Do I Have Post-Inflammatory Erythema? (Top 10 Questions Answered)

Below you will find the answers to the most common questions about post-inflammatory erythema. 

What is post-inflammatory erythema?

After experiencing inflammatory acne, Post-Inflammatory Erythema (PIE) is the pink to red discoloration left after the acne lesion begins to heal (1).

How is it different from acne scarring?

PIE is the temporary discoloration of the skin that is usually resolved over a short period of time. This is different from a scar, which causes a persistent textural change in the skin (1).

Do I have post-inflammatory erythema? 

When your skin undergoes trauma, the capillaries break, causing the red discoloration in the skin. If the lesion is flat, red and/or pink after experiencing a breakout, without distinct textural characteristics, then you most likely have PIE. You can test this by pressing and releasing the area of the skin where the discoloration is. If your skin lightens, and then returns to pink, you have PIE. A pigmented scar will not change colour once you release pressure from that area. 

How long does it take for erythema to go away?

Depending on the severity of the inflammatory acne lesions, PIE can take anywhere from one month to a year to lighten. Some of the discoloration may fade completely, while others need specific treatments to help heal them faster.

What is the best treatment for PIE?

There are multiple treatments available to help expedite the process of healing your PIE. The most well-studied method is the use of dye-pulsed lasers. This involves targeting vessels in the skin with heat to improve the look of erythema (2). 

Another method to help fade PIE includes intense pulsed light therapy. This treatment works by damaging Cutibacterium acnes (C. acnes) through thermal energy (3). C. acnes contain many porphyrin rings, which are a type of pigment. When they are exposed to light by the use of the laser, they become damaged and therefore destroy the C. acnes bacteria. 

While lasers are the gold-standard in treatments for PIE, they can be quite expensive and may not be easily accessible to the everyday person. Fortunately, there are topical applications that help improve the look of PIE, increase overall skin health, and promote changes to help your skin tone become more even. Click here to see a detailed list of over-the-counter topical ingredients for PIE that you can start using TODAY!

How do you fade inflammatory redness?

The main characteristic of PIE is skin redness. It is beneficial to look for skincare products that focus on calming skin redness and inflammatory lesions. Here a few ingredients to look for:

         1. Dexpanthenol

Pantothenic acid is an essential part of metabolizing carbohydrates and fatty acids in the body. Its topical form, dexpanthenol, is a type of panthenol that is biologically active and has been shown to increase moisture in the skin, improve skin softness, and exhibits anti-inflammatory effects (4). It improves the effects of erythema caused by UV light, and has been beneficial for patients with scarring. In addition, wounds on the skin have shown a decrease in redness when dexpanthenol was applied (4). You can find panthenol listed in the ingredient section of multiple products, such as serums and moisturizers. 

         2. Niacinamide 

Niacinamide has been well-studied in scientific literature and has been shown to reduce inflammation in the skin. It is great for soothing acne and rosacea. It increases the synthesis of proteins that create a stronger skin barrier, and upregulates the production of ceramides in the skin, which is an essential component in maintaining skin moisture (5). By using niacinamide, your skin will be able to fight irritation and redness, and help fade PIE faster. Read more about niacinamide’s effects on PIE here. 

          3. Jojoba Oil

Certain plant oils have positive effects on the skin when applied topically. Jojoba oil has been shown to have anti-inflammatory effects on the skin, and may aid in wound healing (6). Jojoba oil repairs the skin barrier by helping to prevent water loss from the skin, and is a good choice for those with an impaired barrier, such as those suffering from acne, eczema, general redness or irritation in the skin. 

         4. Azelaic Acid

Redness in the skin, such as rosacea, can be caused by Reactive Oxygen Species (ROS) that are produced in response to UV damage. These are highly reactive molecules that reduce our skin’s ability to defend against external stressors. This causes irritation and an increase in inflammatory molecules, leading to skin redness (7). Topical use of azelaic acid has been shown to protect the skin against UV damage, and inhibit the formation of ROS, thus improving skin barrier function and reducing inflammation and erythema in the skin (7). 

Does retinol help with post  inflammatory erythema?

Retinoids are a great treatment for moderate acne. They block inflammatory pathways that contribute to the formation of acne (8). They normalize the proliferation (growth) of skin cells, which reduces the risk of clogged pores. They have also been shown to promote direct anti-inflammatory effects on the skin (9). Since retinoids are used to prevent acne from occurring, they can be used as a preventative measure against PIE. Once PIE is present on the skin, retinoids can help increase cell turnover. This allows dead skin cells to be shed faster, thus promoting younger, healthier cells to come to the surface. In turn, this can help speed up the healing process of PIE. 

Does vitamin C help post inflammatory erythema?

Vitamin C is a multi-tasking ingredient. It helps promote wound healing and has anti-inflammatory effects. It works by inhibiting a protein called NF-κB. This protein plays a role in cellular responses and is responsible for inducing many pro-inflammatory molecules in the skin (10). Topical application of vitamin C has been shown to interfere with the production of inflammatory proteins, reducing redness and irritation in the skin, making it a good choice for those with acne and/or PIE. 

How do you prevent erythema?

