well hey guys welcome back to the QA
today I'm going to be answering all of
your questions about something called
post inflammatory erythema or persistent
red marks on the face that occur
oftentimes in the setting of healing
acne acne that has been previously
treated with accutane the acne is no
longer active but you're still plagued
by persistent red marks this is a topic
that I get many questions about and it's
come up frequently in the comments of my
videos such as the video I posted last
week and last week's Q&A all about
accutane for acne so if that's of
interest to you make sure you check it
out but my name is Andrea if you're new
here by the way I'm a dermatologist I
have a YouTube channel here that I post
a lot of fun vlogs too of my life as
well as fun lifestyle and recipe videos
and skincare q and A's and discussions
on skincare topics and skincare
ingredients so you know at this type of
content is of interest to you then stick
around and subscribe for more so with
that let's get started now in my prior
Q&A is I've talked a lot about something
called post inflammatory
hyperpigmentation or those dark spots
that oftentimes occur after either acne
or a bug bite or some sort of bomb cyst
cut heal they heal with a dark mark and
I've talked all about how to have what
those are how to deal with it and how to
treat it in Prior q and A's but a
similar but different condition post
inflammatory erythema it's one that
unfortunately we don't have as many
options available yet for treating and
for dealing with so what is it post
inflammatory erythema is red kind of
pinkish blemishes on the skin that often
occur as I said after acne has healed or
is in the healing stages can also occur
however after any kind of trauma to the
skin just like post inflammatory
hyperpigmentation it can occur after
aggressive exfoliation of the skin
either with a facial scrub scrub brush
sonic cleansing brush or you know going
to medi-spa
too frequently and getting too many
aggressive harsh chemical peels that
aren't necessarily right for your skin
so you know that can unfortunately
result in in post inflammatory erythema
as can a really bad sunburn tends to
affect people who are fairer skin types
light light eyes like hair or red hair
tend to be plagued with post
inflammatory erythema more so than post
inflammatory hyperpigmentation and the
reason that post inflammatory erythema
occurs is that when there's inflammation
in the skin you know I talked about on
post inflammatory hyperpigmentation the
inflammation can make a lot of the color
leak out and stain the skin well in post
inflammatory erythema similarly you can
get so much inflammation going on that
it kind of agitates the blood vessels in
the skin makes them leaky makes them
bulge they come in to try and repair the
skin this is something called the
vascular phase of wound healing
you know you can frequently see it and
other other wounds whether they be
surgical or or traumatic and it's part
of the body's response to heal itself
and you know acne in particular is a
disease that is inflammatory and nature
and cystic and you know creates
essentially a wound in the skin as it's
healing post inflammatory are thema you
know it's something that also can be
going on for a long time after you have
gone through a course of accutane as I
mentioned last week I think
accutane you know does very well for for
treating the acne but the acne then is
still in a healing phase long after the
Akron accutane course is complete
because it's almost a healing it is a
healing wound okay you have to think of
it that way and that's really what that
redness is that you're dealing with and
you know one kind of way to know if
something is post inflammatory erythema
is that it you know if you press on the
skin then the redness should actually
fade that's called blanching that
indicates that their blood vessels there
in the skin that are dilated in
whereas if you have a condition called
purpura where the blood is leaked all
over into the skin and it's not a blood
vessel problem then then those spots
won't Blanche but sometimes that can be
hard to do your cell phone on your face
you know if you have a a glass
microscope slide like a glass microscope
slide and you mash it on your face
gently that that's an easy that's the
easiest way to tell so even even with no
treatment post inflammatory erythema
does eventually fade but unfortunately
the process can take between months you
know almost a year okay and depending on
the severity the distribution of the
initial inflammatory respond whether it
be acne or you have some sort of wound
depending on the distribution in degree
and that's where think it can last a
long time
okay as many of you have had verbalize
that you you're suffering with and there
definitely some things that you the
individual suffering with post
inflammatory erythema should know like
things that you should do it should
definitely avoid okay hopefully this
video will help help you in that manner
first and foremost do not pick the skin
or pop anything okay because essentially
you know post inflammatory erythema can
be the result of popping popping pimples
that's why I tell you guys never pop a
