Post Inflammatory Hyperpigmentation

What Is Postinflammatory hyperpigmentation (PIH)?

Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis occurring after skin inflammation or injury that can arise in all skin types. PIH results from the overproduction of melanin or an irregular dispersion of pigment after skin inflammation. This can result from a variety of reasons, most commonly, it occurs after acne heals. It can also result from insect bites, cuts or even sun damage.

Are There Different Types of PIH?

Post Inflammatory Hyperpigmentation – appears as a brown pigmented spot left behind after a skin injury

Post Inflammatory Erythema (PIE) – appears as a pink or red spot left behind after a skin injury

PIH within the dermis results from inflammation-induced damage to basal keratinocytes, which release large amounts of melanin. The free pigment produces a blue-gray appearance to the skin at the site of injury. Epidermal hypermelanosis will appear tan, brown, or dark brown and may take months to years to resolve without treatment. Hyperpigmentation within the dermis has a blue-gray appearance and may either be permanent or resolve over a protracted period of time if left untreated.

If Untreated, How Long Does PIH Last For?

Epidermal PIH can last for 6 to 12 months or more. Dermal PIH can take years to fade, and spots may be permanent. There is also a chance new spots can show up, or that your PIH will come back again after fading.

What Can I Do About My PIH?

When it does occur, the underlying inflammatory conditions should be sought and treated as the first step to reduce the progression of inflammation and PIH (which is an inflammatory consequence). If the inflammatory conditions subsides or there is no evidence of inflammation at the time of diagnosis, the treatments of PIH should be considered as the next step.

Different methods are needed to treat different types of PIH. For example, topical agents are typically used to treat epidermal PIH as deeper pigmentation does not respond well to these agents.

Which Treatments Are Research-Proven To Reduce PIH Effectively?

Combination products containing hydroquinone and retinoids appear to be the most beneficial treatment options, although there are few evidence-based studies for this. Topical tyrosinase inhibitors, such as hydroquinone, azelaic acid, kojic acid, arbutin, and certain licorice extracts, can effectively lighten areas of hypermelanosis. Other depigmenting agents include retinoids, mequinol, ascorbic acid, niacinamide, N-acetyl glucosamine, and soy with a number of emerging therapies on the horizon.

Topical therapy is typically effective for epidermal postinflammatory hyperpigmentation; however, certain procedures, such as chemical peeling and laser therapy, may help treat recalcitrant hyperpigmentation. It is also important to use caution with all of the above treatments to prevent irritation and worsening of postinflammatory hyperpigmentation.

In-Clinic Treatments

Glycolic acid (GA), found in sugarcane, is a naturally occurring alpha-hydroxy acid (AHA) that induces epidermolysis, disperses basal layer melanin, and increases dermal collagen synthesis. It is commonly used to treat epidermal pigmented conditions. At VIDASKIN, our Depigmentation Peel contains a cocktail of different acids and lightening agents. In addition to reducing pigmentation, it also tones down the pigment cells to reduce the risk of recurrence.

Lasers and light sources may be an effective adjunct to therapy or alternative for treatment failures. The laser that is most suitable for you depends on the nature of your PIH and your skin tone. For example, PIE would respond better to lasers that target redness and vascularity, whereas PIH which is brown responds better to pigment lasers. At VIDASKIN, our Laser Medley programme allows for complete customisation to suit your skin concerns as we may use multiple different lasers to treat your skin at different points in time.

Frequently Asked Questions

What Is Post Inflammatory Hyperpigmentation?

Post-inflammatory hyperpigmentation (PIH) is a condition where dark spots or patches develop on the skin after an inflammatory event, such as acne, eczema, or injury. It occurs when the skin produces excess melanin as it heals.

What Causes Post Inflammatory Hyperpigmentation (PIH)?

PIH is caused by an overproduction of melanin in response to skin inflammation or injury. Common triggers include acne, burns, cuts, and certain skin treatments. People with darker skin tones are more prone to developing PIH.

How Can I Prevent Post Inflammatory Hyperpigmentation?

To prevent PIH, it’s important to treat skin conditions like acne early, avoid picking or squeezing spots, and protect your skin from the sun. Using gentle skincare products and avoiding harsh treatments can also help. Seeking help from a medical professional can be useful to identify a personalized treatment plan for you.

What Treatments Are Available For PIH?

There are a range of treatments for PIH, including chemical peels, laser therapy, microneedling, and topical lightening agents. These treatments target the excess pigmentation, helping to fade dark spots and improve overall skin tone. We recommend consulting a medical professional to identify a treatment regimen that is best for you.

How Effective Are Chemical Peels For PIH?

Chemical peels are effective for treating PIH by exfoliating the skin and promoting the growth of new, evenly pigmented skin cells. They can significantly reduce the appearance of dark spots over a series of treatments.

How Long Does It Take To See Results From PIH Treatments?

The time it takes to see results from PIH treatments depends on the treatment method and the severity of the pigmentation. Generally, patients can expect to see improvements within a few weeks to months with consistent treatment.

Can Post Inflammatory Hyperpigmentation Fade On It's Own?

PIH can fade on its own over time, but this process can take several months or even years, depending on the severity of the pigmentation. Professional treatments can significantly speed up the fading process and achieve more even skin tone.