Tips for managing post-inflammatory hyperpigmentation of acne

Abstract

Post-inflammatory hyperpigmentation (PIH) is a reactive hypermelanosis, profoundly common in the Asian skin. The post-acne sequelae may have profound effects on the patients’ mental status, sometimes even more than the acne itself, as they are long lasting and sometimes treatment refractory. PIH occurs secondary to release of inflammatory mediators such as prostaglandins and interleukins in acne which stimulate melanogenesis. There are a multitude of therapeutic modalities available for the treatment of PIH associated with acne. Treating acne and PIH simultaneously would be a logical approach. Epidermal PIH usually responds to topical skin lightening agents which are the first line in these cases. Patients refractory to topical and oral treatment modalities usually have dermal PIH and may be offered interventional therapies. These therapies can be utilized simultaneously along with conventional therapies to hasten up the results, as combination treatment works synergistically by multipronged action at different pathways of etiopathogenesis. The patients with dermal PIH refractory to standard treatment may require other adjunctive therapies such as chemical peels, PRP, and lasers. This review provides an insight into rational and holistic approach to the management of the underlying acne, early customized treatment along with correction of underlying nutritional deficiencies, and lifestyle modifications in effective treatment of PIH.

Advancements in Laser Therapies for Dermal Hyperpigmentation in Skin of Color: A Comprehensive Literature Review and Experience of Sequential Laser Treatments in a Cohort of 122 Indian Patients

“…The rationales of the laser combinations were based on their specific mechanisms. (Table 7, Figure 1) Standard clinic protocol involved ensuring patient consent, screening contraindications, and correcting nutritional deficiencies guided by blood investigations, with an emphasis on regulating meal timings [63,64]. Post-procedure, the use of antibiotic-topical steroid cream for two days was advised, in addition to sunscreen and ample emollient application.…”

“…The use of a sequential combination of lasers in the protocols is a strength rather than a limitation, as it reflects a thoughtful and individualized approach to dermal pigmentation treatment. Additionally, correcting various macro and micro-nutrient deficiencies and incorporating a protein-rich diet in the early morning was suggested to promote healing, potentially reducing PIH based on the authors' previous experience [63,64]. Further research could be conducted to validate these findings.…”

“…At the same time, it is essential to recognize that certain parameters require individualization to achieve optimal outcomes. Given the link between specific micro-/macro-nutrient deficiencies, meal timings, etc., with various cosmetic dermatological conditions, including PIH, future studies could pursue an investigation involving pre-and post-treatment blood tests to address diverse deficiencies, implementing appropriate laser protocols and dietary modifications to explore a potential correlation between nutrition and pigmentation [63,64].…”