Our battle with acne doesn’t stop as soon as they flattened and healed. We are often left with the aftermath of acne marks (depigmentation). It may leave brown post-inflammatory hyperpigmentation (PIH) or red spots post-inflammatory erythema (PIE) on our skin. Both of these marks may look kind of similar to each other, but they are caused by different things and have to be tackled with different strategies. We have talked about post inflammatory hyperpigmentation on our previous post, so make sure to check it out. In today’s post we are going to discuss the red marks or also called PIE.   

What is it 

This term of post-inflammatory erythema was coined the first time in 2013 (they are considered as a pretty new term). It described the residual pink-to-red discoloration after an inflammatory acne lesion. This type of pigmentation often occurs on people with lighter skin type (Fitzpatrick type I – III). 

PIE doesn’t really require any type of treatment to resolve, however, it may last from months to even years. It may really affect one’s confidence since it aggravates or gives an illusion as if your acne is not getting any better. 

Why people get them

The exact process of how it happens (pathogenesis) hasn’t been clearly elucidated, however it is speculated due to the continuous dilatation of the blood vessels during the acne healing process. The small blood vessels are located mainly near the surface of our skin and give that red appearance due to high concentration of blood vessels around the area. This condition may be worsened or accentuated on people with lighter skin tone or on areas with ‘thinner’ skin.

Just like any other types of acne marks, some characteristic of your acne may determine the severity of the aftermath we will be facing. Some of the characteristics are:

1. 1) Type / severity of your acne 

This type of scars may occur from most inflammatory acne and even more commonly seen in cystic acne.

1. 2) Duration of active acne 

The longer the inflammatory process, the more damage it causes on your skin. The more damage means the longer the process of healing / repair. 

1. 3) Picking / popping the pimple 

Picking or popping your pimple inappropriately may aggravate and prolong the inflammatory process and leave you with deeper and stubborn red marks.

How to prevent them 

Before we talk about the treatment, let’s get into how to prevent them in the first place because prevention is always better than treatment. Here are some of the steps you can take to minimize the risk / chance of developing a PIE that last forever to heal:

1) Use your sunscreen

Use sunscreen of at least SPF 30 with broad spectrum protection every single day. This prevents the exacerbation of inflammation due to excessive UV radiation. Make sure to reapply appropriately throughout the days especially if you are sweating or exercising.

2) Early and proper treatment 

The sooner your pimple resolves, the less chance it forms any kind of acne marks. Ingredients that help strengthen the skin barrier and lessen inflammatory processes may reduce the inflammation process, but it won’t be a 100% guaranteed preventive measure.

If you are prone to PIE formation and it does really affect your confidence, don’t hesitate to seek professional help from your dermatologist. They can provide the most appropriate treatment tailored for your skin condition.

3) Do not pick your pimple

• Ingredients in skincare to look for

  Evidence for topical products to tackle PIE are limited and has been unsatisfactory. However, there is some evidence that shows the benefit of tranexamic acid (5%) for PIE. 

1. However, having the right skincare regime that helps strengthen the skin barrier, high in antioxidants with anti-inflammatory properties can help support and fasten your skin healing process.

☑️ General: 

• • Sun protection

• • Be gentle to your skin

• • Set the right expectations

• • It takes time to heal

Here are some of the ingredients you want to look for 

☑️ Skin barrier repair 

• • Ceramide 
• • Fatty acids 
• • Cholesterol
• • Niacinamide 

☑️ Anti-inflammatory 

• • Azelaic acid 
• • Green tea 
• •  Allantoin
• • Panthenol

☑️ Antioxidant 

• • Vitamin C 
• • Resveratrol
• • Astaxanthin 

Other treatment you can consider 

If your topical treatments haven’t been working well for you and you are not patient enough for it to resolve naturally, you may want to consider some medical treatments, such as:

Laser treatment:

This type of laser targets transfer heat to the blood vessels on the dermis, eliminates the damaged areas of blood vessels and reduces the inflammation / discoloration, thus called as vascular laser. 

2. 1. 1) Pulsed-dye laser (PDL): Gold standard treatment for PIE.  
   2. 2) Intense pulsed light (IPL)
   3. 3) Potassium Titanyl Phosphate (KTP) laser  
   1. 4) Nd:YAG laser 

Other non-laser treatment:

1. 1) Fractional microneedle radiofrequency 
2. 2) Microneedling