Dr Dray Warns Hidden Skin Inflammation Keeps Dark Spots Active

Why Your Hyperpigmentation Won’t Go Away | Dermatologist Explains — Dr Dray

Dr Dray

Dark marks persist after acne and eczema because microscopic inflammation continues driving melanocytes under seemingly clear skin, meaning halting maintenance therapy or layering harsh brighteners only worsens discoloration.

AI-assisted summary of Why Your Hyperpigmentation Won’t Go Away | Dermatologist Explains — original source. Check the original for full context.

Source published:

Key ideas

  • Post-inflammatory hyperpigmentation (PIH) frequently coexists with subclinical, microscopic inflammation that persists beneath the skin surface even after primary lesions appear fully healed. (0:00)
  • In melanin-rich skin, erythema often manifests as purple, slate gray, or brown rather than visible red, causing active inflammation to be easily overlooked during standard clinical observation. (4:00)
  • Prematurely stopping acne or eczema maintenance regimens upon visible clearing allows residual inflammation to continue stimulating melanocytes and entrenching dark marks. (6:00)
  • Tinted sunscreens formulated with iron oxides are necessary for stubborn hyperpigmentation because standard UV filters fail to block high-energy visible blue light, a recognized driver of melanogenesis. (16:20)

Detailed notes

## Background Published on YouTube on August 13, 2026, by board-certified dermatologist Dr Dray, this video examines why post-inflammatory hyperpigmentation often coexists with ongoing, microscopic inflammation even when the skin appears clear. The video description highlights how persistent inflammation from conditions like acne, eczema, and contact dermatitis perpetuates dark marks—particularly in darker skin tones where redness is obscured—while outlining the hazards of product overload, mechanical trauma, and unverified at-home devices alongside clinical solutions like Tri-Luma and tinted sunscreens.

## TL;DR Dr. Dray explains that post-inflammatory hyperpigmentation (PIH) is rarely just an inactive surface stain, as subclinical inflammation often smolders beneath seemingly healed skin, particularly in deeper complexions where erythema presents as purple, brown, or invisible tones. Halting acne or eczema treatments prematurely allows this underlying activity to continuously stimulate melanocytes, while aggressive product-hopping, picking, and at-home microneedling or IPL devices inflict additional trauma that worsens pigment. True clearance requires extinguishing the inflammatory driver beneath the surface, exemplified by prescription formulas like Tri-Luma that integrate a mild steroid to calm irritation alongside pigment inhibitors. A successful regimen hinges on sustained maintenance therapy for primary conditions, an ultra-minimalist skincare routine, and daily tinted sunscreen formulated with iron oxides to block visible light.

## Atmosphere & style The presentation carries Dr. Dray's characteristic clinical, no-nonsense authority paired with dry wit and grounded pragmatism. Her pacing is unhurried and educational, systematically dismantling viral cosmetic trends, product-chasing consumerism, and risky at-home gadgets with calm, reasoned explanations. The viewing experience feels like an intimate, reassuring consultation with a seasoned dermatologist who cuts through marketing hype to champion biological simplicity, barrier respect, and clinical patience.

## Bulletin - [00:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=0s) Post-inflammatory hyperpigmentation (PIH) frequently coexists with subclinical, microscopic inflammation that persists beneath the skin surface even after primary lesions appear fully healed. - [04:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=240s) In melanin-rich skin, erythema often manifests as purple, slate gray, or brown rather than visible red, causing active inflammation to be easily overlooked during standard clinical observation. - [06:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=360s) Prematurely stopping acne or eczema maintenance regimens upon visible clearing allows residual inflammation to continue stimulating melanocytes and entrenching dark marks. - [16:20](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=980s) Tinted sunscreens formulated with iron oxides are necessary for stubborn hyperpigmentation because standard UV filters fail to block high-energy visible blue light, a recognized driver of melanogenesis.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=0s) The term 'post-inflammatory' is misleading because active inflammatory cascades routinely persist under the skin long after surface redness or bumps subside. - [04:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=240s) High baseline melanin alters light scattering, masking active erythema as subtle dusky brown or purple tones and making naked-eye assessment of inflammation unreliable. - [01:35](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=95s) Product overload and aggressive active layering backfire by causing cutaneous barrier disruption, which acts as 'fuel on the fire' for melanocyte stimulation. - [06:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=360s) Acne maintenance therapies, such as retinoids and azelaic acid, should not be halted when blemishes flatten because they suppress microscopic inflammation and microcomedone formation. - [08:06](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=486s) Managing inflammatory dermatoses like atopic dermatitis often requires proactive, tapered anti-inflammatory therapy on clinically clear skin to fully clear silent tissue inflammation. - [11:43](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=703s) Mechanical manipulation, such as picking and squeezing blemishes, drives trauma deeper into the dermis and dramatically elevates the risk of persistent PIH. - [12:29](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=749s) At-home microneedling and IPL energy devices present significant hazards for darker skin tones due to poor precision and thermal injury risks that readily trigger rebound hyperpigmentation. - [14:11](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=851s) The Kligman formula (Tri-Luma) incorporates the mild corticosteroid fluocinolone acetonide specifically to suppress subclinical inflammation and mitigate the irritancy of hydroquinone and tretinoin. - [16:20](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=980s) Visible light, specifically high-energy visible blue light, directly induces long-lasting pigmentation in melanin-rich complexions, necessitating iron oxide-containing sunscreens for adequate protection. - [17:50](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=1070s) Resolving persistent dark marks requires treating the underlying inflammatory 'gasoline' rather than attempting to bleach pigment on irritated or actively inflamed skin. - [18:52](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=1132s) Discoloration is clinically diverse and not always standard PIH or melasma; atypical presentations may stem from conditions such as Voigt's (Futcher's) lines or other distinct pigmentary patterns.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=0s) Rethinking "Post-Inflammatory": The Hidden Inflammation Beneath Dark Spots

The term post-inflammatory hyperpigmentation (PIH) is commonly used to describe the stubborn dark marks left on the skin after an insult such as acne, eczema, an injury, or an allergic reaction. However, the prefix "post-inflammatory" can be deceptively misleading. It encourages the assumption that the primary inflammatory event has entirely concluded, leaving behind only a passive cosmetic stain that needs fading. In reality, active, microscopic inflammation frequently continues lurking beneath the skin surface long after the initial lesion seems clinically healed.

This hidden activity presents a major challenge in melanin-rich skin tones. Individuals with deeper complexions are not only physiologically more prone to PIH, but their cutaneous inflammatory signs are far less visually obvious. Erythema—the redness caused by increased microvascular blood flow during an inflammatory surge—is easily spotted in fair skin, but presents entirely differently against higher baseline melanin. Relying purely on visual redness severely underestimates the extent of ongoing disease, obscuring the fact that the underlying pathology is still driving pigment production.

