Skin is a remarkable and largest organ that serves as a protective barrier against external environments. However, it is susceptible to various insults, including inflammatory processes triggered by acne, eczema, psoriasis and other skin conditions.
When inflammation subsides, it will leave behind a mark that often persists for weeks to months. Two common post inflammatory outcomes are Post Inflammatory Erythema (PIE) and Post Inflammatory Hyperpigmentation (PIH). Despite their distinct characteristics, they are often easily confused and have different modes of treatments.
What is PIE?
Post Inflammatory Erythema (PIE) is a condition characterized by red or pink marks on the skin, resulting from inflammation-induced vascular dilation and increased blood flow to the affected area. The redness in PIE is primarily caused by the presence of oxygenated blood (hemoglobin) in the dilated blood vessels near the skin’s surface.
It is different from Post Inflammatory Hyperpigmentation (PIH), which involves an overproduction of melanin pigment that is usually seen as brown or darkened colour at the affected area.
What is PIH?
Post Inflammatory Hyperpigmentation (PIH), is a condition characterized by the overproduction of melanin in response to inflammation or injury. It occurs when the body produces excess pigment to repair and protect the skin from further damage. PIH appears as darker patches or spots on the skin compared to their surrounding, and the colour can range from light brown to black, depending on the individual's skin type and severity of the inflammation.
Distinguishing Features and Appearance
PIE appears as flat, erythematous patches and they can vary in size and shape. These marks can be more significant on fair skinned individuals, as the redness is more visible against a lighter skin tone. They are particularly noticeable after a flare up of an inflammatory skin condition and take weeks or months to resolve, depending on the individual healing process.
PIH presents as areas of hyperpigmentation that are typically tan, brown or black. These patches can be round or irregular shaped and can occur anywhere on the body. PIH can often persist for an extended period, lasting months or even years, particularly in individuals with darker skin tones.
The Metamorphic Process: From PIE to PIH
The conversion from Post Inflammatory Erythema (PIE) to Post Inflammatory Hyperpigmentation (PIH) involves a complex interplay of biological factors. When inflammation persists or is more severe, it triggers the release of inflammatory mediators that activate melanocytes, the cells that are responsible for producing melanin. Melanin, the pigment that is responsible for the discolouration seen on PIH, accumulates within the skin’s deeper layers and is carried out to the epidermis (outer skin layer), leading to the appearance of dark spots.
In individuals with darker skin tones, the process from PIE to PIH can be more rapid and pronounced due to presence of higher melanocytes activity.
The natural course of PIE converting to PIH is inevitable, some external factors can exacerbate the process. One crucial factor is exposure to ultraviolet (UV) radiation from the sun. UV rays stimulate melanocytes, leading to increased melanin production. Thus, unprotected sun exposure during the inflammatory phase can intensify PIH and prolong its duration.
Treatment Approaches
The distinction between PIE and PIH is essential for determining the most appropriate treatment approaches.
For Post Inflammatory Erythema, topical anti-inflammatory agents and laser therapies that target blood vessels can be effective in reducing redness and promoting healing. Laser treatments such as intense pulsed light (IPL) devices or yellow lasers or Fotona SP Dynamis can selectively target the dilated blood vessels and help restore a more even skin tone.
For Post Inflammatory Hyperpigmentation, modes of treatment that focus on inhibiting the overproduction of melanin pigments and promoting cell turnover are the key treatments that are being used. Topical agents containing ingredients like hydroquinone can help fade dark spots over time. Chemical peeling and microdermabrasion are also commonly used to exfoliate skin and encourage the removal of hyperpigmented cells while promoting cell turnover. Besides, Pico lasers like Fotona Starwalker PQX can be used to break those melanin pigments to lighten and even out your skin tone.
Conclusion
Understanding the differences between PIE and PIH is crucial as treatments can be done as soon as the diagnosis is established to reduce the tendency of the transformation of PIE to PIH which might be stubborn or takes longer treatment duration during the healing process.
If you have any inflammatory pigments that are affecting your outer confidence and you are interested to know more about your skin condition, make an appointment with our aesthetic doctors in Dream Clinic, where we can tailor our treatment strategies to address those conditions that can lead to more successful outcomes, helping individuals to regain their natural radiance and confidence.
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