skin types 4, 5, and 6 and in patients with Pacific Rim heritage. The Fitzpatrick skin type refers to the way your skin responds to ultraviolet light exposure (burn or tan). Generally, patients with darker skin have higher Fitzpatrick scores.
The risk of PIH can be reduced by pretreating the skin with a bleaching cream (hydroquinone) and mild steriod (hydrocortisone). We recommend pretreating with these creams for several weeks before treatment. Also, it is imperative to avoid sun exposure BEFORE and AFTER laser treatment.
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Using Hydroquinone a month prior and Gentlewaves helps prevent PIH from Fraxel
Starting hydroquinones 4% 1 month prior and restarting soon after the procedure will help prevent PIH from Fraxel. There is also a recent paper that suggests pre and post procedure Gentlewaves will decrease the risk of PIH as well. Avoiding the sun for 6 weeks prior to the procedure and good sunscreen also is important.