Melasma, also known as facial hyperpigmentation, causes brown or tan patches on the face, due to an overproduction of melanin. There are a number of triggers to melasma including pregnancy, birth control pills, and sun exposure. Melanin is the primary determinant of skin pigmentation and hair color, and if you produce too much melanin in any area of your body, the result is hyperpigmentation, a brown spot, or discoloration on your skin. Dr. Michele Green is an expert in treatment melasma as well as disorders of hyperpigmentation on the face and body. As a leader in cosmetic dermatology, she is an expert in treating pigmentation with chemical peels, Cosmelan, Mesopeels, and laser treatments.
Hyperpigmentation, as well as melasma, can be exacerbated by treating the skin with the wrong laser therapy, or a laser which is not correct for your particular skin type. Dr. Michele Green specializes in treating these cases of hyperpigmentation as a consequence of laser therapy. In some cases, pigmentation can occur after laser resurfacing with Fraxel laser, IPL, Picosure, Halo laser, ablative lasers, laser hair removal, or other laser treatments. This side effect, known as post-laser hyperpigmentation or post-inflammatory pigmentation (PIH) consists of dark patches or lesions, which can take a year or longer to resolve on its own, or be permanent without the proper treatment. Patients who have darker skin tone, are at an increased risk for this condition, so special care must be taken when choosing laser treatments. Unfortunately, poor patient selection and laser choice can often cause this unwanted side effect from laser treatment.
Post inflammatory hyperpigmentation (PIH) can be caused by injury to the skin as a result of a sunburn, surgery, laser treatment or other cosmetic procedure. If you are suffering from post inflammatory hyperpigmentation from laser treatment, Dr. Green is here to help you. With over 25 years of experience in treating melasma and disorders of pigmentation, in her boutique NYC office, she will help remedy your facial or body discoloration. From the best skin care, skin lightening and brightening, bleaching, chemical peels, and non-ablative treatments, Dr. Green is a world renowned, board certified dermatologist, in New York. She is an expert in treating conditions involving pigmentation and post inflammatory hyperpigmentation.
55-64 year old woman treated with Cosmelan
What is Post inflammatory hyperpigmentation?
Post inflammatory hyperpigmentation (PIH) is a temporary, or permanent, pigmentation that follows an injury to the skin. PIH is most common in patients with darker skin tones, whose skin is more sensitive to this type of injury. Post inflammatory hyperpigmentation can be the result of inflammatory acne, eczema, various dermatoses, or after laser treatment. Even some medications, such as antimalarial drugs, can cause post inflammatory pigmentation of the skin.
When the skin gets damaged, the inflammation in the epidermis stimulates the melanocytes to increase melanin production and to transfer the pigment to the surrounding keratinocytes. The dermal layer of the skin can be injured as well and the melanin becomes trapped in this basal layer and appears discolored. The areas of the skin which are inflamed heal with patches that are light brown to almost black in color. Exposure to ultraviolet light (UV light) worsens this inflammation, as well as laser treatment. For this reason, strict sun protection of the inflamed or hyperpigmented areas is crucial to allowing the skin to heal, as well as constant reapplication of sunscreen with an SPF 50 or higher.
Topical Therapies for Post inflammatory Hyperpigmentation
There are many different topical creams which can be used to lighten post inflammatory hyperpigmentation and improve the appearance of the skin. The following topical treatments can be used in combination to brighten this pigmentation both in the dermis and epidermis of the skin:
- Vitamin C
- Tranexamic Acid
- Azelaic Acid
- Kojic acid
- Glycolic acid peels
- Steroid creams
- Licorice extracts
- Lactic Acid
- Salicylic Acid
- Mandolin acid
- SkinMedical Lytera Skin Brightening Complex
- Tri-Luma (Prescription of fluocinolone acetone 0.01%, Hydroquinone 4%, tretinoin 0.05%)
- Elure Advanced Brightening Night Cream and lotion (contains Ligninase)
- Extracts of orchid, grape seed, Aloe vera, marine algae, or green tea
Woman treated with Cosmelan – 10 weeks
Who is most susceptible to post laser hyperpigmentation and PIH?
