There are so many types of hyperpigmentation, and it can be one of the most frustrating skin concerns to treat. Post-inflammatory hyperpigmentation, or PIH, is one form that can occur in all skin types, but most commonly and chronically impacts darker skin tones (Fitzpatrick types four to six). Treatments for this condition can be tricky, but when skin care isn’t getting the job done, a laser may be able to help. Here are the ones dermatologists recommend for melanin-rich skin, and what to know before your appointment to achieve optimal results.
What is post-inflammatory hyperpigmentation (PIH)?
“PIH is a skin condition that results in darkening of the skin after an inflammatory injury or condition,” says New York dermatologist Michelle Henry, MD. “It occurs due to the excessive production of melanin, causing the appearance of dark spots or patches on the skin. Common conditions that can lead to PIH include acne, eczema and psoriasis, as well as injuries, cuts or burns.” According to the Skin of Color Society, PIH is very common in skin of color, with more than 65 percent of African Americans experiencing symptoms.
Which laser treatments are best for treating PIH?
Washington, D.C. dermatologist Tina Alster, MD says laser treatments for those with PIH are difficult because laser interaction with the skin causes inflammation and can result in further PIH. “As such, it’s important to first ‘prime,’ or prepare the skin with skin-lightening agents, such as topical vitamin C, retinol or tranexamic acid, in order to reduce baseline pigmentation. If a laser treatment is administered, it should be pursued with caution. I recommend a low-energy laser, such as a nonablative fractionated laser like Clear + Brilliant or Fraxel Dual.”
For those with melanin-rich skin and PIH, Dr. Henry says treatments such as Nd:YAG and pico-second lasers are suitable due to their ability to target excess melanin without damaging the surrounding skin. “Nd:YAG lasers emit a longer wavelength of light that can penetrate deeper into the skin, making it effective for treating PIH in deeper layers of the skin,” she explains. “Pico-second lasers like the Picosure, on the other hand, use short bursts of energy to break up the excess melanin, which is then absorbed by the body’s immune system.”
Is there anyone with melanin-rich skin and PIH who shouldn’t get a laser?
Along with patients who have darker skin types, Dr. Henry says those with a history of a keloid scarring are at a slightly higher risk for complications following aggressive laser treatments. “Laser therapy can lead to further hyperpigmentation or hypopigmentation in these patients. Therefore, it is crucial that they consult a qualified dermatologist or laser specialist before undergoing laser treatment for PIH.”
Dr. Alster adds that patients who have not been adequately “primed” with a suitable topical skin-care regimen should avoid laser treatment. “In addition, anyone who has had recent sun exposure and/or is planning to have sun exposure during the first one to tweo weeks after treatment should not be treated with a laser.”
How many treatments are needed to see results, and what downtime should patients expect?
The number of sessions needed depends on the individual getting treated and the severity of their PIH. “Each treatment should produce progressive fading of the PIH, and is further enhanced with appropriate at-home topical skin-lightening products [like those ingredients mentioned above],” says Dr. Alster. “Treatments are usually administered at monthly, or longer, time intervals.” Dr. Henry adds that patients typically notice some improvement after the first session. “They can expect mild-to-moderate redness, swelling and temporary darkening of the treated area, which usually resolves within a few days to a week,” she notes.