[01:35](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=95s) Triggers of PIH and the Trap of Product Overload

Any insult that traumatizes, irritates, or inflames the cutaneous barrier can provoke PIH. Common triggers span a broad spectrum of clinical and environmental sources: - Inflammatory dermatoses like acne vulgaris, atopic dermatitis (eczema), contact dermatitis, and rosacea - Physical injuries, including insect bites, excoriation, and habitual skin picking or squeezing - Procedural trauma, such as in-office or at-home light-based energy devices and cosmetic procedures

In deeper skin tones, PIH is not only more noticeable and widespread, but it also persists far longer. Once the primary bump or rash subsides, patients routinely assume the disease is gone and shift their focus to targeting the dark spots. This shift often triggers a frenzy of product-hopping. As Dr. Dray jokes, "in the span of me filming this video, there'll be 200 new ones that get launched in the next 5 to 10 minutes." Consumers rush to layer an endless carousel of pigment-lightening agents, such as topical retinoids, hydroquinone, tranexamic acid, azelaic acid, and kojic acid.

While these actives are clinically proven, piling on new, potentially sensitizing formulations frequently backfires. Applying irritating topicals onto tissue that already harbors subclinical inflammation functions as "pressing the gas pedal on unwanted pigmentation." The resulting contact irritation sparks a fresh wave of melanocyte hyperactivity, locking the patient into a frustrating, self-perpetuating cycle.

```mermaid flowchart TD accTitle: The Vicious Cycle of Subclinical Inflammation and Hyperpigmentation accDescr: Flowchart illustrating how hidden inflammation combined with product irritation exacerbates pigment production.

subgraph TriggerPhase ["Initial Insult"] A["Inflammatory Skin Event<br/>(Acne, Eczema, Trauma)"] --> B["Surface Lesion Clears<br/>(Erythema & Bumps Fade)"] end

subgraph HiddenPhase ["Subclinical Activity"] B --> C["Ongoing Inflammation<br/>Lurking Beneath Surface"] C --> D["Persistent Pigment Production<br/>(PIH)"] end

subgraph IrritationCycle ["Treatment Backfire"] D --> E["Aggressive Product Hopping<br/>(Multiple Actives & Lighteners)"] E --> F["Barrier Disruption & Skin Irritation"] F -->|"Presses the Gas Pedal"| C end ```

[04:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=240s) Subclinical Inflammation: Why the Naked Eye Deceives in Deeper Skin Tones

Emerging dermatologic evidence reveals that inflammation and hyperpigmentation do not proceed in an orderly, linear handoff where one finishes before the other begins. Instead, active inflammation frequently overlaps with the emergence and persistence of pigment. When skin that looks to the naked eye like an isolated, static brown mark is evaluated with objective bioengineering instruments or histological biopsies, tissue samples routinely show dense infiltrates of active inflammatory cells directly within the pigmented zone.

The optical physics of melanin explain why clinical examinations often miss this phase: - **Altered Light Scattering:** High concentrations of epidermal melanin change how visible light reflects off hemoglobin and dermal structures. - **Atypical Color Presentation:** Instead of appearing bright red, erythema and underlying inflammation in skin of color often manifest as shades of purple, slate gray, or dusky brown. - **The Brown-on-Brown Dilemma:** When inflammation manifests as brown, differentiating between active erythema and true melanin deposit becomes virtually impossible with the naked eye. - **Completely Silent Inflammation:** In many instances, there is no discernable color shift at all; active inflammation remains completely masked beneath the pigment.

While this does not mean every single hyperpigmented spot warrants a targeted anti-inflammatory prescription, understanding that inflammation can quietly endure changes the entire strategy for managing chronic discoloration.

[06:00](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=360s) Acne Maintenance: Why You Shouldn't Abandon Topicals When Skin Clears

Acne serves as a clear example of why stopping therapy too early compromises pigment clearance. A patient undergoing treatment may see their painful inflammatory cysts, pus bumps, open comedones (blackheads), and closed comedones (whiteheads) completely flatten out, leaving behind only post-acne dark marks and subtle textural irregularities. The immediate impulse is often to declare the acne cured, abandon the acne regimen, and switch all effort toward lightening agents.

This approach overlooks the fact that acne vulgaris is a chronic inflammatory disorder. Even when the epidermal surface appears calm, the pilosebaceous units beneath maintain an inflammatory baseline capable of continually stimulating surrounding melanocytes. Dermatologists consistently stress remaining on maintenance therapy—whether topical retinoids, benzoyl peroxide, azelaic acid, or systemic options like oral antibiotics or isotretinoin: - **Preventing Recurrence:** Continuous maintenance keeps microcomedones from developing into inflammatory breakouts that trigger new PIH. - **Suppressing Deep Disease:** Consistent therapy treats the invisible, subclinical inflammation still simmering under flat spots. - **Dual-Action Synergy:** Many frontline acne topicals pull double duty. Topical retinoids accelerate cell turnover and disperse melanin, while azelaic acid directly inhibits tyrosinase (the key enzyme in melanin synthesis) alongside its anti-inflammatory and antibacterial properties.

Halting maintenance therapy removes these protective mechanisms, leaving the door wide open for persistent inflammation to keep the dark spots entrenched.

[08:06](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=486s) Lingering Inflammation in Eczema, Contact Dermatitis, and Rosacea

The exact same underlying mechanisms occur across other inflammatory skin conditions, including atopic dermatitis, contact dermatitis, and rosacea. In an acute eczema flare, a patient treats the area until the severe pruritus (itching), oozing, weeping, and barrier stinging resolve. Seeing that the skin appears structurally intact, many stop using their medicated topicals immediately.

However, microscopic inflammation routinely persists long after sensory symptoms and surface scaling vanish: - **Subclinical Eczema Activity:** Quitting treatment the moment skin looks clear leaves quiet inflammatory pathways active, continuing to stimulate melanocytes and deepening post-eczema pigmentation. - **The "Proactive" Topical Steroid Approach:** To combat this, dermatologists often recommend continuing a topical corticosteroid (or steroid-sparing anti-inflammatory) on clear, "normal-appearing skin" for an additional one to two weeks following an acute flare. - **Treatment Duration:** Tailoring the taper period to the initial severity ensures that invisible inflammation is fully extinguished, stopping it from quietly maintaining chronic discoloration.

[09:16](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=556s) The Hidden Battles of Contact Dermatitis and Subclinical Inflammation

Identifying the underlying cause of contact dermatitis presents a major clinical challenge. The hardest hurdle is often pinpointing the exact offending allergen and then uncovering every single place it exists across your daily environment. The culprit is not always an obvious skincare product or cosmetic; it frequently hides in nail care formulations or in a staple product you have trusted for years that underwent an unannounced manufacturer reformulation swapping in a sensitizing ingredient. Occupational exposures compound the problem, as people routinely become allergic to ingredients in their personal products that overlap with materials they are mandated to handle at work.

Because of this constant, low-grade exposure, contact dermatitis turns into an ongoing battle beneath the surface. Dr. Dray emphasizes a core truth: "clear skin does not always mean that you don't have ongoing active disease lurking beneath the surface of the skin." Even if the surface displays no overt rash, inflammatory signaling can persist silently and continue feeding pigment production.

[10:09](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=609s) Why Overcomplicating Skincare Backfires on Pigmentation

When dealing with stubborn hyperpigmentation, the instinctive response is to take aggressive action. People assemble elaborate routines featuring at-home peels, exfoliating acids, physical scrubs, vitamin C serums, topical retinols, specialized brightening toners, and weekly masks—often chasing recommendations from social media videos. Instead of fading discoloration, layering so many potent actives compromises the skin barrier and triggers acute irritation.

Once the barrier is disrupted, those products actively drive the very pigmentation they were bought to treat. In deeper skin tones, the resulting inflammation rarely manifests as bright erythema or obvious redness; instead, it whispers through subtle symptoms like tightness, dryness, flaking, stinging, itching, or heightened sensitivity. Dr. Dray stresses that products are not always the answer, reiterating her philosophy of maintaining an ultra-simple baseline:

- **The non-negotiable minimalist core**: Cleanse, moisturize, and apply sunscreen. - **The risk profile of multi-step routines**: Every additional active introduces a new vector for barrier breakdown, irritation, and subsequent post-inflammatory darkening. - **The risk-averse approach**: When treating pigmentation, simplicity minimizes the chances of aggravating melanocytes.

[11:43](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=703s) The Compulsion to Pick and the Fallacy of "Getting the Gunk Out"

Picking and squeezing blemishes is another major driver of lingering dark marks. Many people squeeze pimples under the mistaken belief that extracting the contents will accelerate healing. Dr. Dray refutes this directly: you are not helping the skin heal; you are simply inflicting mechanical trauma. That mechanical force drives deeper inflammation into the tissue, worsening the acne lesion and virtually guaranteeing persistent, dark post-inflammatory hyperpigmentation (PIH).

For many, picking is an unconscious coping mechanism tied to anxiety and stress. Dr. Dray notes that she has created a dedicated guide on skin picking disorder featuring a comprehensive behavioral coping program. Overcoming the compulsion demands active, deliberate behavioral effort, but breaking the habit is mandatory if you want discoloration to fade.

[12:29](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=749s) The Dangers of At-Home Microneedling and IPL Devices

Dr. Dray warns sternly against using at-home procedural tools, noting that while she receives pushback in the comments, more dermatologists on social media are finally echoing these concerns. At-home microneedling rollers and pens pose extreme risks, particularly for melanin-rich skin. While professional microneedling performed in a controlled clinical setting can be effective, consumer devices lack the precision, engineering caliber, and sanitary control of medical-grade equipment. The resulting micro-tears routinely trigger unwanted hyperpigmentation. Dr. Dray rejects the notion that complications only arise because consumers "didn't follow the online social media tutorial right and they're stupid"; the devices themselves are inherently high-risk for pigment-prone individuals.

At-home Intense Pulsed Light (IPL) gadgets carry comparable dangers. Though marketed under the guise of gentle light therapy for hair removal or evening out skin tone, IPL is not a targeted laser; it emits broad, scattered wavelengths of high-intensity light. On deeper skin tones, at-home IPL can easily burn the epidermis, leading to severe thermal injury and recalcitrant hyperpigmentation.

[14:11](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=851s) The Tri-Luma Rationale: Why Kligman's Formula Contains a Steroid

The gold standard prescription therapy for stubborn melasma and hyperpigmentation is the Kligman formula, commercially known as Tri-Luma. Patients are frequently alarmed to discover that this cream incorporates a topical corticosteroid alongside pigment fighters, wondering why a steroid belongs on facial skin given potential long-term adverse effects.

