Know Your Acne Marks: Post-Inflammatory Erythema 101

Persistent acne scars and marks are often a prolonged battle for most acne sufferers. Acne is one of the most common skin diseases, which affects approximately 80% of the global population. Its inflammatory nature usually leads to acne scars and marks that have a significant effect on one’s self-image.

Often times, individuals will have a combination of discoloured marks, skin pigmentation and textural scars. Recognizing these distinctions is important so the right acne scar removal methods can be carried out to meet patients’ concerns adequately and address the residual acne imperfections.

1. Not all inflammatory acne scars are the same

Post-inflammatory erythema, or PIE, is a new term that was introduced in 2013 to describe the phenomenon of pink-to-red discolouration that is left behind on the skin after an inflammatory acne lesion. These persistent red marks can appear following your acne treatment. PIE is distinct from PIH as PIH (hyperpigmentation) refers to pigment change while PIE describes residual erythema (redness).

Facial PIE can improve and fade over time, but it occurs very slowly. In some cases, however, a complete clearance of PIE cannot be achieved. PIE can vary in appearance, depending on the severity – from pink, red to deep purple discolouration.

2. Caused by damaged capillaries under the skin

While hyperpigmentation is caused by an overproduction of melanin, PIE happens when tiny blood vessels (capillaries) get dilated or damaged due to inflammation and trauma. This can occur by causes like popping pimples and inflamed acne. However, there are also non-acne related causes like sunburn, chemical/laser burns, over-exfoliation, cuts, and scratches.

3. Check for it with a simple touch test

It’s pretty easy to tell if you have atrophic or hypertrophic acne scarring. But it can be hard to differentiate between PIE and PIH. It is also not uncommon that you might have a combination of both. But this simple touch test can help you figure out whether you have post-inflammatory erythema. Apply light pressure to the skin and press down on the area where the suspected PIE is. Check to see if it momentarily disappears or turns white – if yes, PIE is present. Known as skin blanching, this refers to the temporary restriction of blood vessels. Hyperpigmentation does not react the same way under pressure.

4. Treating and caring for PIE

It is crucial to prevent further inflammation when dealing with PIE. Avoid picking your skin with your fingers as this will push bacteria further into the wound, thus risk contaminating and aggravating the condition. Harsh physical exfoliating scrubs can be abrasive and induce micro-tearing into the skin, leading to weakened and broken blood vessels. Sunscreen is also highly recommended – unprotected and extended sun exposure can darken the marks and make it harder to treat.

If you’re looking to quickly improve the appearance of post-inflammatory erythema on your skin, vascular or pulsed dye lasers have been shown through anecdotal studies to improve PIE. It targets haemoglobin in the blood through the process of selective photothermolysis, and dissipate the pooled or damaged blood vessels to reduce the prominence of vascular in PIE effectively. The VBeam Prima is one such efficient pulsed-dye laser that works with dual wavelengths – 595nm and 1064nm to treat various skin conditions including rosacea, wrinkles, port wine stains, facial and leg telangiectasia and similar vascular conditions. It comes with a built-in dual cooling system to treat vascular and pigmented lesions simultaneously, and ensure epidermal protection.

Another suitable treatment is the Q Switch Nd:YAG laser which produces non-invasive laser energy pulse with a wavelength of 1064nm, enabling it to penetrate deeper into the skin without affected surrounding healthy skin. The targeted pigments will be broken down into smaller fragments and get naturally disposed by the body’s lymphatic system. At the same time, the laser helps to stimulate the skin’s own collagen production for increased skin firmness and elasticity. With low downtime, it has been provide to decrease skin pigmentation such as PIE, freckles, sun spots and melasma.

It’s important to get a full assessment of the cause and nature of the condition before starting on any treatment plan. Do consult with our doctors to determine the type of acne scars you have and the recommended approach to resolve your skin concern.

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