        1. Use a Gentle Cleanser

Cleansers contain surfactants, which are substances that actually clean your skin. However, many surfactants cause dryness and irritation. When cleansers come into contact with the skin, they denature proteins, leading to cell damage (11). It is important to find a fragrance-free cleanser with a minimal ingredient list. Do not leave your cleanser on the skin for an extended period of time, as this will help prevent weakening of the skin barrier, and thus prevent reddening of the skin. 

         2. Moisturize

You need to nourish your skin’s barrier by consistently using a high quality moisturizer to prevent transepidermal water loss (TEWL) from occurring. There are multiple types of moisturizers including emollients, humectants, and occlusives (12). Emollients, such as oils, maintain skin softness and smoothness. Humectants are substances that attract water to the skin, such as hyaluronic acid. Occlusives include wax-like substances, such as petrolatum, that create a barrier on the surface of the skin to prevent TEWL. By using a moisturizer, you strengthen your skin’s ability to heal inflammatory lesions faster, with less damage to the cells, and thus less redness and discoloration in the skin.

3. Use Sunscreen

Redness is exacerbated by the sun’s damaging UV rays (13). In order to reduce the irritating effects of the sun and help prevent cellular damage and pigmentation, you must incorporate a good quality sunscreen that has broad-spectrum protection against both UVB and UVA rays. 

To note, many consumers do not apply enough sunscreen to get the full SPF protection intended. It is imperative to apply a liberal amount of sunscreen to the face, and to reapply sunscreen every 2-3 hours, or after swimming, showering, or sweating heavily. 

Does Microneedling help PIE?

Microneedling is a non-invasive procedure that involves puncturing the surface of the skin with short needles. This allows the skin to experience a controlled injury, which induces the process of wound healing by upregulating certain growth factors. This stimulates collagen formation and revascularization, otherwise known as the restoration of damaged vessels in the skin (14). This may be an effective treatment for PIE, as it has been shown to improve scarring, burn marks, and inflammatory acne by reducing sebum production. Therefore, microneedling may promote healing of discoloured areas of the skin and may be an effective treatment for PIE. 

_____________________________________________________

References

1. Bae-Harboe YS, Graber EM. Easy as PIE (Postinflammatory Erythema). J Clin Aesthet Dermatol. 2013 Sep;6(9):46-7. PMID: 24062874; PMCID: PMC3780804.
2. Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017 Sep;10(9):12-23. Epub 2017 Sep 1. PMID: 29344322; PMCID: PMC5749614.
3. Patidar MV, Deshmukh AR, Khedkar MY. Efficacy of Intense Pulsed Light Therapy in the Treatment of Facial Acne Vulgaris: Comparison of Two Different Fluences. Indian J Dermatol. 2016 Sep-Oct;61(5):545-9. doi: 10.4103/0019-5154.190115. PMID: 27688446; PMCID: PMC5029242.
4. Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol. 2002;3(6):427-33. doi: 10.2165/00128071-200203060-00005. PMID: 12113650.
5. Gehring W. Nicotinic acid/niacinamide and the skin. J Cosmet Dermatol. 2004 Apr;3(2):88-93. doi: 10.1111/j.1473-2130.2004.00115.x. PMID: 17147561.
6. Lin TK, Zhong L, Santiago JL. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017 Dec 27;19(1):70. doi: 10.3390/ijms19010070. PMID: 29280987; PMCID: PMC5796020.. 
7. Jones DA. Rosacea, reactive oxygen species, and azelaic Acid. J Clin Aesthet Dermatol. 2009 Jan;2(1):26-30. PMID: 20967185; PMCID: PMC2958186.
8. Leyden J, Stein-Gold L, Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb). 2017 Sep;7(3):293-304. doi: 10.1007/s13555-017-0185-2. Epub 2017 Jun 5. PMID: 28585191; PMCID: PMC5574737.
9. Millikan LE. The rationale for using a topical retinoid for inflammatory acne. Am J Clin Dermatol. 2003;4(2):75-80. doi: 10.2165/00128071-200304020-00001. PMID: 12553848.
10. Telang PS. Vitamin C in dermatology. Indian Dermatol Online J. 2013 Apr;4(2):143-6. doi: 10.4103/2229-5178.110593. PMID: 23741676; PMCID: PMC3673383.
11. Mukhopadhyay P. Cleansers and their role in various dermatological disorders. Indian J Dermatol. 2011 Jan;56(1):2-6. doi: 10.4103/0019-5154.77542. PMID: 21572782; PMCID: PMC3088928.
12. Sethi A, Kaur T, Malhotra SK, Gambhir ML. Moisturizers: The Slippery Road. Indian J Dermatol. 2016 May-Jun;61(3):279-87. doi: 10.4103/0019-5154.182427. PMID: 27293248; PMCID: PMC4885180.
13. Nisbet SJ, Targett D, Rawlings AV, Qian K, Wang X, Lin CB, Thompson MA, Bulsara PA, Moore DJ. Clinical and in vitro evaluation of new anti-redness cosmetic products in subjects with winter xerosis and sensitive skin. Int J Cosmet Sci. 2019 Dec;41(6):534-547. doi: 10.1111/ics.12559. PMID: 31309600; PMCID: PMC6899962.
14. Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016 Jul-Aug;7(4):244-54. doi: 10.4103/2229-5178.185468. PMID: 27559496; PMCID: PMC4976400.