Post-inflammatory hyperpigmentation is the discoloration, in the form of red marks or brown marks, that remains on the skin after the acne subsides.
According to Healy and Simpson from the Department of Dermatology at the University of Newcastle, “acne is as common as it was 20 years ago but is now less severe in teenagers and affects more people in their 20s and 30s, who have high expectation of treatment.” The prevalence factor and the transition from the teens toward the slightly older generation are both significant because millions of people of all ages are left with post-inflammatory hyperpigmentation as their skin attempts to heal from the inflammatory lesions.
Several beauty products, medications, and home remedies have shown moderate efficacy in treating post-inflammatory hyperpigmentation. The most popular choices in the United States and the rest of the world are outlined and discussed below.
Remedy Number One: Chemical Peels
Chemical peels have gained popularity over the recent years due to their economical and convenient uses. A chemical peel consists of applying several layers of acid to the hyperpigmented areas in order to remove the top layer of the skin through a controlled burning mechanism. Addressing active acne lesions prior to starting any type of skin care procedure is absolutely necessary!
Glycolic, lactic, and trichloroacetic acids–all examples of alpha hydroxy acids–are the three most recommended chemical peels.
Glycolic acid, both colorless and odorless, comes in concentrations varying from 10% to 80%. It is the most popular at-home peel due low risks and great penetrating ability. Before attempting a glycolic acid peel, a glycolic-based toner is recommended in order to prep the skin for the forthcoming peel. Following the prepping procedure, the glycolic peel is applied with a q-tip for two minutes. After the two minutes elapse, the solution is neutralized by applying baking soda or rinsing with water. The procedure may be repeated once every two weeks for maximum results; six treatments are usually enough for significant improvement of post-inflammatory hyperpigmentation. Individuals who have no previous experience with glycolic peels are recommended to start with concentrations between 10% and 15%; more experienced peel users may find concentrations between 30% and 50% perfectly tolerable. After the skin adjusts to the procedure, higher concentrations are suggested and necessary in order to see improvement.
Lactic acid is the mildest alpha hydroxy allowing the users to start with 30% to 50% concentrations without adverse side-effects. Depending on the skin care kit, some peels come with a pH-prepping solution that is applied right before the peel is performed. The procedure for doing a lactic peel is similar to that of glycolic peel, except for longer duration of the application–usually lasting 3 to 7 minutes. Lactic peels are great for individuals with sensitive skin; however, due to mild nature, lactic acid peels are less effective compare to glycolic or trichloracetic peels.
Trichloroacetic acid (TCA) is the strongest of the three peels listed above. As a result, it is generally only used in concentrating ranging between 10% and 50% with 15% being the average. Generally, the recommended concentration depends on the skin tolerance as well as the depth of the hyperpigmented acne scars; furthermore, as the concentration of the peel increases, so does the strength of the peel. A small amount of the solution is placed on the toothpick and applied to the skin. Instead of just letting the solution sit on the skin for few minutes, the peel is applied through a layering process where one rubs the toothpick over the affected areas for up to two minutes. TCA peel does not need to be neutralized; therefore, it is left on the skin and not rinsed out. The same procedure is repeated the next day for greater results. The following couple of days are marked by skin tightening and finally peeling where large layers of skin are removed. The new skin is a refreshing pink color depicting improved tone and texture.
Remedy Number Two: Apple Cider Vinegar
Apple Cider Vinegar (ACV) can be purchased in most supermarkets, such as Walmart, and it has been recently advertised as a weight loss cure. However, many acne sufferers use apple cider vinegar to diminish stubborn acne marks–or post-inflammatory hyperpigmentation. The application is simple: use a cotton ball to apply a solution of two parts water to two parts apple cider vinegar to the affected areas of the skin and rub for one to two minutes every morning and night.
As early as one week into the treatment, a noticeable reduction of pseudo acne scars should be noted. (Since post-inflammatory hyperpigmentation marks are not indented scars in a sense that they disappear over time, they are often referred to as pseudo acne scars.)