Patients with darker skin types are the most susceptible to the effects of laser treatment. In particular, Asian patients, Hispanic patients, and African American patients who have Fitzpatrick skin types III or greater. While fractional lasers are considered safe for patients with darker skin tones, they are at an increased risk for having erythema and pigmented areas with resulting post inflammatory hyperpigmentation. The darker your skin tone, the more difficult it can be to lighten this epidermal melanosis.
Laser Hair Removal and PIH
Choosing the correct hair removal laser is essential not only to having the best cosmetic results, but also to avoid unwanted side effects, such as post inflammatory hyperpimentation (PIH). If you have darker skin tone, such as Latina, Asian, or African American skin, special care must to used in selecting the correct laser and settings used for laser procedures, including laser hair removal. The Candela Gentle Yag Pro Laser is specially designed for patients with darker skin types, who are most susceptible to post inflammatory hyperpigmentation.
When choosing to have laser hair removal, it is crucial to select a clinician who understands your skin type and the correct laser treatment to prevent any unwanted side effects, such as PIH. Unfortunately, in many states, laser treatments are not under regulations, and there are many spas and clinics which have untrained and unauthorized assistants doing laser hair removal. It is important to do your research and google the best lasers and treatments for your skin type, before proceeding with any cosmetic treatment.
Woman treated with Cosmelan – 12 months
How to treat hyperpigmentation after laser?
Depending on the area of the body which is hyperpigmented by laser treatment, there are a number of different skin lightening creams and modalities used to treat hyperpigmentation after laser. First line treatment is with skin lightening creams and sun avoidance. Depending on the area of skin involved, hydroquinone based products may be best to use to have the quickest response. Unfortunately, there are areas of the body which are too sensitive to hydroquinones and a skin lightening cream which contains tranexamic acid or other non-hydroquinone based product should be used.
Dr. Green offers both hydroquinone, retinoid, and hydroquinone-free products for skin lightening, for the different areas of the body. Areas such as the axillae, inner thighs, and bikini area are more sensitive to hydroquinones and require different creams and different methods of skin lightening. Dr. Green is an internationally renown expert in skin lightening, chemical peels, Cosmelan and laser skin treatments, and with her MGSKINLABs unique line of products will help customize the best treatment for you.
Chemical peels for PIH
One of the classic methods for removing post inflammatory hyperpigmentation from lasers are chemical peels. There are a variety of types and strengths of chemical peels, from trichloroacetic (TCA) acid, salicylic acid, to glycolic acid, to treat PIH. Strong chemical peels cannot be used when treating PIH since this will induce too much inflammation and can result in an increase in hyperpigmentation.
Vi Peels are another form of chemical peel, which can treat pigmentation, pores, scarring, and PIH. Vi Peels are a combination of TCA, retinoid acid, salicylic, acid, and phenol. Vi Peels do not induce the same inflammation as high strength peels induce. These peels can be used in conjunction with hydroquinones, kojic acid, and hydrocortisone, to increase the improvement of the PIH.
Cosmelan, Mesopeels, and Dermamelan are excellent types of chemical peels, which can be used to treat post laser hyperpigmentation on various areas of the body. Cosmelan is ideal for treating facial pigmentation, especially when melasma is worsened by laser treatment. Mesopeels can be used on the more delicate areas of the body, such as the axillae and groin, and Dermamelan Intimate for discoloration and PIH in the groin and vaginal area. Depending on the area of the body affected with PIH, there are unique treatments to ameliorate each of these special areas.
What is the Best treatment for Post Inflammatory Hyperpigmentation (PIH)following laser
The best treatment for PIH depends on both your skin type, and the area of skin affected by the laser treatment. Again, laser treatment is not the best way to treat PIH. Topical skin lightening creams and sunblocks is the first line treatment for PIH. Unfortunately, when numerous laser treatments have been performed, the post inflammatory hyperpigmentation can be severe, and cosmetic treatments such as chemical peels are indicated.
One of the best treatments for resolving PIH after laser treatment is Cosmelan. Cosmelan is uniquely able to treat PIH on the face and chest as a result of laser treatment and other discoloration. For more sensitive areas, such as the axillae and groin, Mesopeels combined with hydroquinone free skin care is very effective at treating these areas of hyperpigmentation. When the under eye area is involved, Mesopeel Periocular peels are specifically formulated for the delicate skin around the eyes and treating dark circles.
