Skin care professionals and clients alike have experienced those annoying red spots that remain long after an acne breakout. They seem to last forever. Eventually, these red spots disappear, but as aestheticians know, there is a quicker solution and ways to help clients rid their skin of post-inflammatory hyperpigmentation.
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UNDERSTANDING POST INFLAMATORY HYPERPIGMENTATION
Post-inflammatory hyperpigmentation is “inflammation or trauma to the skin that causes the release of inflammatory cells that cause melanocytes to produce more pigment in the skin. Severe inflammation or trauma can disrupt the bottom layer of the epidermis causing pigment to leak into and become trapped in the dermis. This results in a deeper and more treatment-resistant pigmentation.”1 Aestheticians commonly see post-inflammatory hyperpigmentation with post-acne clients. Post-inflammatory hyperpigmentation is more common in clients with darker skin types, such as Fitzpatrick types IV to VI. These clients are also prone to develop melasma and sun damage.
CAUSES & TRIGGERS
“Inflammation in the epidermis stimulates melanocytes to increase melanin synthesis and to transfer the pigment to surrounding keratinocytes. If the basal layer is injured, melanin pigment is released and subsequently trapped by microphages in the papillary dermis.”2 When skin care professionals perform skin consultations with clients, they can automatically see which clients pick at their skin. The ones who pick tend to have flat, red marks on their face. They have created trauma and damage to their skin, which results in an inflammatory response of the melanocyte. Melanocytes lie within the basal layer of the epidermis. Another key player is tyrosinase, and it controls the production of melanin.
“Tyrosinase is responsible for the first step in melanin production. It converts a protein building block called tyrosine to another compound called dopaquinone. A series of additional chemical reactions convert dopaquinone to melanin in the skin, hair follicles, the colored part of the eye, and the retina.”3 In order to effectively treat post-inflammatory hyperpigmentation, the use of a tyrosinase inhibitor is best when used daily by clients.
Most clients are careless when it comes to their skin; they go outside without wearing sunscreen or only wear makeup containing sunscreen. Many clients pick at their skin, even though they know better. They buy harmful over-the-counter skin care products or handheld devices beauty bloggers promote. Many clients create post-inflammatory hyperpigmentation by using improper products or devices.
PREVENTION OF POST-INFLAMMATORY HYPERPIGMENTATION
Practitioners know their clients are going to do what they feel is best, but an aesthetician’s job is to educate clients. This gives them the knowledge and tools to make informed decisions when faced with skin care products or how to best care for their skin.
Begin with education. Clients know picking at blackheads or acne is bad, but it is important to sit down with the client and help them understand what they are doing to their face when they pick. Do not use scientific or professional words because that will confuse them, and they may stop listening. Help clients understand in terms like, “When you pick at a blackhead, you are getting dirt from your hands and nails on your skin, creating inflammation and damage that can result in a scar.”
Skin care professionals know exactly which of their clients are notorious for picking because they are the ones who come in with flat, red post-inflammatory hyperpigmentation marks. Once the scar forms, it is much more difficult to treat than if the client had left it alone and let a proper extraction occur.
Another great way to prevent post-inflammatory hyperpigmentation is to teach acne clients to ice their acne, rather than try to pick or extract it themselves. Practitioners can even recommend clients to spot treat with an acne mask overnight to reduce inflammation. For example, buy sample-sized containers of an acne mask and sell that to the regular clients since they will be primarily be using it as a spot treatment. Skin care professionals do not want to sell clients retail products that will strip their skin or contain certain ingredients that are not designed for their skin type. In the cases of older clients who are pickers and tend to have those few random breakouts, a sample-size amount of an acne mask can work wonders and prevent post-inflammatory hyperpigmentation when used properly.
Just remember to continue to educate clients. Life gets hectic and clients forget what has been discussed during their last facial. Making sure they have the right homecare products and knowledge will build their personal toolbox, so they stop doing things to further damage their skin.
In acne clients, post-inflammatory hyperpigmentation is common because inflammation is present in the skin. Teaching young clients to ice their acne each day helps to reduce inflammation. Just like when an individual sprains their ankle, they immediately apply ice it to reduce swelling and ease the pain; if practitioners treat acne inflammation the same way, they will help clients achieve better results and reduce the painful acne eruptions that occur. Most likely these clients’ skin will result in post-inflammatory hyperpigmentation once the acne inflammation has subsided, but for some, ice and a spot treatment of an acne mask can greatly reduce the appearance of post-inflammatory hyperpigmentation.
