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Everything you need to know about post-inflammatory erythema

The battle with acne doesn't always stop once blemishes have flattened out and healed. Oftentimes, after acne breakouts heal, they leave behind pink, red, and sometimes purple patches on the skin. These scars are known as post-inflammatory erythema or PIE.

What is post-inflammatory erythema (PIE)?

The term was coined for the first time in 2013 and described the residual pink or red mark discoloration after healed inflammatory acne lesions. This type of pigmentation typically occurs in people with lighter skin tones. While the condition isn't dangerous to one's health, it could last for months or even years if not treated properly.

What causes post-inflammatory erythema?

The superficial blotches that characterize PIE are caused by inflammation, dilation, or damage to small blood vessels under the skin, known as capillaries. Typically, cystic acne is the common cause of PIE, but other conditions such as dermatitis, prolonged sun exposure, aging, hormonal fluctuations, cuts, or rashes can cause post-inflammatory erythema.

How can I treat post-inflammatory erythema?

PIE can dissipate on its own, but it can quite some time if left untreated. If you want to expedite the healing process, there are plenty of treatments you can try to minimize the condition's appearance.

Topical treatments for post-inflammatory erythema

Topical treatments help decrease inflammation, reduce blood vessel dilation, promote wound healing, and improve skin barrier function.


Niacinamide is a form of vitamin B3 that strengthens the skin barrier, reduces inflammation, and helps the skin retain moisture. It can reduce the appearance of PIE and may help minimize cystic acne breakouts.

MDacne's active moisturizer, formulated with niacinamide 4.0%, is a wonderful addition to your skincare repertoire as it can minimize and tighten pores, strengthen your skin's natural barrier, balance oil production, and reduce skin redness.


Hydrocortisone is a steroid that works to reduce inflammation. Sometimes it is used in conjunction with other medications as an acne treatment, but it should always be used with a dermatologist's guidance.

Vitamin C

Vitamin C has been shown to have skin-lightening properties, making it beneficial for people with dark spots, PIH, and PIE. Rich in antioxidants, vitamin C also boosts collagen production and strengthens capillary walls that can reduce redness.


Retinoids are derived from vitamin A, and they work by reducing acne inflammation and preventing the formation of new lesions. Retinol treatment creams are an excellent option for fading acne scars as they can effectively smooth out the skin by increasing the speed at which your body replaces skin cells.

Medical treatments for post-inflammatory erythema

In addition to topical treatments, various medical treatments can help reach below the skin's surface to break down damaged capillaries and brighten the skin's complexion.

Laser treatments

There are several types of lasers that dermatologists can use to treat PIE. They work by pinpointing and eliminating the damaged areas of blood vessels under the skin, reducing discoloration and inflammation. Some treatment options include pulsed dye laser/intense pulsed light, fractionated resurfacing laser, and blue light treatments. Laser treatments can also be used as an option for those suffering from rosacea, wrinkles, port wine stains, and other vascular conditions.


A device lined with tiny needles called a derma roller is used to generate a superficial, controlled skin abrasion during a micro-needling treatment. This encourages the skin to produce new elastin and collagen-rich tissue that can eliminate surface discoloration, smooth skin's texture, and break up acne-related scarring.

How can I prevent post-inflammatory erythema?

Prevention is often easier than treatment. Here are some of the best steps you can take to minimize your chance of developing PIE.

Keep your hands off

Never pick, squeeze, touch, or scratch at your pimples or other blemishes - even if the temptation is high. Picking at blemishes can spread germs and dirt from your hands to the affected area; it can also cause the bacteria to spread and intensify existing breakouts. Since broken blood vessels cause PIE, popping pimples can dramatically increase the chances of developing the condition.

Use sunscreen daily

It's no secret that SPF is a must when protecting the skin's health and preventing premature aging. Using a sunscreen of at least SPF 30 every single day can lessen the potential of sunburn, limiting the exacerbation of inflammation due to excessive UV radiation that can lead to damaging hyperpigmentation.

Establish a skincare routine

The sooner your acne breakouts resolve, the less chance it has to leave a scar. Look for skincare products that contain ingredients that reduce inflammation, strengthen the skin barrier, and hydrate the skin. Your routine should include a medicated cleanser, toner, treatment cream, and moisturizer.

Active ingredients such as salicylic acid and benzoyl peroxide are excellent for clearing acne and other skin conditions.

  • Salicylic acid has the ability to deeply penetrate the skin to unclog pores and reduce acne-causing bacteria. It's also an effective chemical exfoliator that can gently slough away dead skin cells. This helps keep sebum production at bay, prevents future breakouts, and calms red irritated skin.
  • Benzoyl peroxide is antimicrobial, reducing the number of bacteria on the skin to prevent blemish formation and help remove blockages. It is available as an OTC treatment, or your dermatologist can offer a prescription-strength treatment.


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