PIH or post inflammatory pigmentation is a common sequela of acne. It is very common in darker or ethnic skin types & can take over 5 years to settle. Picoway is by far the best laser to treat PIH cutting down the recovery time by as much as 90%.
- PIH or brown marks from acne is classed as grade 1 scarring
- It is frequently seen in darker skin types
- If left untreated pigment can take 3-5 years to resolve
- Pico lasers can accelerate resolution in only 2-3 sessions
- Prevention of further PIH is paramount for long lasting results
Acne scars; PIH post inflammatory hyperpigmentation treatments at a glance
Our results speak for themselves
Post inflammatory hyperpigmentation treated with oral retinoids, SPF & topicals. PIH can self-resolve in some
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Laser Resurfacing, excision, TCA. PIH or darkening resolves in 4-10 weeks.
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PIH is also known as grade one macular acne scars. These are brown flat scars. PIH occurs when inflammation from acne stimulates the pigment cells called melanocytes. These cells produce more melanin (pigment); hence the site becomes darker than the surrounding skin.
PIH can also occur secondary to insect bites, burns, chemical peels, lasers and trauma. It is almost universal in darker skin types, including ethnic and Asians.
Dermatologists are methodical at treating PIH, hence our high success rate. Treatment options are-
- Reduce inflammation; treat the cause. In this case, acne.
- Reduce pigment output from the pigment cells, prescription pigment correctors
- Treat the excess pigmentation within the skin; lasers work best
- Ensure sun protection
- Place the cause of inflammation in remission (cure it)
Pico lasers, in particular Picoway, are by far the best laser for PIH.
Pico lasers help by-
- Reducing brown pigment in both the upper & lower levels of the skin. This means fast resolution of dark spots.
- Stimulation of collagen. This can correct low volume loss atrophic scars (not larger volume deficits).
Learn more (link to picoway laser in the laser section)
No. Picoway is not painful. You do not require any local numbing creams. Recovery is within an hour or two.
Treatments are more affordable than you think. Pico for PIH starts at $199, packages are readily available. Book a consultation with our nurses at Clinic Cutis.
1-4 weeks, depending on your skin type, & depth of PIH. Darker patients will require more treatments compared to fair patients.
We can speed up the results with pigment correctors to be used at home.
Book a FREE consultation with our nurses. They can guide you as to how to treat pigment efficiently & effectively.
Consult fee redeemable with procedures.
Pico lasers in the context of PIH have no downtime. You will recover within an hour or two. In some cases, we prescribe a topical cream to help reduce more pigmentation in between visits.
Fractional lasers have a downtime of 1-3 days, depending on the device and settings. Our nurses and dermatologists will guide you accordingly.
The most important thing is sun protection. Get this right before spending money on skincare. If you don’t sun protect, everything else is a waste of time, effort and money.
From there, you can use various skincare products with ingredients listed below.
Sun protection summary-
- Hats are first line, followed by sunscreen then antioxidants
- SPF 50+, brand does not matter. Amount & frequency does.
- Twice a day, 3 ml per application.
- You should go through a bottle in 2.5 to 3.2 weeks.
- Do this before anything else.
PIH management is centered on eliminating the cause of inflammation. Once settled, we employ pigment specific lasers including Picoway & Picosure Pro to quickly clear up pigment & restore the normal color of skin.
If you are into your DIY skin care and would like to try things out, the following secret squirrel ingredient list can help with pigmentation. Results may take 4-12 months.
- Botanicals (plants); liquorice root, ginseng, bearberry, blueberry, green tea
- Arbutin: alpha from a lab, beta from wheat and plants
- Azelaic acid
- Ascorbic acid
- Kojic acid, citric acid, lactic & glycolic acids
If you are the type of person who just wants to get the job done right, book a consultation with our dermatologist or nurses.
Yes. The new revision guidelines in 2016 have cleared up the confusion with acne medication & lasers. In the context of pico lasers, you do not need to stop your medication if you have laser treatment.
Don’t do it. Just don’t. We are not against microneedling as we use this daily to treat scars or deliver topicals into the deeper layers of skin. It is just a very bad treatment for any sort of pigmentation, including PIH. You don’t need a needle to deliver ‘actives’.
Microneedling often ruptures the membrane that holds your pigment cells in the upper layers of skin, pushing pigment down low.
If you don’t control acne, you’re playing hit the gopher. This means when we subside old spots with lasers, new ones will form (due to active acne). At Cutis we are in the business of giving you good skin with as little treatment appointment as possible.
If you have acne, our specialists can employ chemical peels, prescription topicals, vitamin A and LEDs to control your acne. This means your end goals are achieved faster.
A pico laser uses laser light energy delivered over a super short time (picosecond) to shatter pigment in the skin. Therefore, it’s the laser of choice for post inflammatory hyperpigmentation. It clears up pigment 3-5 times faster than older nano or Q switch lasers.
At Cutis we have replaced the generation one Picosure (7 years old) with the better, more efficient laser, the Picoway & the new Picosure Pro. Picoway is much more effective at removing PIH compared to older C6- Revlite lasers.
It can get complex. PIH is part of PIPA or post inflammatory pigment alteration. This entity describes both brown & red pigmentation. If you have red, vascular lasers can help. Other lasers include-
- Thulium 1927
- Diode 1927
- 1940 fractional
- CO2 with enhanced delivery of topicals
- Nano QSL 1064 NdYag
- Fractional Erbium
Pico is best for flat brown scars, or grade one scars. Scars that exhibit volume loss or atrophy do not respond well to pico. These include deep ice pick, boxcar and rolling scars. These types of scars do best with deep focal peels, fractional lasers, subcision & surgery.
Our dermatologists will guide you as to what is the best approach to address your pattern of acne scarring.
Yes, but they are not as good as lasers. If you want a peel, we suggest the following;
- AHA peels, step up. 3-4 peels over 2-4 months.
- Salicylic acid peels if you have active acne as well.
- Retinoic acid peels or LARI/ Laser assisted retinoid infusion peels
- TCA at a very low strength.
Peels start at only $120; packages are available. Book a consultation with our nurses. Peels can be done on the day.
Undergoing pigment treatment is an investment for patients. Here are some helpful points that may help you along your journey.
- Always control your acne. You will go infinitely faster & better with any pigment treatment process. This means absolute (or almost absolute control), it does not mean ‘much better than before.’ If in doubt, see a dermatologist.
- Sun protection is paramount. It does not mean you can’t go out in the sun; it means sun protection is important. SPF 50+ twice a day regardless of exposure. If a 50 ml bottle lasts longer than 3 weeks, you are not using enough sunscreen.
- More than one treatment is needed. At minimum 2, if your PIH is bad, it could take 3-4 sessions.
- Darker skin type: you may require more sessions compared to lighter skin.
Settings of pico matter. Lasers are just tools to get the job done. Laser parameters are crucial for best outcomes.