Post Inflammatory Hyperpigmentation – a Concern for Practitioners and Patients


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Treating common tone and texture issues like rosacea, acne and other scars, and ironically, uneven pigmentation, is the bread and butter work of aesthetic clinics. These concerns are the very driving force sending men and women in search of a doctor that can help. The irony is that one of the top concerns for skin resurfacing patients is post-inflammatory hyperpigmentation – also known as PIH.

What is PIH exactly and when are you particularly at risk as a patient?

Post-inflammatory hyperpigmentation occurs when the skin overproduces melanin, or disperses pigment irregularly, in response to inflammation or injury. The most common causes of facial skin inflammation are acne vulgaris (pimples) atopic dermatitis (a rash), and impetigo (a bacterial infection).

A person may also develop PIH as a result of time in the sun (UV exposure), an insect bite, an allergic reaction, a chronic disease like psoriasis, or as a side effect from medication. Since PIH causes an uneven skin tone, it’s one of the many reasons people seek skin resurfacing treatments. It presents as flat, discoloured spots on the skin that create an uneven skin tone.

According to the Journal of Clinical and Aesthetic Dermatology, PIH is a risk for individuals with skin types IV to VI on the Fitzpatrick scale — a significant portion of the aesthetic market here in Africa and specifically also South Africa. Davis EC, Callender VD. Postinflammatory Hyperpigmentation: A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color. J Clin Aesthet Dermatol. 2010 Jul; 3(7): 20–31.

Despite the fact that individuals with skin types IV to VI make up the majority of the world population, comparatively few skin resurfacing devices are safe for patients with these Fitzpatrick scale skin types. For clinics committed to offering these advanced aesthetic treatments, choosing the right device can make a world of difference in terms of serving greater numbers of customers.

PIH can be treated with over-the-counter and prescription topical remedies as well as with cosmetic procedures like chemical peels, laser, and other resurfacing techniques. However, some treatment types can cause irritation, or even end up worsening PIH.

If you are a medical practitioner, how can you prevent it?

For may years, the CO2 laser was the gold standard in skin resurfacing technology. However, the treatments has its pitfalls. PIH occurs in a large percentage of patients with darker skin tones treated with non-fractional CO2 devices. When fractionated lasers appeared on the scene, the downtime after treatments were reduced, but not the risk of PIH. With the arrival of non-ablative fractional laser therapies, the risk of PIH was reduced for lighter skin tones, but still posed a threat for darker-skinned patients. Light-based therapy is an alternative to laser, where using Intense Pulsed Light (IPL) further reduces the chance of PIH compared to laser, but the condition is still a potential side effect.

Radiofrequency Skin Resurfacing Treatments

Innovations such as the NanoFractional RF™ technology used by Venus Viva™ prove to be the safest choice for patients over a wider range of skin types, and for aesthetic professionals looking for non-invasive solutions for tone and texture problems, with minimal adverse effects.

Study results comparing RF treatment with laser treatment on Asian patients found minimal occurrence of PIH with the RF method. Yeung CK, Chan NPY, Shek SYN, Chan HHL. Evaluation of combined fractional laser treatment for acne scars in Asians. Lasers Surg Med. 2012;44(8):622-630.

NanoFractional RF™ utilizes needle-shaped pin electrodes to deliver RF energy. A 2016 study in Thailand observed the effects of NanoFractional RF™ on patients of skin types III-IV with striae albae (stretch marks). Both physicians and patients observed an improvement in the appearance of stretch marks. Due to the smaller size of the impact area at the pin tips, along with leading SmartScan™ technology, researchers found that the Venus Viva™ NanoFractional RF™ system could ensure consistently high-intensity energy to be effective in skin resurfacing while reducing risk of PIH. Ponqgsrihadulchai N, Chalermchai T, Ophaswongse S, Pongsawat S, Udompataikul M. An efficacy and safety of nanofractional radiofrequency for the treatment of striae alba. J Cosmet Dermatol. 2016; 1-7.

Venus Concept is a leading global innovator of versatile medical aesthetic devices that offer high efficacy, strong ROI, and award-winning support; we take pride in keeping our practitioner partners at the forefront of aesthetic expertise.

Get in touch with Venus Concept Africa

Enquiries: +27 72 255 8957 or +27 31 535 7241





About Author

Rochelle is co-owner of A2 Aesthetic & Anti-Ageing Magazine - she looks after A2's Blog and the Sales & Marketing for A2 Magazine. Follow her on twitter by clicking the birdy on the top right of this block.

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