```mermaid flowchart TD accTitle: Tri-Luma Triple Combination Mechanism accDescr: Diagram illustrating how fluocinolone, hydroquinone, and tretinoin work synergistically in Tri-Luma to eliminate pigment and control irritation.

subgraph Actives["Tri-Luma Triple Combination"] HQ["Hydroquinone"] TRET["Tretinoin"] FLUO["Fluocinolone Acetonide 0.01%"] end

subgraph Actions["Mechanisms of Action"] T1["Inhibits Tyrosinase (Pigment Production)"] T2["Accelerates Epidermal Turnover & Halts Enzymes"] T3["Suppresses Lingering & Active Inflammation"] T4["Blocks Retinoid & Hydroquinone Irritation"] end

HQ --> T1 TRET --> T2 FLUO --> T3 FLUO --> T4

T1 & T2 & T3 & T4 --> OUT["Effective Pigment Clearance Without Triggering Rebound PIH"] ```

The combination is carefully engineered so that each component complements and buffers the others:

- **Hydroquinone**: Serves as a direct tyrosinase inhibitor, blocking the rate-limiting enzyme responsible for synthesizing melanin. - **Tretinoin**: Accelerates epidermal cell turnover to shed accumulated pigment while simultaneously applying the brakes to pigment-producing pathways. - **Fluocinolone acetonide (0.01%)**: A mild corticosteroid that directly suppresses melanogenesis and extinguishes subclinical inflammation lingering from primary skin disorders like acne. Crucially, Dr. Albert Kligman realized that hydroquinone and tretinoin are notoriously irritating molecules capable of inducing irritation-induced rebound hyperpigmentation. Adding a gentle "whiff of steroid" neutralizes that irritation, allowing the other two actives to work at maximum potency without backfiring.

[16:20](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=980s) Sun Protection, Visible Light, and Iron Oxides

Diligent sun protection is an absolute, non-negotiable requirement for resolving hyperpigmentation. Ultraviolet (UV) radiation delivers a double hit to the skin: it directly upregulates melanocyte activity while simultaneously instigating an inflammatory cascade. Furthermore, solar radiation emits broad-spectrum visible light, particularly high-energy visible (HEV) blue light, which is now recognized as a potent trigger of long-lasting pigmentation in darker skin tones.

Because standard chemical and untinted mineral filters do not sufficiently block visible light, dermatologists specifically advise using tinted sunscreens for melasma and PIH. The iron oxides used to create the cosmetic tint serve a vital photoprotective function by creating a physical barrier against blue light. Dr. Dray underscores that "there's no such thing as unwanted pigmentation that was helped by unprotected sun exposure"—unshielded daylight will unfailingly aggravate dark marks from multiple angles.

[17:50](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=1070s) Treating the "Gasoline": The Final Clinical Takeaway

Addressing hyperpigmentation requires shifting focus away from surface discoloration alone and targeting the silent driver underneath. Dr. Dray compares inflammation to gasoline: trying to wipe away the dark pigment while leaving inflammatory pathways active is futile because the fuel feeding the fire is never removed.

Even when the skin surface appears completely calm and clear, microscopic inflammation often continues smoldering underneath. To successfully resolve hyperpigmentation:

- Do not assume that an absence of redness means an absence of disease, especially in melanin-rich skin. - Eliminate avoidable sources of friction, trauma, and irritation, including mechanical picking, aggressive at-home microneedling, and overly elaborate skincare routines. - Strictly adhere to daily broad-spectrum, tinted sun protection. - Consult your dermatologist to confirm appropriate treatment durations; maintenance regimens must often be sustained long after visible clearing to keep underlying disease activity fully suppressed.

