If you’ve ever had a pimple flatten out and heal, only to leave behind a reddish mark that doesn’t seem to go away, then you have experienced the unfortunate condition of post-inflammatory erythema of acne (PIE). Even if these marks eventually go away on their own, you’ll spend a good couple of months needing to cover it up for an even complexion--and in large numbers, they can definitely take a toll on your self-esteem.
If you want to get rid of your PIE, you should first know what you’re dealing with. This will help you choose the most appropriate treatment for this particular post-pimple skin change.
PIE, PIH, or a true acne scar?
The ghosts of pimples past come in three forms. Because their pathophysiological mechanisms are different, their treatments differ too. What may work on one may not improve appearance of another, so the first step to resolving post-acne lesions is to identify what they actually are.
A true acne scar represents a difference in texture. These are caused by the inappropriate amount of collagen that is deposited when your skin heals. When there’s too little collagen, you get indentations or depressions on the skin, resulting in “icepick”, “boxcar”, or “rolling” scars. When there’s too much of it, you get raised patches called keloid scars.
Post-inflammatory hyperpigmentation (PIH) occurs when the skin where an active pimple used to be is smooth and flat in texture, but is brown, grey, or grey-blue in color. This is caused by overproduction of the skin pigment melanin during the skin healing process and is particularly prominent in people with skin that tans easily.
Post-inflammatory erythema lies flat on the skin just like PIH, but the color is pink, red, or dark purple. In fact, it was only in 2013 when dermatologists differentiated PIE from PIH. They realized that the reddish coloring occurred because there was underlying and chronic damage to the capillaries just under the skin. It appears that this type of post-acne lesion is most prevalent among light-skinned people.
It’s important to note that people may have a combination of PIE, PIH, and tru acne scars, depending on their skin type, the depth of pimple, and severity of infection or irritation.
How can PIE be treated?
The one saving grace of PIE is that it resolves on its own in a shorter period of time than PIH and acne scars. There is still a lot of research to be done since it’s been less than a decade since PIE was identified as a separate condition. However, understanding the vascular nature of PIE helps dermatologists make logical suggestions about products that will improve the appearance of those pesky red spots.
Use anti-inflammatory topical products.
We know that PIE is vascular in nature--that is, it has something to do with problems in our skin’s normal blood supply. Redness is one of the cardinal signs of inflammation, so anti-inflammatory products are likely to have a positive effect.
There are products that have long been proven effective in decreasing the number of PIH lesions, including those we now know as PIE. Doctors hypothesize that drugs used to treat rosacea may also improve the appearance of PIE because both conditions are vascular in nature. Azelaic acid, Vitamin C, tranexamic acid, niacinamide, and topical steroids have anti-inflammatory properties that can help keep redness down.
Note that these active ingredients may lead to unwanted side effects if used incorrectly. Do your research, do a spot test, and consult your dermatologist before taking any topical drugs.
Consider laser treatment.
Aside from topically-administered products, you may also consider laser treatment. Pulsed dye laser treatment has had promising results in early studies on PIE. It works by selectively destroying hemoglobin, which is found in the red blood cells in the capillaries under the skin. By targeting hemoglobin, other cells and tissues are not damaged.
This treatment has been successfully used in treating vascular disorders such as telangiectasia, cherry angiomas, and even superficial hemangiomas, so it’s easy to see why it would be effective on PIE. But even procedures like this take time to work. It’s a little pricey because you will need multiple sessions to show noticeable improvement, but many people say it’s well worth the investment. Because of side effects involved in laser treatment, you should consult your dermatologist before trying it out.
Protect your skin from the sun.
The ultraviolet radiation of the sun has long been associated with skin damage, hyperpigmentation, and increased redness. If you want your skin to heal from acne, as well as from the marks it leaves behind, you should be strict about sun defense measures. Use a broad spectrum sunscreen with SPF 30 and apply multiple times throughout the day. Avoiding the sun when able, or protecting your face by using hats are other important ways to minimize worsening of PIE.
Prevent breakouts.
As they say, an ounce of prevention is worth a pound of cure. Treating PIE is not going to improve the skin’s appearance if zits keep popping out and leaving more red marks in their aftermath. There are many acne fighting options in the market that can also help address inflammation, making it a two-in-one-product for the PIE-prone.
