Scars; post inflammatory hyperpigmentation or PIH

PIH or post-inflammatory pigmentation is more common in ethnic and darker skin types. It results from inflammation of the skin, leading to more pigment production. It can take 5 years to recover from PIH. Picoway is by far the best laser to treat PIH cutting down the recovery time by as much as 90%. 

Key Points

  • PIH is seen in darker skin types as this is part of the healing process
  • Pigment may last 1-5 years
  • Sun protection will markedly reduce the chances of PIH
  • Established PIH can be treated with pico lasers
  • Pigment correctors including arbutin, cysteamine & hydroquinone are helpful
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Scars; post inflammatory hyperpigmentation or PIH 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

FAQs

Why do scars pigment?

Pigmentation within scars is universal in darker skin patients, this occurs when the skin produces too much pigment as a consequence of trauma. Common causes of PIH include burns, insect bites, acne, trauma, including scratching & surgery. It also occurs after laser & chemical burns.

How do we treat PIH?

Dermatologists are methodical at treating PIH, hence our high success rate. Treatment is as follows; 

 

  • Reduce inflammation & skin trauma 
  • Reduce pigment output from melanocytes via pigment inhibitors
  • Treat the excess pigmentation within the skin; lasers work best
  • Ensure sun protection

What is the BEST way to treat PIH?

Picoway laser is the best way to treat PIH. We replaced the old Picosure laser in 2020 with the newer Picoway. 

Pico lasers help by- reducing pigment in both the upper & lower levels of the skin. This means fast clearance of dark spots. Pico also helps remodel collagen within skin scars.

Does laser treatment hurt?

No. Picoway is not painful (unlike Picosure). 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?

2-4 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. 

Products

Medik8 Physical Sunscreen SPF50+
$69.00

Dermaceutic All Things Pigment 21 Day Kit
$154.00

The Cosmelan Peel is one of the fastest methods to clear up superficial melasma, but comes with a one week downtime.

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 be done with iron staining following iron transfusion?

This form of PIH is very different from normal pigmentation due to trauma. Iron staining responds unpredictably to even pico lasers. This is because your immune system does not efficiently carry the iron pigment away.

 

If you have iron staining, book an appointment with a nurse. They will guide you through test spots. 

Why is microneedling not a good solution for pigmentation?

Microneedling frequently pushes the pigment into the deeper layers of skin. You are far better off using a 0.1 to 0.2 mm stamper at home, over a clinic microneedling session.

Can chemical peels help?

Peels can lighten skin, including post inflammatory hyperpigmentation. We prefer lasers as they are much more effective & cost effective in the long run. As a guide it takes 3-4 times longer to fade pigmentation with peels, in comparison to laser. 

 

Our peels include:

 

  • Dermamelan / Cosmelan
  • Salicylic acid 
  • AHAs, lactic, glycolic, mandelic acids
  • Retinoic acid
  • Jessner mix. Lactic, salicylic & resorcinol 

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 apply 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.

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

This ingredient list can help with post inflammatory pigmentation-

 

 

  • 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

What should you consider before undertaking treatments for pigment?

Laser therapy is an investment of time, effort & money for patients. Here are some helpful points that may help you along your journey. 

 

 

  • Always control your inflammation. You will go infinitely faster & better with any scar revision treatment. If you have inflammation, your collagen remodelling is compromised, & pigment is recurrent. If in doubt, seek professional advice from our dermatologists and nurses. 

 

  • Time. Pigment resolution can be seen in weeks to months. You must be committed to the timeline & treatment plan. 
  • Sun protection is paramount. SPF 50+ twice a day regardless of exposure. If a 50 ml bottle lasts longer than 3 weeks, you are not using enough sunscreen.

 

  • Darker skin types; you may require more sessions compared to lighter skin. In some cases, we will expectedly darken your skin, but will come up with solutions to lighten it back to normal. 
  • Settings of laser / devices matter. Lasers are just tools to get the job done. Parameters are crucial for best outcomes. Additionally, using the best brands are super important. 

 

For more information, book a FREE nurse consult at Cutis.

 

*Redeemable with procedures

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