Will Laser Resurfacing Make PIH Worse from Prior Laser Resurfacing?

Question

I had laser and the lady burned me. It healed and now the area is darker then the rest of my skin. Since laser resurfacing helps hyperpigmentation, will another laser treatment help or make it worse? Before the first laser i was not advised to use bleaching cream, but now i am a month into using it. I had affirm first and im now looking in to fraxel restore dual with a more reputable doctor.

David R. Stephens, MD · Answer

Post laser hyperpigmentation is a common problem following laser resurfacing and is not necessarily related to the "burn" that you experienced. That said, the greater the injury the greater the degree of PIH. Laser resurfacing is just that, in that is smooths out the skin and has the additional benefit of evening out darker skin tones. It is not specifically designed to treat browns, though, but more to smooth out wrinkles. There are different opinions in the industry regarding whether to pre-treat the skin with hydroquinone or not before laser resurfacing. Not pre-treating risks increasing the possibility of PIH. The good news is that it typically responds to topicals and bleaching creams.I would continue to use your topicals and "bleaching cream" and give it a good 3 to 6 months before trying another light source therapy if at all. It takes time for these to work, especially if you are young or have any degree of melasma or of darker skin ethnicity.

Martie Gidon, MD, FRCPC, FAAD · Answer

Please consult a board certified dermatologist to treat your postinflammatory hyperpigmentation.  Laser is not recommended.  You must avoid the sun. Fading creams and light chemical peels may be appropriate.

Michael Contreras, MD · Answer

Post-inflammatory pigmentation is the term given to darkening of the skin after injury or inflammation whether intentional (laser) or unintentional (road rash).  It is more common in people with darker skin types.  This type of pigment sits deeper in the skin and is more difficult to treat.  The most helpful thing you can do at this point is to apply a zinc containing sunscreen (SPF > 30) daily and every 2 hours when outdoors, continue the bleaching cream nightly (I prescribe hydroquinone 4-7% combined with tretinoin .025%), and wait about 3 months to assess your progress.  As another doc pointed out, light chemical peels with salicylic acid or Jessner's can be helpful during this period every 2 weeks or so for a series of about 5 peels.  While additional laser including the fraxel restore dual or intense pulsed light devices may help, these would not be my first line treatment.  Given your propensity to hyper pigment, I recommend lower-than-average settings (which equals more treatments) for any future laser treatments.

Cynthia Golomb, MD · Answer

I treat postinflammatory pigmentation with mild chemical peels or bleaching agents.  I have gotten excellent results with this approach.   I would be very cautious using a laser for postinflammatory change and recommend that you are evaluated by a board certified dermatologist for specific treatment recommendations regarding your problem

Jason Pozner, MD · Answer

I would be very wary of using laser resurfacing to treat PIH (post inflammatory hyperpigmentation). I love laser resurfacing and probably do as much or more then anyone in the US. At our office we have a lot of experience treating difficult skin problems and our first line treatment for PIH is always chemicals/skin care. The best thing is to make an appointment at a place that really deals with these issues.

Will Laser Resurfacing Make PIH Worse from Prior Laser Resurfacing?

Answers (6)

Answer: Post inflammatory pigmentation

Answer: Post inflammatory pigmentation

Answer: Laser resurfacing to treat PIH

Answer: Laser resurfacing to treat PIH

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Will Laser Resurfacing Make PIH Worse from Prior Laser Resurfacing?

Answers (6)

Answer: Post inflammatory pigmentation

Answer: Post inflammatory pigmentation

Answer: Laser resurfacing to treat PIH

Answer: Laser resurfacing to treat PIH

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Recommended reading

Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.