- Good day, my name is Michelle Rodrigues,
Aussie dermatologist and founder of Chroma Dermatology,
and today we're going to be having a chat
about post-inflammatory hyperpigmentation
and how that differs from post-inflammatory erythema.
So, pigmentation doesn't actually mean anything to me.
It's kind of just a descriptive term that tells us
that someone has more pigment than they should
or potentially less pigment than they should.
Pigmentation really needs to be broken up
into many different forms.
There there's hyperpigmentation,
which means excess pigment, more melanin in the skin,
or hypopigmentation, which means a decrease amount
of pigment in the skin.
And then there's depigment or depigmentation,
which means a complete absence
of pigment in the skin altogether.
So, hyperpigmentation can be a result
of so many different things.
There's literally 49 that I can think of
causes of facial hyperpigmentation.
And each one of these conditions
actually has completely separate treatments sometimes.
So for some, lasers are great,
for others it's going to make it irreversibly worse.
They can all look very, very similar.
So it's in the first and most important thing
with pigmentary disorders,
is A, get your diagnosis first by someone who's qualified
and can give you that proper diagnosis
otherwise you might bark up the wrong tree
and spend thousands of dollars potentially
on stuff that's never going to work
because you didn't have the right diagnosis to begin with.
Post-inflammatory hyperpigmentation
is the name given to brown discoloration,
and it can be light brown, medium tan, or quite dark,
that occurs on the skin after inflammation.
So this can occur after say acne,
after psoriasis, after a skin burn,
and basically the intensity of the inflammation
or the intensity of the acne can actually determine
the depth of the pigment, so the color and the duration.
So how long it sticks around after the event.
For any kind of post-inflammatory hyperpigmentation, or PIH,
we actually try to treat the underlying cause first.
So, many patients will come and say,
"Hey, I'm really stressed
about all the pigment on my face."
But when we look carefully,
there's actually active acne there.
So the most important thing is treat
the underlying cause first and then we can try
and fix the hyperpigmentation.
Second, it's really important to try to, where possible,
use photoprotection, meaning a really good SPF50 sunscreen
that has a high UVA and UVB blocker and visible tint.
After you've treated the primary issue
and got your sunscreen on board,
vitamin B3 or niacinamide, vitamin C, azelaic acid
and retinols or retinoids can be very, very helpful
for treating hyperpigmentation.
If you are going to work in vitamin A
to your skincare regime,
it's probably really important to start
with just a few times a week,
say a retinol that you get over the counter,
mix it with your moisturizer at night
and gradually increase the frequency of use.
If you are going to vitamin B or vitamin C,
they are best used in the morning as your first layout
with your sunscreen on top.
And of course, if the creams and so forth are not effective,
you can actually move to in-clinic treatments.
So specifically tailored chemical peels can be helpful
as can certain lasers, and in particular picosecond lasers
are definitely the safest and quickest way
of helping hyperpigmentation
or post-inflammatory hyperpigmentation specifically.
And that differs from post-inflammatory erythema, or PIE,
which is a really nifty term
that these really smart dermatologists in Boston
came up with in 2013.
And they invented this term basically to describe
the redness that occurs in the skin post acne,
and this is most commonly seen in patients
with lighter skin types, Caucasian skin types
and Asian skin types.
And this again can last from a few months,
right through to a few years depending on how severe
or how deep seated the acne is.
So again, really important terms of treatment to A,
treat the acne first and as quickly as you possibly can,
two, sun protect,
B, vitamin B3 is actually really important.
And of course you can actually try and utilize
topical active ingredients.
And interestingly, there's some research to suggest
that surface superficial redness can actually be helped
with topical tranexamic acid,
which is more commonly used in its oral form for melasma.
But also you can actually go
to in-clinic laser-based treatments,
and again, vascular lasers, lasers that target redness
are actually probably the best bet for reducing
that post-inflammatory erythema over time.
Most people need a good three treatments
spaced about eight or so weeks apart
to get the best possible results.
Don't forget,
you can learn more on videos about skin just here.
So if you have any comments, questions, queries,
just pop them in the comments below.
See you next time guys.