POST INFLAMMATORY ERYTHEMA - WHAT IS IT AND HOW TO TREAT IT

 Hi, babes! Emma here, and today's post will be about post-inflammatory erythema, better known in the skincare world as PIE. But what is it? Keep reading to find out. 

If you’ve ever experienced acne, you know that once a pimple itself is finally gone, the skin can often look red or irritated in the area where the original blemish was. There’s a technical term for this: Post-Inflammatory Erythema, often referred to as PIE. And it can often be just as stubborn and frustrating as the original acne itself.

This usually happens when inflammation occurs associated with an acne bump and it triggers an increase and dilation of blood vessels and vascularity. This is where that redness comes from, relating to an increased concentration of blood vessels in that area. Additionally, the general redness that goes along with the inflammation can linger and also contribute to post-inflammatory erythema. 

Mild, non-inflamed acne, which includes blackheads and whiteheads, or comedonal acne, is not typically a cause of PIE. Acne with inflamed papules and pustules is more likely to result in PIE. Papules are red inflamed bumps that are usually less than 5 mm or one-tenth of an inch, with pustules bearing a white or yellow centre.

So, how does one treat post-inflammatory erythema? What can you do about it?

 It’s worth mentioning that post-inflammatory erythema can vary in intensity, in some cases appearing like a faint pink colour while in other cases appearing as more of a deep red. Sometimes as the post-inflammatory erythema fades and begins to go away, the colour can shift as well.

PIE can impact the face and body anywhere that acne occurs, including common areas such as the neck, chest, and back. As for who is impacted, individuals of any age can be affected by post-inflammatory erythema but it generally tends to be more common in those with fair skin, while those with darker skin types tend to experience more post-inflammatory hyperpigmentation, which refers to brown or dark spots that result from an increase in pigment cells following an inflammatory process.

CAUSES, CURES AND PREVENTION

As we’re already aware by now, acne sufferers commonly have higher amounts of oil production, and the oil is thicker and stickier than those with balanced skin. What does this mean? Oil causes a build-up in the follicle and blocks the duct, causing pimples to form. Acneic skin also has lower levels of free fatty acids like linoleic acid, and higher amounts of squalene and wax esters, which are believed to contribute to acne.

Of course, acne can also be attributed to bacteria. While all skin has bacteria, acne sufferers have a higher level of P. acnes bacteria than others, dermatologists say. P. acnes feed on the excess oil and cause inflammation, redness, and infection, which manifests as acne. When the bacteria digest the trapped oil, this produces fatty acid waste that causes the irritation. This exact irritation can then translate to PIE, often leading to pink or red patches on the skin.

Another common cause is the use of harsh products. If you’ve ever used a harsh product that did not agree with your skin, the odds are that you’ve dealt with irritation and redness as a result. While there are many treatments for acne, it is important to not overdo it and to avoid harsh soaps and abrasive scrubs which can lead to skin irritation and can exacerbate redness and post-inflammatory erythema. You should avoid using too many active ingredients at the same time to avoid disrupting the skin barrier and causing excess irritation.

I’d also like to point out that picking acne can increase the risk of PIE, as it can trigger more inflammation which can subsequently lead to more redness and scarring. It’s a good idea to avoid touching your pimples, no matter how tempting it may be. 

I’d be amiss if I didn’t mention hormones! Whether you learned it the hard way growing up or learned it in health class, you’re likely aware that any shift in hormone levels can result in acne. High levels of testosterone lead to more oil production and breakouts, puberty, monthly menstrual cycles, polycystic ovary syndrome, perimenopause and menopause are the main hormonally-induced conditions that can trigger acne breakouts.

Treatments for PIE include topical niacinamide, tretinoin, regular and diligent sunscreen use, clindamycin and laser treatments. 

LASER TREATMENTS

PIE will usually fade on its own after a while, but lasers can be used to help expedite the resolution and work by targeting the blood vessels that may be contributing to the redness. Specifically, lasers that can be used include PDL, IPL, and KTP lasers, according to dermatologists.

However, while you may see improvement from just one session, it can often take several sessions to achieve desired results. The laser may cause the redness to initially appear darker temporarily within the first few days after treatment, but then the redness will continue to subside.

NIACINAMIDE

Niacinamide has added benefits of keeping the skin well hydrated while at the same time controlling oil and warding off acne flare-ups and help prevent PIE. A famed product containing niacinamide that could help with PIE is La Roche Posay's Toleriane Double Repair Moisturiser.

TRETINOIN

Tretinoin is one of the best acne treatments currently available. If caught early enough, tretinoin can help prevent closed comedones from developing into inflammatory acne and thus reduce the risk of developing PIE in the first place.

Tretinoin is 10 to 100 times more effective than over-the-counter retinoids. It works by exfoliating and stimulating cell turnover, reducing inflammation, and clearing pores. It also repairs damage to the microvascular system and collagen that can occur due to the bacterial infection of acne, and can reduce pH levels to help normalise the skin. Tretinoin is prescription-only, so you'll have to consult with your GP before trying.

REGULAR SUNSCREEN USE

Now, here’s the millionth reason why sunscreen use, whether lax or diligent, is a wise choice: More sun exposure can and will worsen the appearance of the blemishes and cause it to take longer to subside. Using a sunscreen that also offers some tint may help to provide some natural coverage to reduce the appearance of red marks.

Here’s some suggestions you could try out: Naked Sundays SPF50+ Collagen 100% Mineral Sunscreen (available at Beauty Bay), Rosalique 3-in-1 Miracle anti-redness formula SPF 50 (available in pharmacies and Amazon, if that’s your jam), and SVR Sun Secure Blur SPF 50 which has a mousse-like texture and is available at Sephora.

CLINDAMYCIN

Our final star remedy is clindamycin. Clindamycin is a topical antibiotic that can help kill the bacterial cause of acne. It can help reduce inflammatory breakouts by up to 50 percent within twelve weeks. To help decrease the risk of antibiotic resistance, derms usually prescribe benzoyl peroxide at the same time and only prescribes clindamycin for the shortest duration needed. You will also most likely be prescribed tretinoin as well since these medications in combination are proven to help decrease breakouts.

We've reached the end of today's topic. I hope it was useful and helpful to many of you that are at your wit's end with PIE. 

Till next time.

Love, 

Emma 

xoxo