An introduction to PIE; your PIH may not be what you think it is.

PSA

Before today, I have never heard the term Post Inflammatory Erythema. I did some research after stumbling upon the term by a post made by u/bathinginreddit and it may be actually more common among us than we think.

So what exactly is Post Inflammatory Erythema?

Small capillaries near the surface of the can become dilated or damaged due to inflammation. This reflects on our skin as an area of redness and on occasion even the individual capillaries are visible. This is a common condition in people with acne and is most visible on lighter skin types.

What is the difference between Post Inflammatory Hyperpigmentatin (PIH) and Erythema (PIE)?

Post Inflammatory Hyperpigmentation (PIH) refers to brown discolorations that are caused the excess production of melanin. Vitamin C, Alpha Hydroxy Acids (AHAs), Hydroquinone are all great ingredients for inhibiting melanin which will in turn fade the discolorations. Although these ingredients do not have any effect on red or purple scarring - which is what many people seem to suffer from. PIH is more common on darker skin types (IV-VI), though it is not limited to just this skin type.
Post Inflammatory Erythema (PIE) is a new term which is still gaining traction and usage in dermatology. PIE is beginning to be used to describe pink to red discoloration caused by inflammation (usually an acne lesion). Although with lighter skin types (I-III) we have almost always associated postinflammatory dyspigmentation with the term hyperpigmentation, though it is often not PIH but instead discrete erythematous macules (PIE).

For a visual guide on what post inflammatory erythema can look like please see the following references pictures; Picture 1, Picture 2

How do you test for Post Inflammatory Erythema?

Erythema disappears when you apply pressure to the area, where in comparison, hyperpigmentation does not. This effect is known as blanching. It is possible to see this effect and tell the difference on your own skin by finding a piece of clear glass (like a cup) or plastic and apply pressure to the area. If the area becomes white or changes color when you depress your skin then you most likely have Post Inflammatory Erythema (PIE). Though the best way to find out is to see a dermatologist.

For more visual example of skin blanching, Here is a .GIF

Treatments of Post Inflammatory Erythema

Now that we know what PIE is, how you can get PIE, we move onto how do you treat PIE.

In a normal conversation, I would say with a knife and fork is the best way to deal with PIE.

However today, I’m going to go over a few different options for people who deal with Post Inflammatory Erythema on their skin.

Outside of professional treatments (Pulsed Dye Lasers and Silicone Sheeting), there is little a person can do in terms of a topical solution. Keep in mind that Post Inflammatory Erythema is not permanent damage. Most dermatologist do not recommend treatment because PIE will often resolve on its own over time; Pulsed Dye Laser treatments often costs hundreds of dollars per session and can take up to ~5 treatments to see maximum results.

Patience is cheaper, but sometimes harder to come by.

Although there has been no studies done, niacinamide has been suggested that it can help lighten PIE on topical application.

u/bathinginreddit has asked Dr. Satur from PocketDerm what her thoughts regarding PIE. Here is what she had to say.

We think of post-inflammatory erythema as being a clinical manifestation of dilated capillaries—helped most by “tincture of time”, i.e., a little patience! Tretinoin helps the redness of inflammatory acne, because it helps the acne itself. I think of any improvement in static redness to be a consequence of increased dermal collagen synthesis induced by the tretinoin, in effect, obscuring capillaries. Tretinoin does have some anti-inflammatory effects; but then, it also may induce a “retinoid dermatitis”, thus worsening redness. So, in summary, for redness, tretinoin may be a wash! A topical cortisone may temporarily help redness (the potency of different topical steroids can be assayed by a skin blanch test, or vasoconstrictor assay). However, longer-term use, especially of stronger topical steroids may result in permanent worsening of dilated capillaries—not good! Silicone gel sheeting may help redness somewhat, as well as thickened scars, for reasons that are not clear. I have not had success with Mederma in my office, but it is available otc.

Bae-Harboe, Yoon-Soo Cindy, and Emmy M. Graber. "Abstract." National Center for Biotechnology Information. March 04, 0006. Accessed September 14, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780804/.

"Post Inflammatory Erythema (PIE) • r/SkincareAddiction." Reddit. Accessed September 14, 2014. http://www.reddit.com/r/SkincareAddiction/comments/1tk78i/post_inflammatory_erythema_pie/.

Puri, Neerja, and Ashutosh Talwar. "Abstract." National Center for Biotechnology Information. December 28, 0005. Accessed September 14, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2918339/.

"Result Filters." National Center for Biotechnology Information. Accessed September 14, 2014. http://www.ncbi.nlm.nih.gov/pubmed/17700980.

"The Science of Acne." The Science of Acne. Accessed September 14, 2014. http://thescienceofacne.com/the-types-of-acne-scars/.

Posted Sep 14, 2014, 11:43 PM UTC · edited

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