[18:52](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=1132s) The Need for Ongoing Care and Wrap-Up

Beneath the surface, skin is often still recovering even if things look clear on top; as Dr. Dray points out, "it's not all sunshines and rainbows down there," meaning active management and maintenance treatments are frequently required to keep underlying inflammation from quietly persisting. She directs viewers to explore the extensive catalog of related content across her channel, which covers various forms of melasma and general hyperpigmentation in deeper detail.

She also highlights that hyperpigmentation is not a monolith strictly limited to post-inflammatory marks or melasma. For viewers dealing with less common or atypical presentations, she has dedicated videos exploring rarer conditions, including Voigt's lines (also known as Futcher's lines) and other distinctive pigmentary disorders. Viewers who have received an unusual diagnosis are encouraged to search her channel archive for targeted breakdowns. Wrapping up the session, she leaves her audience with her signature parting advice to like, share, subscribe, and above all, never forget sunscreen.

- **Underlying Inflammation:** Even when blemishes appear resolved, subclinical inflammatory processes can linger beneath the skin's surface, necessitating consistent maintenance therapy. - **Differential Diagnoses:** Dark patches are not always standard post-inflammatory hyperpigmentation or melasma; pigmentary disorders can encompass distinct physiological patterns like Voigt's lines (Futcher's lines) and rarer dermatological conditions.

## Notable quotes > [01:35](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=95s) in the span of me filming this video, there'll be 200 new ones that get launched in the next 5 to 10 minutes. — Dr. Dray

> [01:35](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=95s) pressing the gas pedal on unwanted pigmentation — Dr. Dray

> [08:06](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=486s) normal-appearing skin — Dr. Dray

> [09:16](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=556s) clear skin does not always mean that you don't have ongoing active disease lurking beneath the surface of the skin. — Dr. Dray

> [11:43](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=703s) Getting the Gunk Out

> [12:29](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=749s) didn't follow the online social media tutorial right and they're stupid — Dr. Dray

> [14:11](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=851s) whiff of steroid — Dr. Dray

> [16:20](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=980s) there's no such thing as unwanted pigmentation that was helped by unprotected sun exposure — Dr. Dray

> [18:52](https://www.youtube.com/watch?v=DYqU1VIR3pw&t=1132s) it's not all sunshines and rainbows down there — Dr. Dray

## Mentioned Dr. Dray, Dr. Albert Kligman, Tri-Luma, Kligman formula, Hydroquinone, Tretinoin, Fluocinolone acetonide, Azelaic acid, Tranexamic acid, Kojic acid, Benzoyl peroxide, Isotretinoin, Iron oxides, Voigt's lines (Futcher's lines), YouTube, Amazon

## Video description Hyperpigmentation is not always simply a dark mark left behind after inflammation. In this video, board-certified dermatologist Dr. Dray explains why post-inflammatory hyperpigmentation (PIH) may sometimes coexist with ongoing inflammation, even when the skin appears clear on the surface.

This is particularly important for people with darker skin tones, where inflammation and erythema may be less visually obvious. Dr. Dray explains how persistent inflammation from acne, eczema, contact dermatitis, rosacea, and other inflammatory skin conditions can contribute to stubborn hyperpigmentation and why treating the underlying condition is an important part of improving dark spots.

The video also covers why constantly trying new skincare products can backfire, how irritation can worsen hyperpigmentation, why picking and squeezing acne can lead to darker marks, and why caution is needed with at-home microneedling and IPL devices.

Dr. Dray also discusses the rationale behind the Kligman formula and Tri-Luma, including why fluocinolone acetonide is combined with hydroquinone and tretinoin, and how its anti-inflammatory properties can help limit irritation while contributing to the overall treatment approach.

Finally, the video explains why sun protection is essential for hyperpigmentation and melasma, including the potential benefits of tinted sunscreens containing iron oxides for visible light protection.

Topics covered

• Post-inflammatory hyperpigmentation and ongoing inflammation • Hyperpigmentation after acne and eczema • PIH in darker skin tones • Why inflammation may be difficult to see • Acne maintenance treatment and dark spots • Eczema, contact dermatitis and rosacea • Skincare irritation and hyperpigmentation • Picking and squeezing acne • At-home microneedling risks • At-home IPL and hyperpigmentation • Kligman formula and Tri-Luma • Hydroquinone, tretinoin and fluocinolone • Tinted sunscreen and iron oxides • Visible light and hyperpigmentation • How to prevent worsening dark spots

TIMESTAMPS

0:00 Introduction: Is PIH Really "Post-Inflammatory"? 1:35 What Is Post-Inflammatory Hyperpigmentation? 4:00 Can Dark Marks Hide Ongoing Inflammation? 6:00 Why This Matters for Acne 8:06 Eczema, Contact Dermatitis and Rosacea 10:09 Why Trying Too Many Products Can Backfire 11:43 Why You Shouldn't Pick or Squeeze 12:29 Risks of At-Home Microneedling and IPL 14:11 Why Does Tri-Luma Contain a Steroid? 16:20 Sunscreen and Visible Light Protection 17:50 Final Takeaway

If you're struggling with stubborn hyperpigmentation, acne dark spots, melasma, or post-inflammatory hyperpigmentation, this video explains why treating pigment alone may not always address the underlying problem.

The key takeaway is that clear-looking skin does not always mean that inflammatory activity has completely resolved. Consistent treatment of the underlying skin condition, avoiding unnecessary irritation and trauma, and diligent sun protection can all play an important role in managing hyperpigmentation.

#Hyperpigmentation #PostInflammatoryHyperpigmentation #PIH #DarkSpots #AcneDarkSpots #Melasma #Skincare #Dermatologist #DrDray #HyperpigmentationTreatment #Acne #Eczema #Sunscreen

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=DYqU1VIR3pw)

中文简报

Dr Dray提醒：隐匿性皮肤炎症会导致色沉持续活跃 痤疮和湿疹消退后黑印仍旧顽固，是因为看似痊愈的皮肤下仍有微观炎症在持续刺激黑素细胞；过早停用维持治疗或叠加刺激性美白成分只会加重色素沉着。 Dr. Dray解释称，炎症后色素沉着（PIH）往往并非只是静止的表层印记，因为亚临床炎症常在看似痊愈的皮肤下暗中持续，深肤色人群尤为如此，其红斑可能呈现为紫色、褐色甚至完全隐匿。过早停止针对痤疮或湿疹的治疗，会让这些潜在炎症活动持续刺激黑素细胞；而频繁更换刺激性护肤品、抠挤皮肤以及在家使用微针或IPL设备，更会造成二次创伤加重色沉。真正实现淡化必须从根源上熄灭皮下的炎症诱因，例如Tri-Luma等处方药配方就结合了温和类固醇以平息刺激，并协同色素抑制剂发挥作用。一套行之有效的方案取决于：针对原发皮肤问题坚持长期维持治疗、践行极简护肤流程，以及每日使用含有氧化铁的润色防晒霜来阻隔可见光。 炎症后色素沉着（PIH）常与亚临床微观炎症并存，即使原发皮损表面看似完全痊愈，这种炎症依然在皮下持续存在。 (0:00) 在富含黑色素的深肤色人群中，红斑常表现为紫色、石板灰色或褐色而非明显的红色，导致活跃的炎症在常规临床观察中极易被忽视。 (4:00) 在皮损肉眼可见消退后过早停止痤疮或湿疹的维持治疗，会导致残留炎症继续刺激黑素细胞，使深色印记进一步固化。 (6:00) 对于顽固性色素沉着，含有氧化铁的润色防晒霜必不可少，因为常规防晒剂无法阻挡高能可见蓝光这一已知的黑色素生成诱因。 (16:20)

