Dark Spots - The Two Types Of PIP

People with white skin tend to complain about red marks that remain red or purplish in color. These spots are called macules in dermatologese. Like freckles and tattoos, they're simply color changes of the skin (you can't feel macules, and if you close your eyes, they don't exist).

 

In black skin, those same red spots look much darker, even deep brown or black in color and many shades in between, particularly after they heal. African-Americans are often more concerned about these dark acne-related macules than they are about the acne itself. The dark spots are known as postinflammatory hyperpigmen-tation or postinflammatory pigmentation — or PIP for short.

 

PIP is limited to the sites of previous inflammation. Think of the spots as "footprints," the aftermath or telltale signs that show where the original injury (inflammatory "battle") took place. The original insult (and injury) that caused PIP can be a cut, a burn, a rash, or the after-effect from a healing acne lesion.

 

Often these "footprints" disappear over a period of time, but they always outlast the original inflammatory acne lesions themselves. In fact, they may take many months or even years to fade completely.

 

There are actually two types of PIP. Both start off when inflammation of the skin, such as acne, stimulates the melanocytes in your epidermis and causes them to step up the manufacturing of melanin. The production of melanin (melanogenesis) increases in response to the tanning effect of sun, injuries to the skin such as burns, cuts, surgeries, as well as the inflammation caused by acne.

 

The two different types of PIP are

 

Epidermal hypermelanosis: The busy melanocytes respond by handing off their melanin pigment in tiny granules to surrounding keratinocytes, your other epidermal cells. This increased stimulation and transfer of melanin granules results in epidermal hypermelanosis. Your skin gets darker, but the pigment isn't deep.

 

The good news is that this type of PIP often responds to topical bleaching creams, which help to accelerate its disappearance. That's because the majority of the melanin pigment is inthe epidermis (the top layer of the skin) which allows it to be treated.

 

Dermal melanosis: Dermal melanosis occurs when inflammation disrupts the basal cell layer, causing melanin pigment to be released and subsequently "dropped" more deeply into the dermis where it gets trapped by macrophages (scavenger white cells). This type of PIP is much harder to treat and may never fade away completely.

 

These spots are not scars, and some, if not all, of them will fade in time, or if necessary, they can be lightened with appropriate treatment. Unless the pigment is very deep, PIP will improve over time. Be an extra patient patient! The dark spots take the longest to fade. The treatment of PIP tends to be a difficult and prolonged process that often takes 6 to 12 months to achieve the desired results of depigmentation.

 

Because these spots can take so long to disappear, it's essential to prevent them from appearing in the first place. Early treatment and prevention for your acne can help put a stop to them. You should be aware of those things that put you at greater risk of developing PIP. For example, you should avoid:

 

Of course, it's tempting to think that squeezing spots will help them heal more quickly. In fact, squeezing actually makes them worse. Squeezing a spot carries a risk of scarring because the pus can burst inward into the skin rather than outward to the surface.

 

In fact, any situation where the skin can be irritated, be it squeezing blemishes, or plucking hair, can result in dark skin's tendency to produce more melanin and create dark spots.

 

Shaving the beard can also wreak havoc with acne and increase the possibility to develop PIP.