Post inflammatory erythema (PIE) is a common but often over looked sign of skin inflammation. Often overshadowed by its more famous cousin, Post inflammatory hyperpigmentation, PIE is a cosmetic concern for many and deserves it’s share of discussion. In this post, we’ll explore the causes post inflammatory erythema including acne, compare it with PIH and review the best treatments for it.
Understanding Post Inflammatory Erythema
Post inflammatory eythema is the result of a complex series of events in the skin, triggered mainly by inflammation and is common following acne. It presents as a rash of reddish or pinkish spots. These are not pigment deposits but evidence of blood vessel changes underneath the skin. These signal a particular phase of skin healing. Essentially, PIE is a visual reminder of the previous inflammatory activity within the skin. It highlights the delicate balance between healing and the potential for lasting changes in the skin’s appearance.
When the skin suffers an injury, such as from acne, harsh skin treatments, or physical trauma, it responds with inflammation. This is a natural healing process. During this, there’s an increase in blood flow to the affected area as the body attempts to repair the damage. This extra blood flow brings along a surge of white blood cells and various inflammatory mediators, which are vital for healing. However, they can also cause collateral damage. As the inflammation settles, it sometimes leaves behind dilated blood vessels or microvascular damage in the deeper layers of the skin. These damaged blood vessels are unable to shrink back to their original size. As such, they remain more visible through the skin’s surface. These appear as the stubborn red or pink marks we call post inflammatory erythema.
What Causes Post Inflammatory Erythema?
As mentioned above, post inflammatory erythema is mainly due to an inflammatory response in the skin. Whilst PIE can occur in all skin tones, it is often more visible and stark in individuals with fairer skin. This is because the difference between the erythema and the nearby skin can make it more visible.
Various factors can trigger this inflammation, with acne being one of the most common causes. When acne lesions heal, they often leave behind red or pink marks, which are sometimes also called post acne erythema. Other causes include physical trauma to the skin, such as cuts, burns, or harsh skin treatments like aggressive exfoliation or laser procedures. Dermatological conditions like rosacea or contact dermatitis can also lead to PIE, as these conditions involve persistent skin inflammation. So in essence, any skin injury or condition that results in inflammation can potentially cause PIE. This makes it a relatively common and sometimes unavoidable skin problem. That being said, although these factors can increase the risk, PIE can occur in anyone. It’s appearance can vary based on individual skin type and tone.
PIE Vs. PIH: What’s the Difference?
Post Inflammatory Erythema (PIE) and Post Inflammatory Hyperpigmentation (PIH) are often confused due to their similar origins in skin trauma or inflammation. However, they are separate conditions and need to be treated differently.
Post inflammatory erythema presents as red or pink marks left on the skin after an inflammatory event, such as acne. It occurs when the capillaries (tiny blood vessels) are damaged or dilated, leading to greater blood flow and visible redness. It is also more common in people with lighter skin tones. On the other hand, PIH appears as brown, black, or even blueish spots. It is a result of over production of melanin, the pigment responsible for skin colour, during the skin’s healing process. Whilst acne is also a leading cause of PIH, sun damage and hormones also play a key role. PIH is also more common in darker skin tones due to the higher amount of melanin.
Post Inflammatory Erythema Treatments
The treatment of post inflammatory erythema needs a multi-faceted approach. The aim is to target both the inflammation and vascular aspects of the condition. As such, post inflammatory hyperpigmentation treatments fall in to three strands. These are topical skincare, professional treatments and preventative measures.
Skincare ingredients like niacinamide and azelaic acid can be effective treatments for post inflammatory erythema. Niacinamide is a potent anti-inflammatory that can reduce redness and improve skin barrier function. Azelaic acid not only soothes inflammation but also offers gentle exfoliation. This helps in the gradual fading of post inflammatory erythema marks.
Retinoids, such as Tretinoin, can also play a significant role in the treatment and prevention of post inflammatory erythema caused by acne. They speed up cell turnover, boost collagen production and improve skin texture. Through these actions, retinoids can prevent breakouts and the red marks linked to post acne eythema. Additionally, their anti-inflammatory properties may help reduce the underlying inflammation that contributes to PIE. However, it’s important to use retinoids with caution, especially in sensitive or inflamed skin, as they can cause irritation, purging and dryness. They can also make the skin more sensitive to the sun.
Laser therapy, particularly pulsed dye laser, is considered one of the most effective treatments for post inflammatory erythema. It reduces redness by targeting and shrinking dilated blood vessels. Intense Pulsed Light (IPL) therapy is another option which uses broad spectrum light to diminish redness. For stubborn cases, treatments such as microneedling may help. These stimulate collagen production and skin regeneration. Regardless of whether you opt for professional treatments or not, you will still need a good basic skincare routine to protect the skin and prevent any causes of PIE. It is best to consult with a dermatologist to discuss your options for professional skin treatments. They will help you decide which post inflammatory erythema treatments are best for your skin type and needs.
Prevention as Treatment
It is really important to manage any underlying causes of post inflammatory erythema like acne. This is often done through a targeted skincare routine but you may need to see a specialist if you have any severe skin problems. You should aim to adopt a gentle skincare routine, avoid skin irritants and protect your skin from the sun and environmental aggressors. If you need active products like retinoids, be sure to introduce these slowly to avoid worsening your PIE.
Post inflammatory erythema is a common skin condition that is not harmful but a cause of cosmetic concern for many. It is normally not permanent but can be persistent if left untreated.There are a number of skin treatments for post inflammatory erythema however preventing causative factors like acne is key to managing it. Like any skin concerns, the right treatment for you will depend on your skin type, extent of your PIE and individual goals. Regardless of treatment type, you will need to be patient and regular to ensure optimal results.
At City Skin clinic, we are passionate about personalised skincare. Through our online skin clinic we connect clients with our doctors for safe and effective treatments like Tretinoin and Hydroquinone. We treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. To get started on your personalised skin protocol, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.