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PIH post inflammatory hyperpigmentation treatments

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%.

Key Points

  • 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
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Acne scars; PIH post inflammatory hyperpigmentation treatments at a glance

Best outcomes: 2-4 sessions
Procedure time: 5-10 minutes
Duration of results: Permanent
Back to work: Immediately
Recovery: 0-1 days
Anaesthetic: Not required
Your specialist: Dermatologist, nurse
How much: $

Our results speak for themselves



Acne Treatment Cutis Dermatology Brisbane 51

Post inflammatory hyperpigmentation treated with oral retinoids, SPF & topicals. PIH can self-resolve in some

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    Laser Treatment

    Post inflammatory hyperpigmentation can be treated with lasers, topicals or chemical peels.

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      Pigment removal

      Laser & pigment topicals

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        What is PIH or post-inflammatory hyperpigmentation?

        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.

        How do we treat PIH?

        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)

        What is the BEST way to treat PIH from acne?

        Pico lasers, in particular Picoway, are by far the best laser for PIH. 

        Pico lasers help by-

        1. Reducing brown pigment in both the upper & lower levels of the skin. This means fast resolution of dark spots.
        2. Stimulation of collagen. This can correct low volume loss atrophic scars (not larger volume deficits).

        Learn more

        Does it hurt?

        No. Picoway is not painful. You do not require any local numbing creams. Recovery is within an hour or two. 

        How much are treatments?

        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.

        When will I see results?

        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.

        How do I know what is the best treatment for my pigment?

        Book a FREE consultation with our nurses. They can guide you as to how to treat pigment efficiently & effectively. Consult fee redeemable with procedures.

        What is the recovery following lasers for PIH?

        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.

        What can you do at home/DIY PIH treatments?

        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.

        best pigment sunscreen

        SHOP SPF50


        Medik8 Physical Sunscreen SPF50+

        Dermaceutic All Things Pigment 21 Day Kit

        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. 

        What are some skin care actives that can reduce skin pigmentation?

        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
        • Niacinamide
        • Kojic acid, citric acid, lactic & glycolic acids
        • Cysteamine

        If you are the type of person who just wants to get the job done right, book a consultation with our dermatologist or nurses. 

        Can I undertake pico lasers if I am on acne medication?

        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.

        What is the go with microneedling?

        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. 

        Why is acne control vital for results?

        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. 

        What exactly is a pico laser?

        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. 

        What other lasers can treat pigmentation from acne?

        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 

        Will pico lasers treat other types of acne scars?

        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. 

        Can chemical peels treat PIH?

        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. 

        What should you consider before undertaking PIH treatments?

        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.

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