TREATMENT OPTIONS
There are many options for aestheticians to help treat post-inflammatory hyperpigmentation in treatment rooms. The most used treatments performed by aestheticians are chemical peels, LED, and intense pulse light.
Chemical Peels
Chemical peels are a popular service performed by most skin care professionals in the treatment room and are either glycolic, lactic, salicylic, or mandelic peels. However, in clients with Fitzpatrick types IV to VI peels, if not done correctly, can cause hyperpigmentation. If a practitioner is going to be performing peels on clients with post-inflammatory hyperpigmentation, they must ensure the client is educated about post-peel procedures, like avoiding sun exposure, using gentle homecare products, and how to treat their dry, flaky skin. If the client does not comply, they will further damage their skin and worsen their post-inflammatory hyperpigmentation.
If the client is on board and ready to clear up their skin, a series of peels may be done. Glycolic acid is most used, but lactic acid is gentler and more effective on all skin types. The client is less likely to have post-peel dry or flaky skin. When done weekly, a lactic acid peel will dramatically improve the client’s appearance and reduce inflammation in the melanocytes. Many peels are a combination of acids, such as glycolic and lactic, which are more effective at improving post-inflammatory hyperpigmentation. Mandelic peels are great for acne clients because it tends to work slower than a glycolic or lactic peel and result in a gentle exfoliation. Mandelic peels are also recommended for clients with Fitzpatrick types IV to VI because of its antibacterial properties. Mandelic acid calms and reduces acne, while also helping clients reduce their post-inflammatory hyperpigmentation. Mandelic peels are also effective and less likely to cause skin reactions and further stimulate melanin, as glycolic or lactic peels may cause irritation.
LED
LED is a go-to treatment for all skin types because of its effectiveness. Plus, clients love being able to relax during this treatment! LED uses either red, blue, or a combination of both lights. If a client is currently suffering from acne, skin care professionals should treat them with blue LED, which is bacteriostatic and reduces p.acne bacteria, inflammation, and redness. Within a few weeks, clients will notice a reduction of inflammation. LED is a natural, effective treatment, and clients will see results quickly. Red LED treatments are ideal for treating clients with post-inflammatory hyperpigmentation because they can stimulate wound healing. “Low level light therapy (LLLT) decreased cellular reactive oxygen species concentrations and increased cellular ATP, suggesting increased electron flow through the electron-transport chain following light treatment.”4 Red LED treatments are ideal for post-inflammatory hyperpigmentation because it targets wound healing, reducing inflammation in the melanocytes, and is especially ideal for older clients who suffer from occasional acne.
Recommend clients to come in for LED treatments two-times a week for three to four weeks. If clients are inflamed, focus on blue LED treatments. If they have minimal inflammation, do 15-minutes of blue then switch to 15-minutes of red. Clients who are suffering from post-inflammatory hyperpigmentation benefit from red LED treatments and within two-weeks of treatments, they begin to notice an improvement in their skin. One benefit of LED treatments is that they are relaxing, and the client can take a nap. The focus is to help clients improve their skin’s appearance, and skin care professionals have the best tools and treatments to gift them with clear skin.
Intense Pulse Light
In certain states, skin care professionals can perform intense pulsed light treatments; in other states, intense pulsed light must be performed by a physician. Unlike LED, intense pulse light treatments use light energy that sends a pulse of light into concentrated areas. Intense pulse light is effective at treating post-inflammatory hyperpigmentation and hyperpigmentation, although it can be slightly painful and uncomfortable. Recovery time is longer and while getting intense pulse light treatments, clients should avoid sun exposure and use gentle homecare products. Intense pulse light treatments are recommended every four weeks and require about four to six treatments. There will be downtime post intense pulse light treatment, and clients must comply to prevent further damage to their skin.
HOMECARE TREATMENT
Practitioners can only do so much in the treatment room with the small amount of time they have with clients. As aestheticians, it is understood that it is up to the client to also work on their skin to continue the results achieved in the treatment room. Clients who follow recommended homecare routines are more likely to see improvement and positive results in their skin. This all begins with the consultation and education of clients to help them understand that using over-the-counter products are not going to help them achieve the results they seek. Not educating clients correctly and sending them home without skin care products is doing them a huge disservice.
INGREDIENTS TO LOOK FOR
A few recommended ingredients that will help clients improve their skin’s appearance and reduce post-inflammatory hyperpigmentation include hydroquinone, vitamin C, retinol, niacinamide, and sunscreen.
