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Post Inflammatory Hyperpigmentation

Some Steps to Take to Deal with PIH

I am trying to get rid of my acne scars, or rather marks (post-inflammatory hyperpigmentation).

I use Neutrogena soy complex and it works but I see no dramatic difference.

I’ve thought of tanning but heard it would make it worse.

I heard that I could use vitamin E pills for it. But am not 100% sure. Help me please.

Enrique

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Postinflammatory hyperpigmentation (PIH) is a common postlude to an acne breakout. As the pimples and papules resolve they sometimes trigger the body to produce excess melanin.

The more inflamed the breakout, the larger and darker the PIH tends to be; and the darker your normal skin tone, the more likely you are to experience PIH.

The good news, as you mention, is that PIH macules are not true scars.

There is no depressed or raised tissue. The better news is that PIH typically fades away on its own.

The more contrast there is between your normal skin tone and the PIH macules, the longer this natural process will take. Without any treatment, they should fade away within three months to two years.

Things NOT to Do

1. Whoever told you NOT to tan was absolutely spot-on. You should be diligent about using a broad spectrum sunscreen to prevent tanning.

Tanning occurs when the sun’s UV rays trigger the body to produce melanin (just like pimples and papules can do), so tanning would worsen your condition!

2. Topical Vitamin E is sometimes used to help heal scars (though there are now stronger topical ingredients that speed scar healing).

But as we both mentioned, your PIH macules are NOT scars, so topical Vitamin E will not help.

Taken as a supplement, Vitamin E is known to be a good antioxidant which fights free radical damage (cell oxidation). Free radicals play a small role in triggering melanin production. So Vitamin E taken internally might help prevent (but not fade) PIH - hpwever, many experts claim that Vitamin E. at least in its most common form, does more harm than good.

3. Try to keep your hands away from active pimples. NO picking; NO popping. In addition to opening the way for infection, picking and popping increase the incidence of PIH.

Things to Do

1. Apply broad spectrum sunscreen at least twenty minutes before you go out into the sun. If you are in the sun for an extended period, reapply every two hours or after being in the water.

2. If you have active acne as well, it is best to focus on treating the acne rather than the PIH. Attack the problem at its source. If OTC products aren’t strong enough, see your dermatologist.

OTC Products to Try

Here are some over-the-counter treatments that should help your PIH, followed by explanations and research on the active ingredients.

bareEscentuals bareVitamins Skin Rev-er Upper. BareVitamins contains a 1% Salicylic Acid concentration and is formulated at a pH of 3.5 which allows it to work. It also contains good anti-inflammatories and antioxidants.

Olay Definity with Niacinimide and N-Acetyl Glucosamine. These ingredients have proven to be more effective at preventing hyperpigmentation in combination.

Peter Thomas Roth Potent Botanical Skin Brightening Gel Complex with Azelaic Acid (which destroys melanocytes) and Kojic Acid (which lightens skin).

Philosophy’s a pigment of your imagination SPF 18 with sun protection, skin-lighteners Hydroquinone-containing Arbutin and Kojic Acid.

Ingredients to Reduce Incidence of PIH

1. The Beta-Hydroxy Acid (BHA) Salicylic Acid is a chemical exfoliating agent often used to fight acne. Salicylic Acid is oil-based and does not work on the surface like Alpha-Hydroxy Acids (AHAs), but rather penetrates oil-clogged pores and breaks down the dead skin cells found there so they can slough off. By reducing inflammation, BHA creams also reduce the occurrence of PIH.

2. N-Acetyl Glucosamine* inhibits the production of melanin in skin cells thereby preventing the formation of PIH.

3. Niacinimide* (Vitamin B) inhibits the movement of melanin up to the visible skin layers. Excess melanasomes (cells which transport melanin to the surface) are trapped where the dark pigment won’t show. Eventually the cells die and the debris is absorbed by the body.

* N-Acetyl Glucosamine and Niacinamide have been shown to be more effective in combination than either one alone. Scientists theorize this is because the combined formula attacks hyperpigmentation at two different points: melanin production; and melanin transportation.

The results of three rigorous clinical trials of N-Acetyl Glucosamine combined with Niacinimde were presented at the 2006 mid-year meeting of the American Academy of Dermatology. The complex produced visible improvement in pigmentation after eight weeks.

Before and after photos (courtesy of P&G Beauty) were taken under polarized lighting conditions, optimized to produce an evenly lit color image.

[The studies also showed increased collagen production. This would be of interest to anyone with the type of hyperpigmentation referred to as age spots, which is commonly accompanied by thinning skin and wrinkles.]

4. Azelaic Acid (available in prescription Finacea) is believed to be toxic to melanocytes (the cells which produce melanin) and to prevent their proliferation.

5. Your doctor may prescribe steroidal glucocorticoids to stop the inflammation which triggers PIH.

Ingredients to Speed the Fading Process

1. There are many OTC skin brighteners or clarifiers.

Some ingredients work to actually lighten the skin.

• Hydroquinone is the most effective skin lightener and has the longest track record. It is available OTC in 1 to 2% concentration. Adverse reactions are rare at these lower concentrations. Hydroquinone is not stable and needs to be kept away from light and air. If it turns brown you know it is no longer effective.
• Kojic Acid
• Licorice Extract
• Arbutin (which contains Hydroquinone)

Other ingredients work by exfoliation. By speeding cell turnover, exfoliants hasten the ascent of excess PIH melanin to the surface where it will slough off.

Don’t expect overnight results. Melanin is formed at the basal layer of the epidermis and takes about a month to rise to the surface.

So while you’re exfoliating the visible layer of skin, new melanin may already be on its way to the surface (unless you are taking steps to stop melanine production and/or transport).

• Glycolic acid (AHA)
• Ascorbic acid (Vitamin C AHA)

2. Your doctor may prescribe

• For skin lightening - Hydroquinone is the most effective skin lightener and has the longest track record. There are some cautions when used at prescription-strength concentrations of 3 to 4%. Follow your doctor’s instructions carefully. Hydroquinone is not stable and needs to be kept away from light and air. If it turns brown you know it is no longer effective.
• For exfoliation - Retinoids (Retin-A, Tazorac or Differin). Retinoid creams are stronger than BHAs and AHAs but not all people can tolerate the irritation. Your doctor will work with you to find the best concentration and application routine for your skin.

Neutrogena Visibly Even

I like a lot of Neutrogena products. They are generally very good values and backed by solid research.

In the Visibly Even line, my favorite is the day cream with SPF 15.

J&J, the maker of Neutrogena, has done one clinical study which indicates that topical soy has a skin lightening effect. I think more research is needed on this.

The soy may be helping as well because of its antioxidant and anti-inflammatory properties.

However, the real active ingredients in Visibly Even Day are the sun protection and Salicylic Acid.

Unfortunately I can’t recommend the night cream for your PIH or acne. Though it too contains Salicylic Acid, the high pH renders it useless.

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This article is for information only. It does not purport to offer medical advice.

 

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