Reading summary

According to dermatologist Dr Dray, post-inflammatory hyperpigmentation persists primarily because subclinical, microscopic inflammation remains active beneath the skin surface even after visible blemishes resolve. Effectively clearing dark marks requires suppressing this underlying inflammatory driver through sustained maintenance and barrier protection rather than aggressively attacking surface pigment with irritating products and procedures. The Illusion of Resolved Inflammation in Darker Skin (4:00) The term "post-inflammatory" misleadingly implies that inflammation has completely concluded before pigment forms. In reality, active microscopic inflammatory cascades frequently persist directly beneath flat discoloration. Dr Dray explains that in melanin-rich complexions, optical physics alters how light reflects off dermal structures and hemoglobin. Instead of presenting as classic red erythema, active inflammation manifests as purple, slate gray, or dusky brown tones, or remains visually masked altogether. Treatment Abandonment, Product Overload, and Barrier Irritation (1:35) When primary lesions such as acne cysts or eczema flares flatten and stop itching, patients often prematurely discontinue their prescribed therapies to focus exclusively on lightening agents. Dr Dray cautions that halting maintenance regimens—such as topical retinoids, azelaic acid, or post-flare corticosteroid tapers—allows lingering inflammatory pathways to continually reactivate melanocytes. Furthermore, many frontline acne topicals provide dual action; azelaic acid directly inhibits tyrosinase while reducing inflammation, and retinoids accelerate pigment dispersal. Switching into an aggressive routine with multiple exfoliating acids, scrubs, and brightening serums frequently backfires. Piling on potentially sensitizing actives disrupts the cutaneous barrier and incites contact irritation. Because this irritation acts like "pressing the gas pedal" on melanocytes, it triggers renewed pigment synthesis, locking patients into a cycle of self-induced post-inflammatory darkening. A similar dynamic occurs in hidden contact dermatitis from reformulated products or occupational exposures, where low-grade irritation silently feeds discoloration. The Hazards of Mechanical Trauma and At-Home Gadgets (11:43) Mechanical trauma from picking or squeezing blemishes pushes inflammation deeper into the tissue rather than expediting healing, virtually ensuring darker, longer-lasting marks. Dr Dray emphasizes that breaking this compulsive, stress-related habit is essential for pigment recovery. Similarly, consumer procedural devices present severe hazards for pigment-prone skin. Unlike clinical-grade equipment operated in controlled environments, at-home microneedling tools lack manufacturing precision and sanitary controls, creating ragged micro-tears that provoke fresh hyperpigmentation. Meanwhile, at-home intense pulsed light (IPL) devices emit broad, scattered wavelengths rather than focused laser beams. On deeper complexions, this unfocused thermal energy risks epidermal burns and recalcitrant hyperpigmentation. Synergistic Formulas and Tinted Photoprotection (14:11) The rationale behind prescription Kligman's formula (Tri-Luma) illustrates why anti-inflammatory control is indispensable in pigment management. The formulation pairs hydroquinone (tyrosinase inhibition) and tretinoin (accelerated cell turnover) with fluocinolone acetonide (0.01%), a mild corticosteroid. The steroid not only quells baseline subclinical inflammation but also neutralizes the inherent irritancy of hydroquinone and tretinoin, averting irritation-induced rebound hyperpigmentation. Photoprotection is equally vital, as ultraviolet rays simultaneously provoke inflammation and stimulate melanocytes. However, untinted chemical or mineral filters fail to block high-energy visible (HEV) blue light, a recognized trigger for persistent pigmentation in skin of color. Tinted sunscreens formulated with iron oxides create a necessary physical shield against visible light wavelengths, preventing unshielded daylight from continuously aggravating dark marks. Resolving stubborn hyperpigmentation depends on extinguishing underlying inflammation rather than stripping away surface discoloration. While simple daily routines, tinted sun protection, and sustained maintenance therapy resolve typical post-inflammatory marks, Dr Dray notes that pigmentary disorders also encompass distinct diagnoses such as Voigt's lines that warrant targeted clinical evaluation.

Source quotes

[1:35] Dr. Dray: in the span of me filming this video, there'll be 200 new ones that get launched in the next 5 to 10 minutes. [1:35] Dr. Dray: pressing the gas pedal on unwanted pigmentation [8:06] Dr. Dray: normal-appearing skin [9:16] Dr. Dray: clear skin does not always mean that you don't have ongoing active disease lurking beneath the surface of the skin. [11:43] Getting the Gunk Out [12:29] Dr. Dray: didn't follow the online social media tutorial right and they're stupid [14:11] Dr. Dray: whiff of steroid [16:20] Dr. Dray: there's no such thing as unwanted pigmentation that was helped by unprotected sun exposure [18:52] Dr. Dray: it's not all sunshines and rainbows down there

