For the record, freckles speak of youth and sunshine. Whether you have a few dainty frecks or a joyful constellation, it’s hard to not be charmed by them. Dark spots of the other variety, also known as post-inflammatory hyperpigmentation (PIH), however, are less so. As we seek to normalise acne and textured skin, it’s normal to also feel that nothing dulls your glow faster than a blemish that simply refuses to budge. While acne can occur at any age, compulsory mask-wearing coupled with the need for long-wearing make-up in our humid climate has meant that it’s open season for maskne. And just when you think you’ve got that pimple under control, you’re left with a dark spot that seems to take forever to heal and fade.
Thankfully, skin discolouration that occurs as a result of trauma—be it acne, injection mark, or even the rubbing of your mask—is remedied with these dark spot fading solutions.
What is post-inflammatory hyperpigmentation (PIH)?
PIH occurs when trauma to the skin triggers its natural healing response, leading to an overproduction of melanin in the skin. Acne, cuts, cold sores, rashes, or sunburn are often the common culprits, and PIH can be further exacerbated from sun exposure, even if you have a deeper skin tone.
“Both PIH and PIE are conditions that result after skin inflammation, caused by the cyst, or trauma from mechanical rubbing or needle prick,” says Epion Clinic‘s Dr Melvin Tan. PIH refers to post-inflammatory hyperpigmentation and “manifests as a brown skin discolouration due to excessive melanin production. This is more commonly seen in darker skin individuals that sit at 4, 5, and 6 on the Fitzpatrick scale.
What is post-inflammatory erythema (PIE)?
PIE occurs when inflammation or trauma causes damage to or dilates blood vessels thanks to over-exfoliation, insect bites, sunburn, picking or squeezing your zits.
“PIE refers to post inflammatory erythema and shows up as reddish discolouration of the skin due to damage to the underlying blood vessels. This is usually seen in fairer skin individuals,” explains Dr Tan.
Does PIH affect people of different skin tones or types differently?
Yes, according to Dr Tan. “PIH is more common in darker skin tones, where it is also more severe.”
What are the best actives for removing PIH and PIE?
“For PIH, effective over-the-counter actives include glycolic acid, lactic acid, arbutin, vitamin C and niacinamide. Prescriptives include hydroquinone and Retin-A,” says Dr Tan. Other treatments include ferulic acid, kojic acid, retinoids and licorice extract.
“PIE is more challenging to treat using skin care products. AHA and Retin-A may hasten recovery of the condition indirectly by replenishing the skin. Azelaic acid may also be helpful although generally there isn’t much clinical data on all these. I often recommend the patient undergo a treatment such as broadband light, long pulsed NdYAG laser or microneedling with radiofrequency.”
And the gold standard for every skin type and condition, of every age: religious application and reapplication of a broadband SPF.
Medicube C 13.5% Deep Vita C Ampoule
Skinceuticals Blemish + Age Defense
How often should I use these PIH-removing actives?
While it’s tempting to go all in with your acids and actives, more isn’t necessarily better. It’s best to introduce them in small amounts, starting from once or twice a week building up to alternate days as bombarding your skin with acids and retinol (always a no-no if mixed together) can cause more harm than good. Spot treat the areas of PIH if they are your only concern. Opt for vitamin c and arbutin in the day, with niacinamide and a pea-sized amount of your retinoid in the evening. AHAs and BHAs such as glycolic and salicylic acids should be used alone, and not combined in the same routine with your vitamin C or retinoids as this will destabilise your skin’s pH causing further irritation.
Dr Tan advises daily use of these skincare actives for his patients, noting that this is moderated to every other day, “depending on how reactive their skin is. I do use all of the above with retinol, however you would need to take advice from your physician, who will need to monitor your treatment,” says Dr Tan.
Would applying a hydrocolloidal patch help to speed up acne healing and possibly blemish recovery?
“These patches provide a moist environment which encourages wound healing and limits inflammation and subsequent scar development,” says Dr Tan.
COSRX AC Collection Acne Patch
Peach & Lily Peach Slices Dark Spot Microdarts
What are the best in-clinic protocols for minimising PIH?
“Skincare-wise, I would advise my patient to use Epion Clinic’s 3.1 Renew AHA serum in the morning, and 4.1 Fortify Retinol serum at night, blended with Tretinoin to replenish the skin.”
Epion Skin 3.1 Renew Apha Hydroxy Acid
“Depending on the severity, I would also prescribe a skin lightening product on the PIH spots as well, either hydroquinone or Retin-A based,” says Dr Tan. “As far as treatments are concerned, Pico Pulsed and NdYAG lasers are excellent for shifting the pigment packets. I find microneedling with radiofrequency solutions such as Sylfirm effective also effective at accelerating PIH and PIE clearance. Resurfacing treatments such sublative radiofrequency and microlaser peeling, and fractional Erbium YAG laser stimulate regeneration of new, healthy skin.”
Are there any PIH-fading treatments to be wary of if you have a deeper skin tone?
“All these treatments can be suitable for darker skin tones, although you would need to consult with your doctor as to which is the most appropriate for your condition,” Dr Tan cautions.