Cosmelan peels for treatment of post laser hyperpigmentation
Cosmelan is a two-part system of chemical peels to treat melasma, discoloration, PIH, and hyperpigmentation of the face. Depending on both the degree of sun damage and your skin type, the Cosmelan MD peel is left on the skin from 4 to 10 hours. Cosmelan peels consists of a compound of 8% hydroquinone, Retin-A, and 51 active ingredients to lighten the skin. The main Tyrosinase inhibitors which lighten the skin in Cosmelan include Kocic Acid, Azealic Acid, Arbutine, Phytic Acid, Licorice, and Ascorbic Acid.
Cosmelan peels are used in conjunction with a specific at home treatment protocol that patients need to follow, to augment the in office Cosmelan peel. The protocol consists of using Cosmelan 2 as directed each day and avoiding all sun with daily use of a high SPF sunscreen. After 3 weeks of using the home products as directed, the patient returns to the office for the second Cosmelan peel. This second peel is followed by continued use of the at home creams and close follow up by Dr. Green after the topical creams are completed.
Cosmelan treatment for melasma
Mesopeels Periocular for Post Inflammatory Hyperpigmentation around the eyes
There are cases of post inflammatory hyperpigmentation around the eyes and dark circles, which are difficult to treat. Mesopeel Periocular are specially designed to treat discoloration and hyperpigmentation around the eye area. A series of peels are performed two weeks apart, until the pigmentation resolves. Typically six Mesopeels are indicated.
Is Post Inflammatory Hyperpigmentation (PIH) after laser permanent?
In general, PIH is a treatable cosmetic problem that requires time and patience with topical treatment, and strict sun avoidance. However, there are many cases which require chemical peels, Cosmelan peels, and strong skin lightening agents to bring the color of patients with darker skin back to normal. Unfortunately, there are times when the damage is so severe from the laser, either with hyperpigmentation or hypopigmentation, that the results are permanent.
What is the Best Laser for Post Inflammatory Hyperpigmentation (PIH)?
Laser treatments are not the best method for treating post inflammatory hyperpigmentation. Although there have been reports, such as those from the J of Am Acad Dermatology and the Journal of Eur Acad Deramatol Venereol describing treatment with low-fluence 1064-nm Q-switched nd:yag laser, Erbium laser and Fraxel laser, it is best not to attempt treatment with these lasers. Even Dermatol Surg Journal describes the treatment of PIH with fractional photothermolysis as well as the Am J Clin Dermatology describing improvement after the low-dose Q-switched neodymium-doped yttrium aluminum garnet laser treatment. Since most post laser hyperpigmentation was caused by too much energy to the skin, applying more heat through laser energy may not be the best treatment option for reducing PIH. There are many patients who have PIH from frequent Fraxel laser treatments, IPL, Picosure, or Halo laser treatments and continuing to do more treatments with these lasers is not the best option. Healing this PIH generally involves topical therapy with some form of chemical peeling to create new collagen in your skin.
Sunscreen and post laser hyperpigmentation
Photo protection is crucial in the successful management of post laser hyperpigmentation, PIH, and especially melasma. Both UVB and UVA rays can stimulate melanin production by melanocytes. UVB is the largest erythemogenic, causing the most pigmentation, while UVA can also lead to increased cases of chronic pigmentation. Dr. Green recommends using both a physical sunblock along with a chemical sunblock, to completely protect your skin from both UVA and UVB rays.
A sunscreen with a physical block would include one with zinc oxide or titanium dioxide. Sunblocks with avobenzone, oxybenzone, or octocrylene, can provide increased broad spectrum protection from both UV rays, and protect against the visible spectrum. Tinted sunscreens, such as those with iron oxide, may produce added photoprotection benefits. In addition to sunscreen, sun avoidance, broad rimmed hats, sun protective clothing, and sunglasses, all help to protect your skin from the sun.
How do I get started treating my post laser hyperpigmentation?
Dr. Michele Green is an expert treating disorders of hyperpigmentation, PIH, and adverse results from laser therapy. Generally, a combination of hydroquinones, retinoids, chemical peels, and Cosmelan therapy are the most effective treatments for all skin types to treat reactive hypermelanosis. To find out how to treat hyperpigmentation and discuss all cosmetic options for treating hyperpigmentation call Dr. Green today at 212-535-3088 or contact us online today.