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist. Today, I [0:05] want to talk about something that could [0:07] really change the way you think about [0:09] hyperpigmentation. We often use the term [0:11] post-inflammatory hyperpigmentation, [0:13] abbreviated PIH, to refer to dark spots [0:17] that remain on the surface of the skin [0:19] after acne, eczema, skin injury, or some [0:22] other inflammatory event. That word, [0:25] post-inflammatory, [0:27] it gives a specific impression, leads [0:29] you to believe well, something happened, [0:31] it went away, and the aftermath was [0:34] hyperpigmentation. That [0:36] hyperpigmentation appears, and beneath [0:38] the surface of the skin, active [0:40] inflammation is still lurking. It can [0:43] paint a very confusing picture because [0:45] to your eye, the primary event has [0:47] completely cleared up and gone away, and [0:49] you think all you have to focus on is [0:52] now fading the hyperpigmentation. But, [0:54] there's still inflammation lurking under [0:56] the surface of the skin. You just can't [0:58] see it with your eyes. This is [0:59] particularly important because people [1:01] with melanin-rich skin tones, deeper [1:04] skin tones, we already know they're more [1:05] inclined towards post-inflammatory [1:07] hyperpigmentation. But, some of the [1:09] clues on the surface of the skin that [1:11] inflammation is going on are a lot less [1:14] obvious in deeper skin tones. In these [1:16] skin tones, inflammation doesn't always [1:19] look red. Relying on the appearance of [1:21] redness alone will underestimate the [1:24] degree of inflammation that is lurking [1:26] beneath the surface of the skin. So, [1:28] today, I want to open your eyes to a [1:30] really interesting and important [1:32] perspective with regards to [1:33] hyperpigmentation and inflammation. [1:35] Post-inflammatory hyperpigmentation [1:37] refers to pigmentation that remains [1:40] after you've had some sort of [1:41] inflammatory event in the skin, whether [1:43] it be acne, eczema, a contact [1:45] dermatitis, rosacea, or a bug bite, some [1:49] sort of skin injury. Could be a cosmetic [1:52] procedure, a light-based device, or [1:54] simply picking the skin. Basically, [1:56] anything that causes irritation, [1:58] inflammation, traumatizes the skin has [2:01] the potential to lead to unwanted [2:03] pigmentation. For people with [2:05] melanin-rich, deeper skin tones, [2:07] however, this post-inflammatory [2:08] hyperpigmentation, not only is it more [2:11] obvious, not only is it more extensive, [2:13] but it tends to be a lot more [2:15] persistent. It's not always accurate to [2:17] think of it as post-inflammatory [2:20] hyperpigmentation, as in, oh, this is [2:22] the aftermath. This is now the thing [2:24] that's left behind. I no longer have to [2:26] worry about the inciting event that [2:28] triggered the inflammation. The [2:29] pigmentation might just be part of an [2:32] ongoing inflammatory process that's [2:35] lurking beneath the surface of the skin, [2:36] even when you don't have active skin [2:38] lesions on the surface that you can see [2:40] with your eyes. And the reason this is [2:41] important is because when it comes to [2:43] tackling the hyperpigmentation, you [2:45] know, if you don't have any active skin [2:47] lesions aside from the pigmentation on [2:49] the skin, you may think, oh, okay, now I [2:51] can just focus on the dark marks. And [2:54] you might be tempted to try different [2:56] dark spot correctors that you come [2:58] across in the store, because heaven [2:59] knows, probably in the span of me [3:00] filming this video, there'll be 200 new [3:02] ones that get launched in the next 5 to [3:05] 10 minutes. We can't even keep up. There [3:07] are a ton of options out there. Topical [3:09] forms of vitamin A, hydroquinone, of [3:11] course, is a go-to in this case. [3:13] Tranexamic acid, azelaic acid, kojic [3:16] acid, melacare. [3:17] I mean, the list of pigment lightening [3:19] ingredients keeps growing and growing [3:21] every day. Trying out a bunch of [3:22] different ingredients, while by [3:25] themselves or together, they could be [3:26] helpful for some people. Here's where [3:28] they can backfire in this case. New [3:30] products increase the likelihood of, [3:32] well, skin irritation. The last thing [3:34] you want to do is irritate your skin [3:36] when you're trying to tackle the [3:38] hyperpigmentation, particularly when you [3:40] have already ongoing active inflammation [3:44] in the skin itself. That irritation is [3:47] going to generate more inflammation that [3:48] is essentially pressing the gas pedal on [3:50] unwanted pigmentation, making it a lot [3:53] more stubborn and persistent. So, this [3:55] is why hyperpigmentation can become such [3:58] a frustrating, persistent cycle. There's [4:01] evidence that pigmentation and [4:02] inflammation, they don't always occur in [4:05] this perfect sequence. In other words, [4:07] it's not always inflammation happens, [4:09] inflammation goes away, pigmentation [4:12] remains, and now we focus on [4:14] pigmentation, and we can just get rid of [4:16] it with these topicals. In reality, that [4:19] inflammation can overlap with the [4:21] pigmentation, and you need to be mindful [4:23] of both things in order to appropriately [4:25] tackle the discoloration. What's [4:27] interesting is that skin lesions that [4:29] clinically, to the eye, appeared to just [4:32] be hyperpigmentation, actually when you [4:35] used objective measurements, you found [4:38] there was not just hyperpigmentation, [4:40] but underlying inflammation as well. In [4:42] other words, the eye might say, "That [4:44] looks like a dark spot." But objective [4:46] measurements could detect persistent [4:48] inflammation. This is huge for darker [4:50] skin types, because redness, erythema, [4:53] is not always going to be obvious to the [4:55] eye. Redness is a marker of increased [4:57] blood flow secondary to inflammation. [4:59] It's easier to visually recognize in [5:02] lighter skin tones. The thing is, [5:03] melanin in melanin-rich skin tones [5:06] changes the way that light interacts [5:07] with the skin. So, in some cases, [5:09] inflammation can look bright red, but in [5:11] other cases, it can look purple, gray, [5:13] brown. And as you can imagine, brown, is [5:16] it red or is it hyperpigmentation? Very, [5:19] very difficult to tease out the two. [5:21] Sometimes, however, there's no obvious [5:23] color at all. The inflammation can just [5:25] easily, easily be hidden beneath the [5:27] pigmentation. When we go in and take [5:29] actual skin biopsies and look under the [5:31] microscope and say, "What the heck is [5:33] actually going on?" because it's obvious [5:36] that we can't figure it out with just [5:38] our eyes. Surprisingly, what you find is [5:40] that in areas that to the eye just look [5:43] like plain hyperpigmentation, do in fact [5:45] have inflammatory cells. Again, this [5:48] doesn't mean that every dark spot is [5:49] going to benefit from an [5:51] anti-inflammatory, but it's definitely [5:53] something to keep in your mind in the [5:55] back burner because it really can change [5:57] the way you approach your unwanted [5:59] pigmentation. Let's use acne as an [6:01] example. You may have acne that heals [6:04] with unwanted pigmentation. Your acne [6:06] may start looking significantly better [6:09] with acne treatment. You don't have big [6:10] red pimples, you don't have those little [6:12] pus bumps, painful cysts, nodules. You [6:15] don't have blackheads or whiteheads. [6:16] Instead, you're left with a combination [6:18] of hyperpigmentation and uneven bumpy [6:20] skin texture. At that point, you might [6:22] be tempted to think, "Okay, the acne's [6:24] gone. Let's focus on this textural [6:26] irregularity and pigmentation." As a [6:28] result, you may abandon your acne [6:30] treatments at this point and focus all [6:32] of your attention on fading the dark [6:33] marks. Well, remember acne is a chronic [6:35] inflammatory skin condition. Even when [6:38] the lesions clear up on the