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What to Know About Post-Inflammatory Erythema

Medically Reviewed by Dan Brennan, MD on April 27, 2021

Post-inflammatory erythema is the red mark left on your skin after injury or irritation. 

What Is Post-Inflammatory Erythema?

When your skin is injured or irritated, it becomes inflamed. This inflammation can cause redness, hyperpigmentation, or grey and brown patches on the skin. It can also cause scarring, even after the skin has healed.‌

These marks are called post-inflammatory erythema or may be called post-acne erythema when the skin condition is caused by acne. 

Acne causes pimples on the face, shoulders, back, neck, and chest. There are lots of factors related to acne, but it is caused mainly by dead skin cells and oil that clog your pores. This causes inflammation and a bacteria infection.

There are different types of acne and some types are caused by hormone problems and medications. Stress, certain foods, makeup, sweat, some types of sports equipment, and some personal care products can make acne worse.

Once the skin is inflamed, irritated or injured, the wound healing process starts. The process is complex, but it has three steps: inflammation, tissue formation, and matrix remodeling.

Post-inflammatory erythema happens when blood flow is stopped during the inflammation stage. Inflammation, blood vessel dilation, and any damage to those blood vessels can cause the red or pink marks that appear on the skin. Your skin is usually thinner as it heals and this might make erythema worse. 

If the skin doesn’t heal quite right, you might have a loss of collagen or extra tissue that can cause scars. 

Post-Inflammatory Erythema vs. Post-Inflammatory Hyperpigmentation

Post-inflammatory erythema, or PIE, is a relatively new term. Many people are familiar with post-inflammatory hyperpigmentation, or PIH, but they’re not the same thing.

Whereas post-acne erythema causes red or pink marks, post-inflammatory hyperpigmentation causes brown, grey, or dark marks on the skin. 

Post-inflammatory hyperpigmentation happens when your pigment skin cells are stimulated during the wound healing process. The darkened spots are a concentration of pigment in one area. 

Post-inflammatory erythema tends to happen more often in fair skin, while hyperpigmentation happens more in darker skin.

Post-Inflammatory Erythema Treatment

Acne and other skin conditions that leave lasting marks and scars can have a profound effect on your self-esteem and quality of life. It’s best to get your skin looked at and treated as soon as possible. Treating acne early on can help your skin recover better.

There are things you can do during and after acne or other irritations that can help treat post-inflammatory erythema. 

Don’t pick or squeeze. The more you squeeze, pop, or pick at your skin, the more inflammation you cause. This leads to a greater chance of having erythema and scars. 

Get treated. The sooner you treat acne, the better chance your skin has to heal. There might be less inflammation and less chance of scarring and other problems, and your doctor may prescribe medications that can help.

Don’t scrub. Scrubbing and overwashing irritates your skin. The more you irritate it, the more inflammation you cause and the higher risk of having post-inflammatory erythema, scars, or longer-lasting skin irritation.

Laser.   Laser resurfacing can sometimes help reduce post-inflammatory erythema.

Dermabrasion. Microneedling or microdermabrasion is a technique that uses small needles to puncture the skin. This stimulates collagen in the skin, which might help get rid of red marks on the surface. This isn’t usually helpful for deep scars. 

Results can take up to 12 months, as it takes time for the collagen to affect the skin. The advantage is that the skin doesn’t slough off the way it does with a chemical peel.

Vitamin C. Vitamin C is anti-inflammatory and helps your body make collagen. This can help with better skin healing, reduce inflammation, and prevent redness or depigmentation.

Sunscreen. Acne meditations and some treatments like laser and acids can make your skin more prone to sun damage. You should wear sunscreen to prevent more redness, irritation, and pigmentation. 

WebMD Medical Reference

Sources

SOURCES:

American Academy of Dermatology Association: “Acne: Diagnosis and Treatment,” “Acne: Who Gets and Causes,” “Acne Scars: Who Gets and Causes.”

Dermatology Research and Practice: “Acne Scars: Pathogenesis, Classification and Treatment.”

Indian Dermatology Online Journal: “Vitamin C in Dermatology.”

The Journal of Clinical and Aesthetic Dermatology: “Acne Scarring—Pathogenesis, Evaluation, and Treatment Options,” “Easy as PIE (Postinflammatory Erythema).”

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