Remove Scars NOW !!! (Your Ultimate Guide To Treat Post Inflammatory Hyperpigmentation / PIH)

How To Get Rid Of Scars

Firstly I would really like to apologize for the delay in putting a new post this time. I was simply confused about the blog topic & it took me this long to finally decide.

Today we’ll be discussing about post inflammatory hyperpigmentaton or PIH.

Now don’t be afraid of the heavy-duty scientific term. Although sounds mouthful, but PIH simply refers to any ‘scar or hyperpigmentation’ due to some kind of ‘inflammation on skin’ which could be anything like acne, or minor injury (like scratching hard, cuts & burns) or sometimes it happens as a side effect of chemical peeling (peeled treated skin looks darker than the rest of the body).

This is a major problem for people of colour. Mostly darker skin types are predisposed to developing this because simply they’re genetically predisposed to synthesizing more melanin in response to inflammation (just like tanning, where sun damage is perceived as an inflammation & melanin synthesis is a protective response) than the lighter skinned population.

As you probably know about Fitzpatrick scale of skin colour which categorizes human population according to skin tone into 6 categories; while category 1 being the lightest & category 6 being the darkest. According to the scale, category 4 & above are predisposed to higher melanin synthesis in response to sun; & the same being true about PIH.

According to Fitzpatrick Scale, category 4 & above are the ones who are more likely to develop Post Inflammatory Hyperpigmentaion in response to skin inflammation. Although, this is an oversimplification.

Many lighter skinned individuals also develop PIH.

The thing about this is, most individuals get turned off by this scientific sounding term ‘post inflammatory hyperpigmentation’ which means nothing more than scars from acne or localized injury. So I had to include the term ‘scar’ in the title or I doubt if anyone would ever read it.

Personally I’ve suffered from the same for real long but it was due to my TCA peeling going wrong. The fun part is that contrary to what many think, I find PIH scars to be extremely easy to treat.

If started out early, as soon as you discover them, they’d rapidly depigment & respond very well to popular treatment options.

Now we can do the following things to depigment such cases:

·         Chemical Peels:  I know it sounds contradictory but it depends on the situation. If your acne has left you with ugly discolorations, then lighter peels can be of great help. Light peels refer to glycolic acid, salicylic acid, lactic acid or even jessner’s peel at a lower concentration.

Modern Azelaic Acid, Pyruvate or TCA 12-15% (Not light enough for your face though) are also considered light peels.

Ideally glycolic acid 30% is considered a light peel. But if the affected area is any body part other than your face, then it’s going to give you a hard time & you may need higher concentrations.

Like for your legs, glycolic acid 30% would not result in major peeling. It’ll simply help exfoliate better & thus, I recommend using one only once a week for 3 months along with other treatment options. It’ll definitely improve the result.

But if the PIH marks are result of a chemical peel going wrong, then better stay away from any kind of chemical peels to treat it, especially if it’s your face. But it’s your arms or legs then you’re game for a few lighter peels like those mentioned above but only atleast after a month of your last ‘went-wrong-peeling-session’.

If chemical peels tend to leave scars on your skin, you should seriously consider pre-treatment before any session of peel which includes application of a bleaching cream atleast 2 weeks prior to chemical peeling.

From my experience I’ve seen, if my skin turns red after peeling (after chemical peel) which is called post inflammatory erythema, it is most likely to turn dark or result in PIH. In most cases, you can limit that redness from turning into a scar (atleast partially) by applying a mild to mid potent corticosteroid like hydrocortisone (mild) or mometasone furoate (mid) & employing strict sun protective measures.

·         Bleaching Creams:  To choose the right treatment for your scars, first you need to look at them carefully to find out the depth of the condition.

 Like if your scars look brown to black, they’re probably superficial & is limited to epidermal layers.

But if they look blue to purplish, they’re probably deeper, spreading down to dermis & are going to give you a hard time removing them. However fret not. We still have treatment options for them.

You can always use over the counter bleaching agents like the following:

1.       Hydroquinone: Mostly found in formulations with tretinoin (is a penetration enhancer, meaning an agent that helps any other agent, just like hydroquinone here to penetrate the skin better/deeper) along with a corticosteroid (to avoid inflammation caused by HQ). This is the classical triple combination cream or popularly known as Kligman’s formula which rapidly depigments scars.

However, please be aware that HQ may cause nominal to severe adverse reactions & because it is a strong formulation, it is highly recommended that you should not expose the treated area to direct or ambient light/sun & always wear sunscreen during the day.

If you’re using this twice a day, once must be during the daylight; then you must cover the area you’ve applied the ointment on after application of a broad spectrum sunscreen, even indoors; to stay safe.

