How to Fade Post-Rash Pigmentation: Tips for Faster Recovery

Regarding the pigmentation that remains after a rash?

Hello Doctor, I am currently not in the country, so I would like to inquire here.
In mid-February, I noticed an oval-shaped red rash near my armpits on both sides of my chest, which was slightly itchy.
It gradually spread to below my chest, and after a week or two, it extended to my chest, abdomen, and back.
After another week or two, the rash subsided, leaving behind significant hyperpigmentation.
The rash was slightly raised compared to the surrounding skin, had an itchy sensation, and worsened with heat, but for the most part, it was manageable without scratching.
Since it is inconvenient to see a doctor abroad, I did some research and found that my symptoms resemble: (1) Pityriasis rosea: it has a similar herald patch appearance, occurs on the chest, abdomen, and back, and I experienced some throat discomfort; (2) Pigmented prurigo: I started eating only one meal a day this year and had a five-day water fast at the end of February, which coincided with the peak spread of the rash.
Recently, I also had a 48-hour water fast, during which some of the rash recurred.
I came across information that one of the symptoms of fasting is keto rash, which aligns with the timing, and the symptoms/hyperpigmentation look similar.
Therefore, I would like to ask if there is a way to expedite the disappearance of the hyperpigmentation left by these two conditions.
Would azelaic acid or AHA lotions be effective?

Evelyne, 20~29 year old female. Ask Date: 2022/03/24

Dr. Wu Yuxin reply Dermatology

Rhododendron acid is permissible, but it requires a physician's prescription.

Reply Date: 2022/03/24

More Info

To address your question about fading post-rash pigmentation, it's important to first understand the underlying causes of the pigmentation you are experiencing. Based on your description, it seems you may have had a condition such as pityriasis rosea or a keto rash, both of which can lead to post-inflammatory hyperpigmentation (PIH) after the rash resolves.
Post-inflammatory hyperpigmentation is a common skin condition characterized by darkened areas of skin that occur after an inflammatory process, such as a rash or injury. The pigmentation occurs due to an increase in melanin production in response to inflammation. This can be particularly noticeable in individuals with darker skin tones, but it can affect anyone.

Tips for Faster Recovery from Post-Rash Pigmentation:
1. Sun Protection: One of the most crucial steps in managing post-inflammatory hyperpigmentation is to protect the affected areas from sun exposure. UV rays can darken existing pigmentation and hinder the healing process. Use a broad-spectrum sunscreen with an SPF of at least 30, and reapply it every two hours when outdoors.

2. Topical Treatments: There are several topical agents that can help fade pigmentation:
- Alpha Hydroxy Acids (AHAs): These are exfoliants that can help remove dead skin cells and promote cell turnover. Products containing glycolic acid or lactic acid can be beneficial.

- Beta Hydroxy Acids (BHAs): Salicylic acid can also help with exfoliation and is particularly useful for acne-prone skin.

- Azelaic Acid: This ingredient has anti-inflammatory properties and can help reduce pigmentation.

- Hydroquinone: A skin-lightening agent that can be effective for treating hyperpigmentation, though it should be used with caution and under the guidance of a healthcare professional.

- Retinoids: Prescription-strength retinoids or over-the-counter retinol can promote cell turnover and help fade pigmentation over time.

3. Duloxetine Acid: As you mentioned, products containing mandelic acid or other AHAs can be effective. These acids help to exfoliate the skin and can improve the appearance of pigmentation.

4. Patience and Consistency: Fading pigmentation takes time. It may take several weeks to months to see significant improvement, depending on the severity of the pigmentation and the treatments used.

5. Avoid Irritation: Be cautious with any new products you introduce to your skincare routine, as irritation can worsen pigmentation. Start with lower concentrations and gradually increase as tolerated.

6. Consult a Dermatologist: If possible, consult a dermatologist for personalized advice and treatment options. They may recommend professional treatments such as chemical peels, laser therapy, or microneedling, which can be more effective for stubborn pigmentation.

7. Healthy Lifestyle Choices: Maintaining a balanced diet, staying hydrated, and avoiding smoking can also support skin health and recovery.

Conclusion
In summary, while post-inflammatory hyperpigmentation can be frustrating, there are effective strategies to help fade the pigmentation more quickly. Sun protection, topical treatments, and patience are key components of the recovery process. If you have access to a dermatologist, they can provide tailored advice and treatment options based on your specific situation. Remember, consistency is crucial, and results will take time, so be gentle with your skin as it heals.

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