Post Inflammatory Hyper-pigmentation (PIH) - Treatment Options?

my skin was destroyed by acne when I went I stopped using benzol peroxide for a period of 3 months. I went back on BP and my skin now only gets the odd zit BUT my skin looks disgusting from all of the PIH. I've had one microdermabrasion treatment and one chemical peel at 20% salicylic acid. Now I'm looking for something that will potentially expedite the healing process faster than either of these treatments. I'm white and have fair skin.

Doctor Answers 14

Red or Brown Acne Scar Treatments

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Hi PIH.  Sorry to hear about your situation, but glad the acne situation is under control.  For the kind of pigmented (colored) acne scars you are describing there are a couple options, but our choice of treatment usually depends on the color of the scars (red or brown).

Caucasians like you generally get red acne scars after treatment.  These can be treated with chemical peels like you have tried, Microdermabrasion and skin care products - we like Glycolic acid or Retin A based products for exfoliation needed in this situation.  You can also use hydroquinone based bleaching agents (if you go this route try to find something over 4% as this will speed the process) and pulsed dye laser treatments.  The pulsed dye laser treatments are specifically designed for vascular conditions like this and will do a better job than Fraxel in getting rid of the pigment.

Finally, if the scars did happen to be brown, we would suggest the hydroquinone bleaching cream again (6% - 8%) or q-switched Nd:Yg laser treatments.  These again will be more effective than Fraxel because the laser is specifically designed to treat dark colored pigment.  Good luck.

Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Post-inflammatory hyperpigmentation

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Topical agents that can help resolve PIH faster include hydroquinone, antioxidants, retinoids, low-potency topical corticosteroids, azelaic acid, among others.  You might want to start with an over-the-counter product containing 2% hydroquinone, for example Ambi fade cream.  Sometimes there is a delicate balance between improvement in the hyperpigmentation and irritation/redness of the skin that can lead to further pigmentation, so I would caution not to use any of these products to the point of irritation/redness.

Bryan K. Chen, MD
San Diego Dermatologist

The best treatment for post inflammatory acne lesions is time

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Unfortunately post inflammatory change following acne is very common. Typically it resolves nicely with time so be patient. There are prescription strength bleaching creams that are available and you should discuss this with your dermatologist.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Post-inflammatory hyperpigmentation relief complex for acne scars

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I recommend Melarase to improve hyperpigmentation as well as Scler-X, a post-inflammatory hyperpigmentation relief complex. Scler-X is an oral supplement that is taken for 3-6 months or more. See link below. 

Laser for Post Inflammatory Hyperpigmentation

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Chemical peels do a great job, you may need more sessions though. Of late, I find the Picoway to be quite a good option for treating post acne PIH - the results do seem to be faster with the laser. You could check with your doctor regarding combining peels with a pigment removal laser. 
Good luck!

Post Inflammatory Hyperpigmentation and Treatment with Chemical Peels

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It would best to use a combination to use a combination of Vitamin C and chemical peels and hydroquinone to treat this pigmentation.  I usually alternate the V-Beam to remove the redness that has resulted.  Please consult an expert in acne and scar treatment.  Best, Dr. Green

Acne treatments in Los Angeles

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PIH and acne scars often go hand in hand. We use a combination of chemical peels (Melapeel); laser resurfacing using sublative, ablative, and non ablative lasers. Our office specializes in acne scar treatments. 

Dr. Karamanoukian 

Time..sunscreen...fading agents

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Given time together with a high SPF PIH usually fades. How do I speed up the process? Often I combine low strength peels (glycolic, lactic or vitamin A)  with fading agents, such as Lytera or Hydroquinone. 

If needed, low fluence Q Switch laser can be used, but you need multiple treatments. Time is the best healer.

Dr Davin S. Lim
Brisbane, Australia

Red acne marks disappear quite well with a prescription cortisone cream.

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From your photos, the red acne marks are very prominent and should respond quite well to a prescription cortsone lotion or cream such as Desowen which your dermatologist can prescribe.  Also a few 10-20% TCA peels will help with the dark acne marks. 

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

Persistent erythema after acne

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From your picture it appears you have persistent erythema rather than post-inflammatory hyperpigmentation. You need to continue to treat your acne. Retinoids would be a good choice for you as it would speed up the resolution of the acne and also help the erythema go away faster. Chemical peels would also help. A combination of the above would be even better.

Dina D. Strachan, MD
New York Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.