Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis occurring after cutaneous inflammation or injury that can arise in all skin types. PIH results from the overproduction of melanin or an irregular dispersion of pigment after cutaneous inflammation.
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.
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HQ remains the mainstay of treatment for PIH. It is a phenolic compound that blocks the conversion of dihydroxyphenylalanine (DOPA) to melanin by inhibiting tyrosinase. This reduces the production of melanin which in turn decreases the amount of pigmentation in the skin.
Azelaic Acid has been shown to be effective in the treatment of PIH by depigmenting the skin and reducing inflammation.
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.
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