pimple it never goes well okay and this
is one one of a hundred examples of
things that can go wrong when you pop a
pimple post inflammatory erythema
because you're wounding your face when
you do that when you squeeze your face
you're you know you're creating a trauma
and you're wounding it and as a result
you know you can then subsequently
experience the vascular phase of wound
healing and be plagued by post
inflammatory erythema so don't pick or
pop anything on your skin don't don't
try and dig out your pores don't try and
clean your pores none of that you know
no one should really be doing that that
to be honest with you as I say and all
of my videos but particularly if you
were sensitive you know a skin type that
develops is post inflammatory erythema
you know you should definitely avoid
that scrub scrub brushes
peels sonic cleansing brushes at home
microdermabrasion kits that there's like
a kid I've seen on the internet for
doing your own microdermabrasion I
talked a little bit about those in my in
my microdermabrasion kind of cosmetic
corner and maybe we're calling it I'm
not sure but know that you should avoid
those things because you're just
creating more wounding and damage to the
skin by abrading the skin okay and it's
gonna make the redness persist longer
it's gonna exacerbate it and you can get
so much inflammation and exacerbation of
the underlying healing wound there that
never heals property properly and you're
subsequently left with a scar okay so
sit on your hands you know and don't do
anything I know it's tough right you've
got a red mark on your face but that
bothers you and you know you want to do
something about it the compulsion to to
alter it it can be quite strong so then
then you kind of want to focus on what
your cleansing your face with it you
definitely want to avoid harsh bar soaps
like a dry out the skin
now while harsh exfoliants and the sonic
cleansing brushes microdermabrasion
should be avoided if you're dealing with
post inflammatory erythema you should
continue any treatments that your
treating physician has advised you to
use either for your acne or whatever
other skin condition you may be
suffering with that it's healing with
post inflammatory erythema you
definitely you know discuss with them
and continue those treatments for
example a salicylic acid face wash you
know may be advised that you continue
using that and that's a good idea
because it can help control the acne is
very gentle and you know very lightly
kind of helps the skin turn over without
aggressively peeling it and as I
mentioned in my how to exfoliate the
face video
salicylic acid in a face wash form is
effective you only need a short contact
time rather than prolonged contact time
so I I favor it in a wash form because
it is still effective and in it with the
short contact time you have less
irritant
Seanna less irritancy you have you know
the more on the more likely it's going
to be to go to bode well for conditions
like post inflammatory erythema that are
worsened by excessive irritation and
aggravation of the skin the other thing
to absolutely get rid of in your
skincare if you haven't already our
harsh toners and astringents and avoid
those absolutely I mean everyone should
avoid those you know they're just
something that the cosmetic companies
have invented and continue to sell
people that they need but they're really
awful and have no utility in skin health
and actually take everyone ten steps
backwards what they do is they dry out
the skin and you know they make this
skin feel nice and tighten and squeaky
everybody likes the way it feels they
think their pores are smaller well
because you've just desiccated your the
top layer of your skin and everything
shrinks up okay
and as that occurs then you know your
skin becomes dry parched loses water
more readily and that interferes with
the wound healing phase of your your
healing acne and it's just going to
prolong the post inflammatory erythema
okay so avoid the the toners the
alcohol-based astringent the peels all
of that kind of stuff for sure and just
stick to simple face washes I can list
some down below basic moisturizers and
definitely a sunscreen now in addition
to a BH a face wash as I mentioned
before salicylic acid face wash another
treatment that you may have been
prescribed that also can be helpful for
post inflammatory erythema is Trenton
omen or retin-a or adapt Aleen
brand name differen or to Zahra teen
brand name Towser AK I talked a lot
about a dappling brand name different in
many of my videos I've talked a lot
about treta no and I haven't really
talked about Towser act that much but
they're all retinoids that are effective
for acne as well as a variety of other
conditions and
you know it's probably it's very likely
that if you're somebody with acne and
post inflammatory erythema that you've
been advised to continue using these and
they can help in the healing phase of
the wounds in your face that appear to
have that are that are manifest with
post inflammatory that are manifesting
the post inflammatory erythema and
another ingredient that you can look for
in the drugstore in your moisturizers is
niacinamide niacinamide I have a whole
