How to manage post-inflammatory hypopigmentation (PIH) one week after a fractional laser session?

From the Guidelines

To manage post-inflammatory hypopigmentation (PIH) one week after a fractional laser session, prioritize gentle skin care and sun protection, as the condition typically resolves on its own within 3-6 months, and consider the potential benefits of platelet-rich plasma (PRP) in promoting wound healing and scar resolution, as suggested by recent studies 1. When dealing with PIH after a fractional laser session, it's essential to focus on maintaining the skin barrier and protecting it from further irritation.

• Use a gentle cleanser twice daily to clean the affected area without stripping it of its natural oils.
• Apply a fragrance-free moisturizer to keep the skin hydrated and supported throughout the healing process.
• Sun protection is crucial: apply a broad-spectrum SPF 50+ sunscreen every 2 hours when outdoors and wear protective clothing to prevent further inflammation and potential worsening of the hypopigmentation.
• Avoid harsh products containing retinoids, alpha hydroxy acids, or vitamin C during the healing phase, as these can exacerbate the condition and prolong recovery. The use of PRP, as discussed in the context of acne scarring treatment with fractional laser therapy 1, may offer insights into its potential role in managing PIH, given its benefits in wound healing and reducing post-procedural symptoms.
• However, for the specific management of PIH, the primary approach remains centered on gentle care and sun protection, with patience allowing the skin to heal and melanocytes to recover. For persistent hypopigmentation lasting beyond 3 months, consulting a dermatologist about topical treatments that can help restore pigmentation by reducing inflammation and promoting melanocyte activity is advisable.
• Options may include tacrolimus 0.1% ointment applied twice daily or pimecrolimus 1% cream, which can aid in restoring skin pigmentation.
• In some cases, low-concentration hydroquinone (2-4%) may be recommended for short periods to even skin tone, though this should be approached with caution and under dermatological guidance.

From the Research

Management of Post-Inflammatory Hypopigmentation (PIH)

• PIH is a common adverse effect of laser treatment, especially in dark-skinned individuals 2, 3.
• The risk of PIH can be minimized with the use of topical corticosteroids after ablative fractional CO2 laser resurfacing 2.
• A short-term application of topical corticosteroids post-operatively can decrease the risk of PIH by 35% compared to petrolatum alone 2.
• The density and energy of the treatment determine the risk of PIH in dark-skinned patients, with higher density and lower energy treatments associated with a higher prevalence of PIH 3.

Treatment Options for PIH

• Topical agents are the first-line treatment for postinflammatory hyperpigmentation, but recalcitrant cases can be challenging to treat 4.
• Fractional CO2 laser can be an effective tool in treating recalcitrant postinflammatory hyperpigmentation, but it can also cause PIH if not used with conservative settings and proper post-treatment care 4, 5.
• Ablative fractional resurfacing can improve hypopigmentation caused by CO2 laser resurfacing, with significant improvement seen after a series of treatments 5.

Prevention of PIH

• Using adequate parameters, such as lower density and higher energy treatments, can reduce the risk of PIH in dark-skinned patients 3.
• Cooling to prevent bulk tissue heating is also important, especially in small anatomical areas 3.
• Topical corticosteroids can be used post-operatively to minimize the risk of PIH 2.