Post-Inflammatory Hyperpigmentation: Causes, Prevention & Treatments

PIH fades gradually with right skincare and sun protection, whereas melasma and sunspots need more targeted (and professional) interventions. Proper diagnosis helps to understand what specific type of hyperpigmentation an individual has, so that they can be given the most accurate treatment for it.

What are the different causes of PIH?

Let’s briefly discuss some of the factors that trigger PIH (i.e., post-inflammatory hyperpigmentation).

1. Acne

Inflammatory acne lesions can damage the skin, encouraging melanin overproduction, by which the skin heals itself.

2. Eczema and Psoriasis

Both are chronic skin ailments that result in skin inflammation, leading to PIH as the skin attempts to repair and heal itself 

3. Injuries and Burns

Physical trauma, including—cuts, burns, and abrasions—can start an inflammatory response, resulting in PIH (which again is the skin just trying to heal itself).

4. Cosmetic Procedures

Treatments like laser therapy, chemical peels or dermabrasion, if not performed correctly, can lead to skin irritation or damage, and eventually PIH.

How does PIH appear on skin?

PIH (post-inflammatory hyperpigmentation) generally appears as flat discoloured patches or spots on the skin. There could be colour variations such as,

a. Epidermal PIH

When the excess melanin is deposited in the epidermis (i.e. the skin’s outermost layer), those ‘flat spots’ are largely tan, brown or dark brown. Epidermal PIH is more common and tends to fade over time.

b. Dermal PIH

If the melanin sinks deeper into the dermis, the spots may take on a blue-grey or purplish colour. Dermal PIH is often more obstinate and requires longer treatment durations.

PIH generally affects the following parts of the body:

• Face: Post acne breakouts, especially on the cheeks, forehead and chin
• Neck and Chest: These areas are susceptible to eczema or allergic reactions.
• Back and Shoulders: These are the common sites for acne in many individuals.
• Arms and Legs: These regions are mainly affected by insect bites, cuts, and other injuries.
  

Let’s now get into how long PIH can take to fade on its own without any treatment. It depends on an individual’s skin type and the depth of pigment deposition in skin.

• Epidermal PIH: It produces superficial spots that may fade within 3 to 12 months, especially when you practise sun protection and skincare diligently.

• Dermal PIH: In this case, deeper discolourations occur and can persist for years. Some might need medical interventions to resolve them entirely.

Note: PIH is not harmful to the body. But yes, it can be distressing for many as it may impact self-esteem and quality of life.

Who is more prone to PIH?

1. How is PIH related to Fitzpatrick skin types?

The Fitzpatrick classification puts skin types into different categories based on their response to the sun’s UV radiation. Individuals with skin types IV, V, and VI (which have skin tones—olive, dark brown, and black in order) are more susceptible to PIH.

This increased risk is due to higher baseline melanin levels and more active melanocytes, which cause more noticeable pigmentation after an injury or infection. In these skin types, PIH not only occurs frequently but also is more severe and persistent. For example, in India, many people have skin types belonging to categories IV to VI. This skin condition may hamper psychological confidence that one has in how they look, which in turn, also affects their social interactions during meetings or other events.

2. Acne-prone and Sensitive skin

Individuals with acne-prone and sensitive skin are more susceptible to PIH. We also discussed earlier that inflammatory skin conditions like—acne, eczema, or psoriasis have a tendency to provoke PIH symptoms. Plus, cosmetic treatments can irritate the skin and exacerbate this response. 

When you are aware of the risk factors, it becomes easy to prevent PIH or manage it effectively (in case it has already begun to show itself on the skin.)

Can PIH be prevented?

1. Sun UV protection

Exposure to ultraviolet (UV) radiation significantly worsens PIH. The UV rays stimulate melanocyte activity, increasing production of melanin in skin and darkening existing spots. To prevent this,

• Daily sunscreen use: Regardless of the weather, use a broad-spectrum sunscreen with an SPF of 30 or higher every day. This helps to shield your skin from both UVA and UVB rays, stopping further pigmentation.