surface of [6:40] the skin and you don't see anything [6:41] active with your eyes, beneath the [6:43] surface of the skin, there can still be [6:45] significant inflammation that drives the [6:47] pigmentation. So, in other words, your [6:49] topical retinoid might still have an [6:51] active role even when you're not [6:52] breaking out. This is why dermatologists [6:54] tell you, "Yeah, it's great that your [6:56] skin has cleared up, but you need to [6:58] continue to use the topical retinoid." [7:00] Not only is it important to impart [7:02] ongoing control to make sure the acne [7:04] doesn't come back, but there's going to [7:06] still be active disease going on beneath [7:09] the surface of the skin that you just [7:11] can't see with your eyes that still [7:13] needs and benefits from that topical [7:15] treatment or oral treatment in the case [7:17] of say an antibiotic or in the case of [7:19] isotretinoin. Your benzoyl peroxide, [7:21] your azelaic acid, they may still have a [7:24] very very active role. Not to mention, [7:26] many of the topicals in the case of [7:28] acne, not only do they actively address [7:30] the acne pathophysiology, but they also [7:33] play a role in addressing the unwanted [7:35] pigmentation. So, even if there's no [7:37] inflammation, okay? You're like, "I [7:39] don't know. I don't see anything [7:41] obviously." But say for example, maybe [7:43] there happens to be no inflammation in [7:45] the skin. Those topical treatments often [7:47] still treat the pigmentation, but they [7:50] treat the inflammation, too. And you got [7:51] to think about addressing both things in [7:53] order to really tackle the pigmentation. [7:55] So, the goal is to keep the underlying [7:57] disease process controlled because every [7:59] new little inflammatory event in the [8:02] disease process can trigger more [8:04] unwanted pigmentation and make it a lot [8:06] more stubborn to fade. It's not just [8:07] acne, though. This same principle [8:09] applies to other inflammatory skin [8:11] conditions, whether it be eczema, [8:12] contact dermatitis, or rosacea. You may [8:15] have an eczema flare-up, and you treat [8:17] it with a topical treatment regimen. The [8:19] itching improves, the weeping, the [8:21] oozing, the discomfort goes away, your [8:23] skin barrier is recovered, stuff no [8:25] longer burns, stings, and sometimes [8:27] people just bail on their medications at [8:29] that point moving forward. But, we know [8:31] that there's still inflammation lurking [8:34] beneath the surface of the skin that [8:35] benefits from ongoing treatment for at [8:38] least a period of time depending on the [8:40] severity and what the treatment regimen [8:42] is. For example, a lot of people use [8:44] topical steroids in the midst of an [8:46] eczema flare-up, and as soon as the [8:48] flare-up is calmed down and looks to the [8:50] eye to be better, they stop the topical [8:52] steroid. But, it's actually advised to [8:54] continue applying the topical steroid to [8:56] the quote-unquote normal-appearing skin [8:58] for usually a week or two after simply [9:01] to address the eczema that you don't see [9:04] with your eyes that is still lurking [9:06] beneath the surface. And in the case of [9:07] unwanted pigmentation, that eczema [9:09] lurking beneath the surface, it's got [9:11] the inflammatory component there that [9:13] is, yeah, nudging the pigmentation [9:16] along. Again, the same is true with the [9:18] contact dermatitis. Sometimes, one of [9:20] the biggest hurdles, actually, in [9:22] addressing contact dermatitis is [9:24] figuring out what it is you're coming in [9:26] contact and then figuring out everything [9:28] in your environment that has that [9:30] culprit contactant in it because it's [9:32] not always just your skin care or your [9:34] makeup. Sometimes, it's your nail care [9:36] products. Sometimes, it's something [9:38] you've used for years and unbeknownst to [9:40] you, the manufacturer decided to swap [9:42] out an ingredient to the ingredient you [9:45] are in fact allergic to. So, you can [9:47] imagine how contact dermatitis can be an [9:49] ongoing battle, not to mention [9:51] occupational exposures. You know, a lot [9:53] of people become allergic to things in [9:54] their skin care products that are also [9:56] present in stuff they have to use and [9:58] work with at work. And it becomes really [10:01] challenging. In other words, clear skin [10:03] does not always mean that you don't have [10:06] ongoing active disease lurking beneath [10:08] the surface of the skin. So, this brings [10:10] me to another really, really important [10:12] point that I want you guys to always [10:14] keep in mind. Someone has [10:16] hyperpigmentation and understandably, [10:18] they want to do something about it. They [10:19] want to take a proactive role in in [10:21] getting rid of it. So, they start all [10:24] the products, a new acid, an at-home [10:26] peel, a scrub, vitamin C serum, a [10:29] topical retinol, another brightening [10:31] serum, a toner. Maybe they're even doing [10:34] some kind of mask once a week. And they [10:36] watch another video, hopefully not from [10:38] my channel, that tells them to buy and [10:40] try another product. The next thing you [10:42] know, you have compromised your skin [10:44] barrier, created a lot of irritation. [10:46] Those products are not only not actively [10:49] addressing your pigmentation, but they [10:52] are now playing an active role in [10:54] driving it by irritating your skin. You [10:56] might experience some symptoms of [10:57] dryness, itching, flaking, stinging, [11:00] increased sensitivity. All of these can [11:02] be hallmarks of subtle inflammation. [11:05] It's just not as immediately obvious to [11:07] your eye, especially if you have a [11:08] deeper skin tone and the redness is not [11:10] going to pop to your eye as as quickly. [11:12] But if that irritation continues, it's [11:15] going to contribute to the pigmentation. [11:17] In other words, don't always assume that [11:19] products are the answer. This is one of [11:21] the overarching reasons why, regardless [11:24] of what your skin care needs are, I [11:26] always advocate for a really simple, [11:29] basic skin care routine: cleanse, [11:31] moisturize, sunscreen, because the more [11:34] products you use, yeah, products can [11:36] definitely be helpful, but they also [11:38] introduce this risk. And in the case of [11:40] pigmentation, let's be a little more [11:42] risk-averse. Don't pick or squeeze. This [11:45] is another thing that a lot of people [11:47] can't help, especially if you have some [11:48] anxieties. A lot of people pick at their [11:50] skin even without realizing that they're [11:53] doing it as a means to cope with stress. [11:56] And I have a whole video actually on [11:57] skin picking disorder that you need to [11:59] watch because I give a comprehensive [12:02] coping plan for how to stop the [12:04] behavior. It requires a lot of effort, [12:07] okay, on your part. You got to do all [12:09] the components of the program in order [12:11] to begin to to heal from the picking [12:13] behavior. But a lot of people like to [12:15] squeeze pimples because they think [12:17] they're getting the gunk out and healing [12:18] the skin. You're not getting the gunk [12:20] out, okay? You're just traumatizing the [12:22] skin and driving more inflammation, [12:24] which can aggravate the acne and can, of [12:26] course, lead to this unwanted, stubborn, [12:28] persistent hyperpigmentation. Also, [12:30] another thing I frequently caution [12:32] against, and I get a lot of pushback [12:34] from this in the comments, is be very, [12:37] very, very careful with at-home [12:39] procedures, at-home tools, at-home [12:41] devices because they can very much [12:44] backfire. And, you know, thank goodness [12:46] now we have more dermatologists coming [12:49] onto social media and you're seeing a [12:51] lot more of a dermatologist presence [12:53] online warning about what I have warned [12:55] about for years is the at-home [12:57] microneedling. This you definitely want [13:00] to stay away from if you have [13:02] melanin-rich skin and you are inclined [13:04] towards hyperpigmentation because while [13:07] in office in a controlled setting it can [13:09] be helpful, at-home devices are not the [13:13] same quality, the same caliber, and [13:15] there are all sorts of risks with doing [13:17] this at home. And we do, in fact, see [13:20] cases of unwanted pigmentation from [13:22] people doing this. And no, it's not [13:24] simply because they didn't follow the [13:26] online social media tutorial right and [13:28] they're stupid and they didn't use clean [13:30] procedures. It's because this is a risky [13:33] thing to do at home and if you are [13:35] inclined to discoloration [13:36] hyperpigmentation, I really caution [13:39] against it. It definitely can and [13:41] frequently does backfire. Likewise, a [13:43] lot of light-based devices are something [13:46] known as IPL, intense pulse light. [13:48] Sounds like a laser but it's not. It [13:50] uses a couple of different wavelengths. [13:52] Many of these devices may be marketed [13:54] for uneven skin tone or they may be [13:56] marketed for uh unwanted facial hair [13:59] removal. These can definitely backfire, [14:02] no pun intended, burn the skin and lead [14:05] to unwanted pigmentation. So, you really [14:06] want to be very, very, very careful. If [14:09] you have a deeper skin tone with these [14:11] things. Who here has heard of Triluma or [14:14] Kligman's formula? If you deal with [14:16] unwanted pigmentation, there's a good [14:18] chance you've heard of Triluma. It's [14:20] just a branded name for a triple [14:23] combination of medications [14:25] in one cream. Uh and this was devised by [14:29] uh a man by the name a dermatologist by [14:31] the name of Kligman. But uh what it is [14:33] is a combination of hydroquinone, [14:36] tretinoin, and a weak uh steroid, [14:40] fluocinolone, 0.01%. [14:43] And you may be wondering, why are they [14:44] putting a steroid in my Triluma? Aren't [14:47] steroids not so great on the face? They [14:50] can be. They can be a game-changer for [14:52] managing certain diseases, but yeah, [14:54] they can have side effects. However, in [14:56] this case, they are doing quite a few [14:58] very strategic things that I want to [15:00] draw your attention to now that you have [15:01] a bit of background about what exactly [15:03] is actually happening at the cellular [15:06] level in your skin with that [15:07] inflammation. And so, you know you have [15:09] tretinoin, right? In there, it's going [15:11] to increase epidermal maturation and [15:13] help to clear out unwanted pigmentation. [15:15] It also helps put the brakes on the [15:17] pigment-producing enzymes. You have [15:19] hydroquinone, which is a tyrosinase [15:21] inhibitor, so it gets in the way of [15:23] pigment production. So, what the heck is [15:25] the steroid doing? Well, we know that it [15:27] can suppress unwanted pigmentation. So, [15:29] you're like, "Okay, great. Do we really [15:31] need a third one?" Well, guess what the [15:32] topical steroid does. It helps calm down [15:35] inflammation. Not only does it calm down [15:37] lingering inflammation from whatever [15:39] primary skin event you have had, like [15:42] acne for example, that may be still [15:44] lurking beneath the surface of the skin. [15:46] But, if you didn't already know, and I'm [15:47] sure you do, tretinoin and hydroquinone, [15:50] they can be pretty stinking irritating, [15:52] especially if you've never used them [15:53] before. And it's, you know, kind of a [15:55] pain because while they're very [15:57] effective treatments for [15:58] hyperpigmentation, they can cause [16:00] worsening of the hyperpigmentation if [16:02] they have the unwanted irritation. [16:04] Kligman figured out that if you put a [16:06] mild bit of a a whiff of steroid in [16:08] there, you could actually cut down on [16:11] that irritation and um really allow [16:13] those ingredients to maximally work. So, [16:16] that's a little bit of the why behind [16:19] your dark spot correcting treatments. [16:21] Here's the other thing that is a [16:23] non-negotiable. It's going to be ongoing [16:25] sun protection because not only do UV [16:28] rays from the sun actively upregulate [16:31] pigment production, but they also [16:33] generate inflammation in the skin. So, [16:35] you're getting two hits. Not to mention, [16:38] the sun not only puts out UV, which [16:41] drives hyperpigmentation, but it also [16:43] puts out visible light. And visible [16:45] light includes blue light, which we have [16:47] come to learn is actually a big driver [16:50] of hyperpigmentation. For that reason, [16:53] you may have heard that dermatologists [16:55] are now recommending for the treatment [16:57] of unwanted pigmentation, [16:59] post-inflammatory hyperpigmentation, and [17:01] melasma, using tinted sunscreens. Why? [17:04] Well, tinted sunscreens, you know, [17:06] they're sunscreens. They're marketed as [17:08] broad spectrum. They've been tested to [17:10] protect you from those UV rays, but they [17:12] have iron oxides in them, which is what [17:14] gives them the tint initially put in [17:16] there and is still put in there to, you [17:19] know, make for a more cosmetically [17:20] elegant formula. But, come to find out [17:23] the iron oxides actually offer some [17:25] active benefit in the form of blue light [17:28] protection. So, that's why that's [17:30] recommended and you want to be really [17:32] diligent, not just with the sunscreen [17:34] use, but staying out of out of the sun [17:37] and protecting your skin as much as [17:39] possible to get that pigment to fade. [17:40] There's no such thing as unwanted [17:42] pigmentation that was helped by [17:45] unprotected sun exposure. It backfires [17:47] in multiple angles, okay, to drive the [17:50] process. All right, guys, that's what I [17:51] wanted to talk about in today's video. [17:53] It's really important for those of you [17:55] who struggle with unwanted pigmentation, [17:57] hyperpigmentation, and even melasma to [18:00] be keenly, keenly aware of the [18:02] contribution that inflammation is having [18:05] in your disease process because it's [18:08] very easy to just treat the pigment and [18:11] not treat the gasoline, which is [18:14] inflammation, okay? So, we need to make [18:16] sure we're addressing that and you may [18:18] not see any clue that inflammation is [18:21] going on, but you still want to be [18:22] proactive in avoiding things that [18:24] unnecessarily irritate and inflame the [18:27] skin, like picking, trying out an [18:29] extensive skin care routine, going out [18:31] in the sun without a sun protection, [18:33] doing at home micro-needling. And you [18:35] also want to follow up with your [18:37] dermatologist and make sure you are [18:40] clear on how long you need to keep using [18:42] a given treatment. Like I said, many [18:44] treatments, they still need to be [18:46] continued after your skin is, quote [18:48] unquote, clear because we know that [18:50] beneath the skin, it's not all clear. [18:52] It's not all sunshines and rainbows down [18:54] there and you still need ongoing [18:56] treatment. I hope today's video was [18:58] helpful for you guys and I do have a lot [19:01] of videos on my channel about melasma, [19:03] hyperpigmentation. [19:05] Definitely check those out. I have [19:07] videos on avoid's lines, aka fletcher's [19:09] lines, and I have videos on other [19:12] pigmentary disorders as well, because [19:14] not all hyperpigmentation is melasma or [19:17] post-inflammatory hyperpigmentation. So, [19:19] check out some of those rarer diagnoses. [19:22] Just search my channel if you've been [19:23] given one of those and you want some [19:25] more information on them. There's a good [19:27] chance I have a video on on said [19:29] disease. But, I hope you enjoyed today's [19:30] video. If so, give it a thumbs up, share [19:32] it with your friends, and as always, [19:34] don't forget sunscreen and subscribe. [19:36] I'll talk to you guys tomorrow. Bye. [19:39] >> [music] [19:52] [music]