video on niacinamide and skincare but
niacinamide has been shown and
moisturizers to help reduce the redness
not only of rosacea but up the healing
lesions of acne so choosing a
moisturizer I will list some down below
that are great for for acne prone skin
as well as all skin types dry skin
mature skin oily skin combination skin
all of those skin types
these are moisturizers that serve serve
everyone well and contain niacinamide in
them okay and niacinamide can help with
redness if you have more questions about
niacinamide make sure you check out that
video because I go into mine into quite
a bit of detail on that alright one
thing that I see on the internet that
terrifies me and motivated me to start
my youtube video is this use of all the
DIY face peels and and at-home skin care
so one thing to walk away from it are
the is the use of lemon juice and lemon
peels on your face okay and lesions of
post inflammatory erythema I see the the
rationale and rational thought work
where people are going with this done
well vitamin C can help heal the skin
and lemons are citrus if your fruits
that are high in vitamin C like
shouldn't that be helpful mmm no okay
lemon is lemon peel and citrus fruit and
lemon lemon juice these all are citrus
fruits that contain something called a
furrow coumarin okay which a furrow
coumarin is a compound within citrus
fruits as well as figs and many other
plants that when put on the skin and
then some
currently exposed to ultraviolet light
either from the Sun or you know God
forbid a tanning bed undergoes a DNA
damaging inflammatory reaction okay so
don't do that lemon juice on the skin is
very it's very very irritating and
that's only going to further exacerbate
your post inflammatory erythema you guys
out there suffering post inflammatory
hyperpigmentation walk away from the
lemon juice as well undiluted tea tree
oil is also a bad idea I have a video
about tea tree oil and acne and I
reviewed some tea tree oil products for
acne that I like yes tea tree oil can be
helpful for acne but you don't want to
put undiluted on your face it can be
it's very very irritating and and likely
to worsen the skin problem
likewise vitamin E oils vitamin E
capsules and our undiluted directly to
the skin these are very potent and you
know when they're at that high level
they're they're irritants okay they're
irritant see potential increases
exponentially if you're interested in
pursuing immoral you know like natural
kind of remedy though or you know some
some ingredients that are popular in a
lot of Korean and Japanese and Japanese
skin care products one ingredient which
I reviewed for you guys is green tea
green tea and a face wash can actually
be helpful for the redness of post
inflammatory erythema and it's very
gentle and I wouldn't recommend putting
just straight green tea on your face
that you brew on the stove but just a
green tea face wash can can be helpful
as well so green tea is is you know it
has anti-inflammatory properties it can
kind of help
and likewise ingesting green tea is is
probably another way to get those
benefits although I have to say the data
on that is is not there at this point
but we do know that green tea has many
health benefits which I've discussed
before with you guys so you know I'm a
fan of the matcha green tea but green
tea can can be kind of a helpful
adjuvant okay dim to just kind of speed
things along a little bit what
QA without emphasis on sun protection
now would it so do not neglect sun
protection all right it is so important
all right you have a healing wound on
your face that is red okay you are
bothered by the redness understandably
so but your skin is trying to do some
physiology and biology to get things
back to normal
and it can't do that so long as it's
being assaulted by ultraviolet light
okay so aggressive sun protection is
critical if you're a fair skin type you
know you you burn easily in particular I
mean you you really really really need
to be careful in the Sun that's why I
caution you to avoid the lemon juice
thing because it will heighten your your
photo you know your your burn your burn
threshold basically so don't neglect
your sun protection I will list my
favorite sunscreens down below but also
wear a broad-brimmed hat you know
studies show that that is another
helpful way of not only lowering your
the number of pre skin cancers that you
could form but in offering some
protection okay it's not it's not a
hundred percent you know you still need
the sunscreen but a broad brim hat and
umbrella these are additional measures
long sleeves those are all kinds of
things that protect those areas of the
skin and hey don't sunbathe all right
now many of you ask me about are there
any professional treatments that could
be pursued for post inflammatory
erythema as I mentioned before at the
beginning of my video unlike post
inflammatory hyperpigmentation there is
just there's simply less data available
and less research out there on different
treatments and efficacies so a lot of
what has been pursued in dermatology for
this problem to try and help it get
better faster because that's our goal is
to help you feel better about yourself
