So, you didn’t follow the proper Peel pre-treatment protocol and ended up with PIH … or, you had acne and now have PIH … or something else caused you to end up with – The TOP reason that most ethnic skinned patients end up in the Dermatologists office. … PIH…
What can you do to treat this at home now that you have it?
Today I am going to tell you.
First, what is PIH?
PIH stands for Post Inflammatory Hyperpigmentation. This is when the skin ends up with a dark area - or areas - of pigmentation after some sort of wounding or irritation. The discoloration generally manifests right in the same area of the original inflammation. Common causes are insect bites, dermatosis, burns, cosmetic procedures such as peels where the skin was not pre-treated properly, acne and so much more.
What causes PIH
Post Inflammatory Hyperpigmentation results from the overproduction of melanin or an irregular dispersion of pigment after an inflammation has gone down. A pimple is the easiest way to show how this happens. The area swells, then darkens as the swelling goes down. That is PIH in action.
Depending on where the pigment is in the layers of skin will determine its color. Shallow injuries in the epidermis will be in the brown range and will take months to years to resolve if left untreated.
If the pigmentation is deeper in the dermis it can have a blue-grey appearance and will most likely be permanent. Both layers of coloring will get worse with UV exposure.
Who gets PIH?
PIH can happen in Caucasian skin, but it is much more prominent in the medium – darker ethnic skin types. It has been shown that melanin-rich skin shows a hyper-reactivity to minor skin traumas resulting in PIH.
A study in 2002 found that 65% of African Americans, 52% of Hispanics and 47% of Asian patients developed PIH after common inflammations such as acne.
Another study in Singapore showed that the darker the natural skin tone within each race - the higher the chances of PIH developing. For example a darker skinned Indian will have a higher chance of getting PIH than a lighter skinned Indian. Same with Asian and black skin types. Here at Platinum we talk on the phone to a large amount in the Indian and Asian communities dealing with PIH. So just because you don’t have the darkest skin tone – don’t think that puts you in the clear. It most certainly does NOT.
A great amount of people who are looking to do chemical peels will fall into this category, that is why it is SO important to properly pretreat your skin before applying any acid peel.
The prep that we recommend for ethnic skin types PRIOR to a peel is the exact same treatment that can be used to TREAT problematic PIH.
How should an ethnic skin type pretreat?
We recommend that all ethnic skin types pretreat their skin with 3 products.
- Fade Bright melanin inhibitor 2x per day for a minimum of 2 weeks. Key ingredients: Alpha Arbutin, Kojic Acid, Azelaic acid, Licorice Extract, Mulberry, Bearberry, Resveratrol, Niacinimide and Lactic acid. All of which help to turn-down the melanin production in the skin. This helps prevent PIH by not allowing the skin to build up melanin after the skin is wounded with the acid. It is continued immediately after the peel and then daily to control pigmentation and brighten the skin.
- Retinol Molecular Serum each evening on top of the Fade Bright. Retinoids have anti-inflammatory properties and create biological effects in the skin that speed up cellular turnover and the lightening of the skin. Retinoids work hand in hand with melanin inhibitors to get quicker balancing of the skin tone.
- The last product is a broad screen SPF of 30 minumum… or 50 *if you are already dealing with PIH prior to your chemical peel.
There is always some concern with SPF’s and darker skin tones. It is true that vitamin D is important to those with darker skin – but clinical studies have shown that sunscreen users levels are still within normal range. *If you are truly at risk for a Vitamin D deficiency, you can always add a total dose of 1000 IU of D through diet and supplementation instead.
If your choice is to forego the SPF, just know that you will not be able to adequately treat your PIH and it will continue to worsen.
You can go further with your treatments than just our peel prep though. So let’s talk about other options to reduce or remove PIH.
How to treat PIH
First and foremost, PIH is caused by inflammation – so the first thing we need to address is reducing the swelling. If you are dealing with a bite, or a burn… simple treatments such as a cold compress or aspirin or ibuprofen can help to reduce swelling. The quicker the better.
After a chemical peel we always recommend to rinse the area well with nice COLD water. This helps in reducing inflammation and calms the skin.
Topical depigmenting agents, such as hydroquinone (for short periods of time only – as long-term use can cause a purpling of the skin and its possibly a carcinogen), Alpha Arbutin, azelaic acid, kojic acid, licorice extract, niacinamide, Ascorbic Acid (Vitamin C) and retinoids, can be effective alone or in combination with other agents, and procedures to treat epidermal PIH. These are to be applied daily and continuously. You will find that every single ingredient except C and Hydroquinone can ge found in our Fade Bright – and that was NOT an accident. We created that formula with all of the most powerful agents to treat pigmentation that we could.
*Unfortunately deeper pigmentation does not respond well to any of these agents and you will have to seek professional help with that.
Chemical peels. In 2018, chemical peeling was the third most common nonsurgical cosmetic procedure performed in the United States,and PIH, was one of the most common indications for this procedure in skin of color.
With darker skin types we need to be cautious about what acids and percentages we apply. The best choices for treating PIH are the following:
Salicylic 15% or 25% 1x every two weeks. Salicylic is an anti-inflammatory and will aid in reducing the buildup of melanin over the course of 3-8 peels average.
Jessners at 2-4 layers 1x per month. This peel contains Salicylic acid 14%, Lactic acid 14% and resorcinol 14% (*7% of that being hydroquinone). Expect to do 3-8 peels as well here.
TCA 13% at 2-4 layers 1x per month is another excellent option as long as you have pretreated properly for at least 2 weeks prior to applying your acid.
There are some minor peels that are options as well. Those are the Mandelic and Azelaic Peel 22% along with our Lactic 50%. These can be done 1x every 10 days or so and will need a complete series of 8 for a result.
A good rule of thumb to see if you will be more prone to getting PIH after a chemical peel is to take a good look at your body. Do you have dark marks on your legs from bites or scrapes. Dark marks on your knuckles or knees? Spots on your face, neck or chest from old blemishes?
If so, then you will want to pretreat for 4 weeks or more prior to applying a peel. Here at Platinum we feel that it is always better to be safe than sorry. It is MUCH easier to prevent PIH than it is to treat it.
You will most definitely find people out there who swear that you don’t need to pretreat your skin prior to a peel – even one such as a deeper TCA - … and maybe they escaped without any issues … but the odds are NOT in your favor – so always pretreat and work up in strength slowly.
Do you still have more questions? You can see our Video on TCA Peels on Dark Skin or you can always reach out to us. We are here to help you!