Post-Inflammatory Hyperpigmentation Treatment Bangkok: Asian Skin Specialist English-Speaking

Post-Inflammatory Hyperpigmentation (PIH) — dark spots left behind after acne, eczema, burns, or any inflammation — is the single most common pigmentation complaint among Asian patients in Bangkok. Fitzpatrick III-V skin produces 5-10x more melanin in response to inflammation than Fitzpatrick I-II skin, making PIH faster to develop and slower to fade. At Siam Dermatology, our IOD-trained dermatologists treat PIH with evidence-based combination protocols specifically calibrated for Asian skin biology.

Why Most Clinics Fail at PIH

The number one reason PIH treatment fails: clinics treat the dark spots without controlling the underlying inflammation. New acne breakouts, eczema flares, or folliculitis episodes continuously generate fresh PIH. Our protocol: Step 1 is always to gain disease control over the active dermatosis (acne with topical retinoid + benzoyl peroxide ± oral therapy; atopic dermatitis with maintenance proactive therapy; folliculitis with antimicrobials). Only when the inflammatory engine is throttled do we layer in pigmentation-targeted therapy. This shortens time-to-clearance by 40-60 percent in our experience.

Topical Regimen + Oral Tranexamic Acid

Multi-modal topical foundation: Hydroquinone 2-4% night (cycled 12-16 weeks then rest), tretinoin 0.025-0.05% or adapalene 0.3%, azelaic acid 15-20% AM, niacinamide 4-5%, cysteamine 5% for hydroquinone-resistant. Oral tranexamic acid 250-500 mg BID for 8-12 weeks: high-quality evidence in Asian PIH and melasma cohorts. Contraindicated in active VTE, pregnancy, hormonal contraception with thrombotic risk. We screen all patients before initiating. Daily broad-spectrum sunscreen SPF 50+ PA++++ — non-negotiable.

Lasers + Peels: Cautious in Asian Skin

Aggressive laser/peel protocols are the leading cause of paradoxical worsening in Asian skin. Q-switched Nd:YAG 1064 nm low fluence toning (2-3 J/cm², 6-10 sessions q2-3 weeks) is our workhorse — minimal thermal injury. Picosecond 1064/755 nm for deeper dermal pigment. Selective chemical peels — mandelic 30-40% or low-dose glycolic 20% superficial. We avoid TCA in darker skin. We never combine modalities in one visit and always test-spot Fitzpatrick IV-V. Expected improvement: 50-70% lightening over 3-6 months.

FAQ

Q1: How long until results? A: 6-8 weeks first improvement; 3-6 months meaningful clearance. Q2: Permanent if I stop? A: Sun exposure can darken residual pigment — lifelong daily sunscreen essential. Q3: Can I laser active acne? A: No — we control acne first to prevent more PIH. Q4: Is oral tranexamic acid safe? A: Yes when screened for VTE risk — personal/family clot history, contraception, medications reviewed before prescribing.

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