Now if the treated area is your face & you’re unable to cover it during the day; then stick to a strict sunscreen routine & apply this hydroquinone preparation only at night before bed. Protective clothing & sunscreen are both must with any kind of bleaching cream.

2.       Arbutin + Kojic Acid Dipalmitate: Alpha arbutin & kojic acid are both effective depigmenting agents while kojic acid itself is a derivative of hydroquinone.

But Kojic acid is a notoriously unstable agent, that’s why kojic acid dipalmitate was introduced on the first place. Palmitate groups stabilize the whole thing.

Many modern bleaching creams have this above formulation. Some even add vitamin E, mulberry extract to enhance it’s efficacy.

3.       Azelaic Acid: Azelaic acid, besides being an effective acne medication is also effective as a bleaching cream. Some claim this to be as effective as hydroquinone (disputed though).

It is so effective that recently I’ve also seen peels based on azelaic acid has been introduced. although strangely, it has never worked for me.

Popularly 10% azelaic acid is perceived as equivalent to 2% Hydroquinone while 20% azelaic acid is as effective as 4% hydroquinone minus the adverse effects of HQ.

4.       Alpha & Beta Hydroxy Acids: Most popular Alpha Hydroxy Acid (AHA) being glycolic acid, the first & lowest molecular weight member of the AHA family is very effective in treating hyperpigmentation.

The most popular beta hydroxy acid /BHA is salicylic acid, widely used as an acne medication. Ideally BHA penetrates deeper than AHA. So, for those with oily skin, a salicylic acid ointment works slightly better than a glycolic acid ointment.

Ideally if you’re formulating a routine for depigmenting scars, I recommend using:

Ø  Bleaching Creams like HQ or arbutin/Kojic acid based ones, once a day.

Ø  An AHA like Glycolic Acid ointment or a BHA like Salicylic Acid ointment at night before bed.

Provided, that you use sunblock along with sun protective clothing. If you compromise in any one of them (like sometimes, it’s difficult to cover your face if face is the area you’re treating) , limit using a bleaching agent (whatever it is) to only once, before bed at night.

5.       Topical Retinoids: Retinoids like Tretinoin (.025-.05%), Adapalene or Tazarotene work kind of the same way as AHAs mentioned above.

These agents not only help other agents applied along with them to penetrate deeper into the skin, but also helps exfoliate the top layer of skin & help it shed the dry/damaged/dead skin gathering on top of stratum corneum.

Usually you can apply it once a day, preferably at night before bed.

·         Massage:  I cannot explain how important this is. There’s a rule of thumb: further away from heart the scar is, greater time it’ll take to clean up.

Because further from heart a body part is, slower the blood circulation will be. So if you have scars on your distal limbs like, on your legs; it’ll take longer to clean up.

One way you can accelerate the rate of depigmentation is by artificially boosting the blood flow by massaging the area. You can use jojoba oil or any other carrier oil with a drop of your favourite essential oil in it (optional) & massage the scarred skin gently once a day, preferably at night.

Alternatively, these days you’ll get jade/rose quartz rollers available for massage & these help immensely as well.

Gentle massaging also encourages lymphatic drainage which in turn will help you get rid of toxins & speed up depigmentation. You just need patience.

This is exactly why working out is thought to helpful in achieving bright skin.

·         Antioxidants: Antioxidants like vitamin C or E can be of great help in removing hyperpigmentation. Get any serum of vitamin C with a concentration of 10% & above or simply empty a vitamin E capsule in your massage oil & shake well to get the same benefits.

At the end of the discussion, I’d like to mention that if you want any of the above technique to actually work, then the first thing you’ll have to keep in mind that these only work with optimal sun protection which includes application of a broad spectrum sunscreen & sun protective clothing, even indoors.

Because most over the counter treatment options will predispose your skin to extreme sun sensitivity, so; without adequate sun protection, any treatment should worsen the condition if not helping.

Secondly antioxidant serums tend to be highly unstable upon exposure to sun; so it’s better to also cover the application area along with applying sunscreen if you’re using these serums in the daylight; is recommended. Otherwise limit application to once a day, before bed at night only; if you can’t ensure sun protection.

Thirdly during the application of any of the agents mentioned above & also upto 2 weeks after cessation of application, scrubbing or simply rubbing the area should be strictly avoided.

So this was it.

Also, above are only recommendations of products that are known to combat post inflammatory hyperpigmentation & this is for educational purpose only; thus it cannot be treated as an alternative to a medical professional’s advice. Please refer to the disclaimer for further information: http://thebeautyblogoflove.blogspot.com/p/disclaimer.html

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Also, Merry Christmas in advance. 

Love,

Koyel M.