Avoiding the Wrath of PIH

Rachel got a rampant case of PIH from a plush salon in San Francisco. Daniel got his from an electrologist who promised to get rid of his flurry of chest hair. Sela fell prey to PIH after visiting her best friend’s doctor in Des Moines. And Deanna got hers from a mosquito attack in Kauai.

Yikes! What’s PIH?

PIH is a little acronym for a potentially big problem—Post Inflammatory Hyper-pigmentation—those brown spots and splotches on your skin that are more stubborn to erase than grease stains on silk. Plus you won’t have the option of hiding your face in the closet.

Nissan Pilest, top laser dermatologist in Irvine, California, treats much of Orange County’s Middle Eastern population. Dr. Pilest, who is from Iran, has 27 years’ experience in how to safely treat PIH-prone ethnic skin. This makes him a favorite with the Persian community.

“The body’s natural response to injury is some level of inflammation, even if you can’t see it. Whether a cut, burn, suntan, abrasion, bug bite or even simple exposure to kitchen heat, any insult to the skin is defined as an injury,” Dr. Pilest explains.

“Nearly all effective dermatologic procedures involve purposeful injury. Chemical peels and resurfacing lasers must create injury so that old tissue will shed and be replaced by new. Collagen-stimulating treatments create an injury beneath the skin surface to induce the formation of new collagen.

“Knowledge of how much injury-creating energy an individual’s skin type can tolerate without tipping the scale to the PIH side is essential. I can offer almost any treatment with no hyper-pigmentation risk to someone from a northern European gene pool,” he says. “But someone with a Mediterranean background would be foolish to risk the same levels of treatment energy because their skin has many more melanin cells and responds completely differently.

“When someone visits my practice the first time,” says Dr. Pilest. “One of the most important things I need to know is where they and their ancestors, from both sides of the family, are from. That information makes a huge difference in treatment selection. The wrong choices can have very unpleasant consequences,” he warns.

“Too much energy causes too much inflammation, which in turn provokes melanin cells to go into overdrive, producing copious amounts of pigmentation. The result? PIH, more commonly recognized as brown spots, streaks and splotches.

“But isn’t ethnic skin “strong” skin? Not at all. Ethnic skin is the most sensitive skin type on the planet. If someone’s going to get a nasty surprise visit from PIH, it won’t be the blue-eyed blonde who just had her entire face resurfaced, it’ll be the golden-skinned brunette from Greece or Iran who decided to have laser hair removal or a ‘rejuvenating’ face peel,” he continues.

“Does that mean people with ethnic backgrounds shouldn’t risk today’s mighty weapons against aging or go back to shaving foam and a razor? Of course not. But if you have high-pigment skin (the case for nearly everyone hailing from the Middle East), you need to be selective in choosing procedures and most importantly, you need to know the person performing them has plenty of expertise dealing with your skin type,” Dr. Pilest concludes.

Even tiny skin assaults cause problems, according to Kansas City dermatologist Audrey Kunin. “Skin trauma, no matter how minor or severe, can lead to cutaneous inflammation. A small blemish, a bug bite, chronic friction; they’re all you need to leave skin irritated and ultimately discolored.

“No one is exempt from PIH,” Dr. Kunin explains. “However, your baseline skin tone ultimately dictates just how discolored the skin becomes. For instance, I have a Mediterranean olive type complexion. PIH for me is often purplish or a faint light brown. The darker your skin tone, the darker the PIH will likely be. Really dark brown skin discoloration can take more than a year to resolve.”

Beating the PIH Monster
—Dr. Pilest’s How-Tos

Laser hair removal:

There are specific hair lasers designed for skin with pigment. If a physician or spa technician doesn’t ask your ethnic background and tailor your treatments accordingly, your best course of action is to wave goodbye as you walk out the door before you let them touch your skin.
Skin Resurfacing: Fraxel, erbium, plasma, CO2 and even microdermabrasion will induce inflammation. Results can be terrific, but they can also be horrific if the treatments are too aggressive.

Waxing:

Hot wax in the hands of a novice can have you looking like a zebra for months.

Chemical Peels:

Great but only in the right concentration and applied by an experienced physician or nurse accustomed to ethnic skin response.

Untreated Acne:

Got zits? Get to a dermatologist and get your acne under control. Each pimple or acne cyst can become a brown spot that might last not just months, but years.

The Best Advice:

Do your homework. How much of the doctor’s patient base is ethnic? How many years has she/he been practicing? What about Board Certification? Who performs the procedures and what are that person’s qualifications and experience?

Get referrals. See who the patrons are. If they all look as if they came from North Dakota, chances are that practice isn’t going to be the most adept at treating your PIH-prone skin.

Ready to Glow

No time to get to the dermatologist? Revitalize your face with the quick and easy facial-at-home with products provided by Sircuit Skin:

Step 1. Start with a gentle cleanser (X-Trap) that doesn’t strip the skin of its natural pH balance.

Step 2. Apply a fruit enzyme or a light lactic acid peel (Youth Accelerator or Mocha Loca), leave it on for 10 minutes and thoroughly rinse. Try to avoid over-the-counter glycolics, they are many times unstable and will leave you splotchy and irritated.

Step 3. Apply a serum that contains antioxidants and/or epidermal growth factors (Addict or O.M.G.)

Step 4. Apply moisturizer with sun protection (Day Care)—and you’re ready to glow!