Skin tightening and greater overall texture are the acquired results with this simple, yet effective Apple Cider Vinegar treatment.
Remedy Number Three: Lasers
N-lite, IPL, and Cooltouch lasers are among the more expensive treatment options for post-inflammatory hyperpigmentation varying between $1,000.00 and $3,000.00 per procedure. Furthermore, compare to ablative lasers–which can cause potential scarring, additional hyperpigmentation, and permanent change of skin texture–non ablative lasers carry almost no risk.
N-lite laser therapy is an FDA approved, non ablative, yellow-light laser that claims to improve skin tone while destroying the acne causing bacteria in the process. The procedure generally lasts about 20 minutes and the pain is minimal. In order to see desired results, the treatment usually needs to be repeated.
IPL, or Intense Pulse Light treatment, is a white light, non ablative laser that interacts with fibroblasts and broken capillaries in the dermis in order to improve skin tone and texture. The downtime is minimal and the laser claims to stimulate collagen formation, thus further improving skin texture and hyperpigmentation.
Cooltouch laser is a grouping of cryogen spray and an Nd-Yag laser, which similarly to IPL claims to induce collagen formation by stimulating fibroblasts. The procedure is very quick, lasting about 15 minutes, and the recovery includes slight redness on the treated areas. The Cooltouch laser has controversial reviews with some people experiencing very little improvement or requiring multiple treatments over a prolonged period of time. Some patients become skeptical of the Cooltouch laser due to lack of the immediate improvement as collagen formation can take up two months.
Remedy Number Four: Hydroquinone
Hydroquinone is a topical treatment in a gel or cream form used for hyperpigmentation.
It is generally advised for patients suffering from hyperpigmented areas such as age spots, cholasma, melasma, and freckles, and those whose spots or marks are brown versus red in color. For this reason, a wide group of acne sufferers with red marks from acne do not see much improvement with hydroquinone.
Those who are willing to try hydroquinone for their post-inflammation hyperpigmentation need to be aware of the potential side effects, i.e., burning, itching, redness, stinging and those more serious such as an allergic reaction or a rash. Furthermore, some countries have banned the use of hydroquinone due to the potential link to certain types of cancers.
Exposing the skin to sunlight while using the medication will lead to additional darkening of the skin, thus counteracting the potential benefits.
Remedy Number Five: Alpha Hydroxy and Beta Hydroxy Acid Products
Beta hydroxy acids (BHA) are lipid soluble, i.e., salicylic acid. Alpha hydroxy acids (AHA) are water soluble and include five groups: glycolic acid, malic acid, tartaric acid, lactic acid, and citric acid.
While the first section of the article refers to alpha hydroxy peels specifically, this section pertains to their use in over-the-counter, skin care products such as creams, gels, toners, and more recently foundations to address hyperpigmentation.
Popular AHA products for hyperpigmentation include HumiNature Aha! Face Toner, Skin Medica Rejuvenative Toner, SkinCeuticals Equalizing Toner, Rejuvenating Lotion-15% AHA by Refinity, Alpha Hydrox AHA Enhanced Lotion, and Alpha Hydrox AHA Souffle 12% Glycolic AHA.
Alternatively, BHA is found in products such as Cellex-C Betaplex Gentle Foaming Cleanser, Benev Salicylic Acid Exfoliator 2%, and Bliss See Spots Run.
Most of the skin care products mentioned in this section can be purchased on a website such as www.shopzilla.com.
Since alpha hydroxy and beta hydroxy acids function by removing the epidermal (top) layer of the skin, they have the ability to improve skin tone and texture. Significantly, the level of improvement is generally lower than with the more effective chemical peels.
Treating post-inflammatory hyperpigmentation requires dedication, research, and general skin care knowledge. Unsurprisingly, beauty doesn’t come without a price, but in this case the emotional pain from damaging the skin is a much greater price than the actual monetary value of the products involved.