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Post Inflammatory

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?

UV Protection

Use a physical sunblock with SPF 50 or higher and boost your SPF coverage further with oral sunscreen pills like Heliocare or Crystal Tomato to prevent more UV damage. Shop our recommended sun protection products here.

Vitamin C

Vitamin C is a naturally occurring antioxidant obtained from certain fruits and vegetables that can help with skin lightening. It has antioxidant and anti-inflammatory properties to protect us from environmental damage that leads to pigmentation as part of skin aging.

Hydroquinone (HQ)

HQ remains the mainstay of treatment for many pigmented conditions. 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. Your doctor may prescribe this topical as a part of your treatment regimen.

Azelaic Acid (AA)

Azelaic Acid has been shown to be effective in the treatment of PIH by depigmenting the skin and reducing inflammation.

Other Topicals

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

Chemical Peels

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

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.