faster and it didn't help make things
better that's that's what we want okay
so some professional treatments that
that could be pursued okay
many of my colleagues have an have have
observed in their own practices
particularly my colleagues who who do
what's called cosmetic dermatology okay
so they they treat the cosmetic
consequences of diseases like acne
like score therapy things that are
covered by insurance as well as you know
kind of some of your your anti-aging
cosmetic concerns like Botox and that
kind of thing I don't do that but my
colleagues who do report and have
discussed at meetings that they are
seeing some good effects performing
micro needling procedures in their
office on these these lesions okay so I
say that with a word of caution because
I see all over the internet these at
home micro needling devices okay micro
needling performed by a physician okay
with experience it's different than what
you're doing at home and that it is done
in a very controlled manner in a you
know sterile setting okay
whereas what I fear and what can occur
on with these at-home micro needling
devices is that essentially what the
micro needling device is doing is
creating tiny little wounds in the skin
okay I know it seems counterintuitive
like aren't I making our arm isn't this
a healing wound already why me why am I
gonna wound a wound I know it doesn't
make a lot of sense to me either but
they do report that when they perform
this procedure alongside some other
laser procedures which I'll mention in a
bit that they do see some benefit okay
so since it seems to be help seems to be
moving in a direction where we've got
something promising okay but the risk of
doing it at home doing it or somebody
doing it who has not experienced doing
this is that you you really put yourself
at risk of introducing an infection into
your skin and that infection not only is
going to just wreak havoc on the post
inflammatory hyperpigmentation and or
excuse me post inflammatory
hyperpigmentation
but can really really really cause
significant problems for you okay
nobody wants a massive skin infection
that is that is bad news pears okay so I
advise avoiding avoiding those at-home
micro needling devices okay they're not
studied they're not regulated in a
manner and you know you're just poking
holes in your skin that
subsequently it can become infected so I
would say avoid those but in a
dermatologists office particularly a
dermatologist who you know has
experience doing this I said asked to
see some before and after pictures so
that you get to get a sense of their
credentials ask for their board
certification that way you know you're
dealing with with somebody with actual
experience versus you know one of these
strip-mall many spas where you can you
know be treated by somebody who has no
clue what's going on alright so ask for
ask for their credentials ask to see
their board certification ask if they
have any fellowship training and
cosmetic dermatology or procedural
dermatology before you go plumping down
the big bucks to have your face
microneedles
so that that's one thing that can be
helpful and then the other thing that
can be helpful are lasers that target
the blood vessels these are you know
broadly in the category of what's called
vascular lasers they include lasers that
are they includes a KTP laser as well as
the Indy YAG n d :
yeah qui AG lasers okay these can be
helpful and I'm telling you these names
k TP nd YAG okay because when you go
into a spa or you know any office they
will they will tell you what laser they
have and they'll use the brand name of
the laser okay and they all have all
these jazzy names okay so what you
should ask them is is this a KTP laser
is the wavelength similar to KT P is
this an indie a Glaser is the wavelength
similar to to an Indy YAG laser and then
ask just ask them very pointedly what is
the wavelength of the laser that you're
going to be using on me and if that
individual cannot respond to you you
know like that then that's a suggestion
then that suggests to me that that
person doesn't know what they're doing
okay so that's kind of it that's kind of
a good way to test the waters if the
person performing the laser procedure
does it know the wavelength of light
that they're going to use to target your
skin then you should probably walk away
okay
but in general the laser wavelengths
that are effective for post inflammatory
erythema are those of the vascular
wavelengths it just ask
and you know if you can't get a straight
answer then I would leave but stay tuned
you know hopefully more research will
come out and maybe more people will
start doing these micro needling
procedures in their office we'll get
some more data and have more of a
consensus on on what would be helpful
for a post inflammatory erythema do you
know that it will get better with no
treatment
I just takes time unfortunately well
guys I hope this video was helpful in
addressing all of your questions on post
inflammatory erythema and if you liked
it give it a thumbs up share it with
your friends and as always don't forget
sunscreen and subscribe I'll talk to you
guys my next few days
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