• Reapplication: Reapply sunscreen every two hours, especially when outdoors or sweating (i.e., jogging, running, or working out) or after swimming.

• Protective clothing: Wear wide-brimmed hats, sunglasses, or long-sleeved clothing to provide an additional layer of defense against UV rays.

2. General Skincare Habits

Aggressive or incorrect skincare routines can further irritate and harm your skin, causing inflammation and subsequent PIH.

• Use mild cleansers: Go for gentle, non-abrasive cleansers that don’t strip your skin of its natural oils.

• Avoid harsh exfoliants: Don’t overuse physical scrubs and potent chemical exfoliants, as they can damage the skin barrier.

• Moisturise regularly: When you keep your skin hydrated, its external barrier functions efficiently. This also reduces any chance of irritation.

3.  Early Management of Inflammation

• Treat underlying conditions: If your skin is prone to acne, eczema, or other inflammatory conditions—get timely treatments to minimise the risk of pigmentation.

• Avoid picking or scratching: Do not manipulate or pick on blemishes or scabs; this may aggravate inflammation and increase melanin production.

• Incorporate anti-inflammatory ingredients: Skincare products containing niacinamide, licorice root extract, aloe vera, etc. can soothe the skin and diminish inflammation.

What are the options available for PIH Treatment?

A comprehensive post-inflammatory hyperpigmentation treatment plan involves the combination of both topical agents and professional procedures 

1. Topical Treatments

a. Hydroquinone

A strong skin-lightening agent that inhibits melanin production. Often considered as one of the best agents for treating PIH in darker skin types. However, you must also note that its prolonged use can lead to side effects. That’s why dermatological supervision is essential.

b. Retinoids (Tretinoin, Adapalene, Tazarotene)

Retinoids accelerate cell turnover, which means they promote the shedding of pigmented cells and the formation of new, evenly pigmented skin. They can help treat PIH effectively, but are also known to irritate. So, you must introduce them into your skincare routine gradually.

c. Vitamin C (Ascorbic Acid)

It is an antioxidant that helps with skin brightening—by reducing melanin synthesis and eliminating free radicals (that you can think of as skin toxins). Vitamin C products help lighten dark spots over time if used regularly.

d. Niacinamide (Vitamin B3)

Known for anti-inflammatory and oil-regulating properties, niacinamide can reduce redness and blotchiness in skin. Quite beneficial for individuals with sensitive skin, prone to PIH.

e. Kojic Acid

It’s a natural alternative to hydroquinone; it too works by blocking melanin production in skin. Kojic Acid is often used in combination with other treatments to improve efficacy.

2. Professional Procedures

a. Chemical Peels

Performed in-office, these chemical peels use agents like glycolic acid or salicylic acid that exfoliate the skin by removing the outer layer. They also promote new cells to develop that grow out as uniformly pigmented skin. These peels are modified for every individual, depending on their skin type and the severity of PIH.

b. Laser Therapy

Laser treatments, such as Q-switched Nd:YAG lasers, target and break down excess melanin compounds in skin. These procedures should be performed by board-certified dermatologists, especially in individuals with darker skin tones, to minimise complications.

c. Microneedling

It is a process that involves creating micro-injuries in the skin using tiny needles to stimulate collagen production and boost the absorption of topical treatments. It’s ideal for dealing with deeper PIH and should always be done under professional supervision.

Lastly, why is a Dermatologist Consultation so important?

Consulting a dermatologist is crucial, especially if you are someone with a darker skin tone.

It is a dermatologist who checks the severity of pigmentation and recommends treatments according to that. Plus, you also need constant monitoring to secure progress at all stages and receive safe and proper outcomes. This personalised approach helps achieve optimal results while also reducing potential risks. 

Moreover, regular follow-ups with a dermatologist further ensure that the treatment plan remains effective and appropriate over time.