- Sunscreen should be a priority on clients’ skin care list because any sun exposure will darken the skin and worsen post-inflammatory hyperpigmentation. Every client should be using a daily sunscreen containing zinc oxide or titanium dioxide. However, clients with post-inflammatory hyperpigmentation should be more diligent with their daily application to prevent darkening of their skin. Clients who are using hydroquinone or retinols should be avoiding the sun. Education is key with clients. The skin care professional is the expert and needs to teach their clients how to care for their skin and explain how damaging the sun is, especially if the client is prone to post-inflammatory hyperpigmentation and using retinols or hydroquinone. Not only are they going to worsen the appearance of their post-inflammatory hyperpigmentation, but now they are damaging the skin and speeding up the aging process.
- Hydroquinone is a tyrosinase-inhibitor, in which tyrosinase is responsible for melanin production. When the amount of tyrosinase is reduced, the melanocytes begin to lighten. Hydroquinone is not readily used anymore because it is known to bleach the skin and can be harmful for darker skin types.
- Retinols accelerate cell turnover and reduce melanin. Retinols can thin the epidermis, which means that treatments like LED are more effective at penetrating the skin. Retinols are effective at reducing post-inflammatory hyperpigmentation.
- Vitamin C protects the skin from free radical damage. However, vitamin C is an unstable molecule and unless formulated correctly, may not be effective because it can oxidize quickly. L-ascorbic acid is the recommended form that will inhibit tyrosinase and reduce the appearance of post-inflammatory hyperpigmentation.
- Niacinamide is gaining popularity in skin care products and can be effective for treatment of post-inflammatory hyperpigmentation. “In the clinical studies, niacinamide significantly decreased hyperpigmentation and increased skin lightness compared with vehicle alone after four weeks of use.”5 While the exact process of niacinamide is still being studied, it is speculated that “niacinamide reduced melanosome transfer from melanocytes to surrounding keratinocytes in a co-culture system, although the specific mechanism remains unknown.”6
There are many ways practitioners can help clients suffering from post-inflammatory hyperpigmentation. Starting with education is key to helping clients understand their skin. Clients should try to comply with all homecare recommendations if they truly wish to see lasting results. As skin care professionals, it is necessary to help clients reduce their hyperpigmentation while also giving clients a chance to see amazing results.
References
- Rodrigues M.D., Michelle. “ACD A-Z of Skin – Post-Inflammatory Hyperpigmentation.” The Australasian College of Dermatologists, 2019. https://www.dermcoll.edu.au/atoz/post-inflammatory-hyperpigmentation/.
- Ngan, Vanessa. “Postinflammatory Hyperpigmentation.” Postinflammatory hyperpigmentation | DermNet NZ, 2015. https://www.dermnetnz.org/topics/postinflammatory-hyperpigmentation/.
- “TYR Gene – Genetics Home Reference – NIH.” U.S. National Library of Medicine. National Institutes of Health, 2020. https://ghr.nlm.nih.gov/gene/TYR.
- Spitler, Ryan, Hsiang Ho, Frederique Norpetlian, Xiangduo Kong, Jingjing Jiang, Kyoko Yokomori, Bogi Andersen, Gerry R. Boss M.D., and Michael W. Berns. “Combination of Low Level Light Therapy and Nitrosyl-Cobinamide Accelerates Wound Healing.” Journal of Biomedical Optics. International Society for Optics and Photonics, 2015. https://www.spiedigitallibrary.org/redirect/biomedicaloptics/article?doi=10.1117%2F1.JBO.20.5.051022.
- Hakozaki T;Minwalla L;Zhuang J;Chhoa M;Matsubara A;Miyamoto K;Greatens A;Hillebrand GG;Bissett DL;Boissy RE; “The Effect of Niacinamide on Reducing Cutaneous Pigmentation and Suppression of Melanosome Transfer.” The British journal of dermatology. U.S. National Library of Medicine. Accessed August 17, 2020. https://pubmed.ncbi.nlm.nih.gov/12100180/.
- Levin, Jacquelyn, and Saira B Momin. “How Much Do We Really Know about Our Favorite Cosmeceutical Ingredients?” The Journal of clinical and aesthetic dermatology. Matrix Medical Communications, February 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921764/.
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Samantha Dench is a 16-year licensed aesthetician, owner of Skin Deep, author, and speaker. Dench’s passion stems beyond treating the skin to include internal health to achieve healthy skin for clients by finding the root of the problem. She loves to educate groups of women and share her knowledge and passion of skin. Dench loves to share her book to help women take control of their skin. She is a single mom of three and loves to cook, bake, and find creative ways to find healthy alternatives to her favorite dishes.
