Post Inflammatory Erythema | Causes and Treatment

PIE, or post-inflammatory erythema, is a very common skin issue shared by many, especially those in their recovery process from acne or any other inflammatory skin problems. This condition is characterized by red or pink marks left on the skin after an injury or inflammation. It occurs due to blood vessel damage and takes time to heal. While PIE can improve naturally, treatments can speed up the healing process.

In this article, we’ll explore post-inflammatory erythema, its causes, symptoms, and various treatment options.

What is Post-Inflammatory Erythema or PIE?

Post-inflammatory erythema (PIE) refers to the general red or pink marks that remain after the skin has gone through some kind of inflammation, irritation, or injury. [1] These are usually due to conditions such as acne but may also follow any other form of inflammatory skin issue. Although PIE most often follows acne, it is also possible to be caused by other types of inflammatory skin issues like dermatitis.

PIE differs from hyperpigmentation (PIH) in that it does not involve extra melanin for discoloration to occur; this involves mainly the dilation or the destruction of capillaries beneath the skin surface. PIE is most noticeable when the skin is thinner during healing, making the red spots more prominent.

What Causes PIE?

Post-inflammatory erythema (PIE) results from damage to the small blood vessels under the skin, often due to inflammation. Several factors can contribute to this condition, including:

• Cystic acne: Deep inflamed acne lesions destroy blood vessels, which may result in PIE.
• Inflammatory skin conditions: Dermatitis, rosacea, and eczema may lead to chronic inflammation, resulting in PIE.
• Sunburn: Overexposure to the sun’s rays may cause destruction of skin cells and blood vessels, which could result in erythema.
• Trauma to the skin: Picking and re-picking at acne, or any mechanical irritation of the skin, will delay healing and worsen PIE.
• Bacterial infections: The bacteria that get caught in pores can increase the inflammation, thus leading to PIE.
• Harsh skincare products: Overuse of aggressive products leads to disruption of the skin barrier and inflammation, resulting in PIE.

Symptoms of PIE

Post-inflammatory erythema (PIE) can be identified by the following characteristics:

• Color: Maintains red, pink, or deep purple spots depending on skin tone and the severity of inflammation.
• Texture: The main difference from active acne is that PIE spots do not have raised bumps common in pimples or blackheads.
• Formations: PIE marks may show up as single spots or come in clusters. They look similar in appearance to acne; however, there is no active inflammation.

These spots most commonly develop on areas of the face where acne or irritation has occurred but can appear anywhere on the body.

Tips for Preventing PIE

• Avoid Pressure or Squeezing: Picking at acne or other aggravations is very likely to increase inflammation and increase the chances of developing PIE.
• Gentle Skin Care: Avoid scrubbing your skin a bit too hard to save it from further irritation that delays the healing process.
• Early Treatment of Acne: Early intervention can minimize the chances of PIE and resultant scarring. Since there will be less inflammation, the time needed for healing will certainly be reduced.

When to See a Dermatologist

When your post-inflammatory erythema does not go away on its own or using over-the-counter treatments, or the marks do not go away after more than six months, it may be time to see a dermatologist. A dermatologist will, based on your skin’s assessment, recommend advanced treatments like laser therapy or microneedling if necessary or prescribe drugs.

Post-Inflammatory Erythema Treatment

Early treatment of post-inflammatory erythema can help improve the appearance of your skin and raise one’s confidence. Of course, PIE will fade over time; however, it may take several months to fully disappear.

However, there are various at-home and professional treatments that can help speed up the healing process:

At-Home Treatments

• Topical Hydrocortisone: It is an anti-inflammatory medication that reduces redness and swelling but has to be used with caution or under the supervision of a dermatologist because of its possible side effects
• Vitamin C Serum: It has skin-brightening and anti-inflammatory properties. Vitamin C can help in reducing any redness, therefore helping in better skin healing. [3]
• Niacinamide: It is a form of vitamin B3 that reduces inflammation and helps the skin retain better moisture that may help treat PIE and prevent future acne breakouts.
• Sunscreen: Sun exposure worsens the condition of PIE; therefore, sunscreens may prevent further irritation and pigmentation of your skin.

Medical Treatments

• Laser Therapy: Intense Pulsed Light (IPL) or pulsed dye lasers destroy and shrink the appearance of blood vessels that cause PIE. [4] Indeed, it takes more than one session to show effective results.
• Microneedling: This is done by inflicting minute, controlled traumas on the surface of the skin to stimulate collagen production in the process of attempting to repair the injured skin, thereby reducing the visibility of PIE. This modality is usually enhanced by either vitamin C or tretinoin.
• Dermabrasion: It is a superficial, non-invasive skin exfoliation that regenerates the skin and helps it grow into new and healthier skin. It can help with superficial redness, but deeper scars may require other treatments.

PIE vs. Post-Inflammatory Hyperpigmentation (PIH)

PIE and post-inflammatory hyperpigmentation (PIH) are both skin conditions that occur after inflammation, but they differ in appearance and causes:

• PIE: Caused by hemorrhage or dilation of the blood vessels, these are red, pink, or purple discolorations.
• PIH: This is a condition in which excess melanin production occurs, usually resulting in brown or dark spots among people of darker skin complexion. [2]
• Duration: PIH can last longer compared to PIE, though the two conditions might appear concurrently, especially after acne or skin injury

Complimentary Consults for PIE

We at UVtreat understand that each one of you has a unique skin. That’s why we offer complimentary consultations to help you find the best solutions for post-inflammatory erythema (PIE) and other skin concerns. Our skincare experts will assess your skin, discuss your concerns, and provide personalized treatment recommendations.

Whether you need over-the-counter products or professional treatments, we will walk you through the procedure to make sure your skin receives the best care it needs.

The Bottom Line

Post-inflammatory erythema (PIE) is a common skin condition that results from inflammation and damaged blood vessels beneath the skin. While it often fades over time, there are several at-home and professional treatments that can speed up the healing process.

Key treatments involve the use of gentle skincare products, protection of the skin from the sun, and visits to the dermatologist for more advanced treatments like lasers or microneedling.