In the wide-ranging world of skin concerns, post-inflammatory hyperpigmentation stands out because of how common it is and how hard it can be to treat. These dark marks are your body’s record of past skin trauma. Post-inflammatory hyperpigmentation occurs due to various causes including acne, injury and skin disease. It can affect any skin type, colour, gender and age, although some people are more at risk than others. In this article, we’ll explore the causes of post-inflammatory hyperpigmentation and the best evidence-based treatments to prevent and remove these dark marks.
What is Post-Inflammatory Hyperpigmentation?
Post-inflammatory hyperpigmentation (PIH) is a type of hyperpigmentation that appears as discoloured or darkened marks on the skin. PIH usually occurs following inflammation or injury to the skin. Common triggers include acne, burns, cuts, or dermatological conditions like eczema and psoriasis. Following injury or inflammation, the skin responds by overproducing melanin to try and protect itself. This is the pigment responsible for skin colour, and excess production results in flat areas of discolouration. These can vary from pink, red and brown to black, depending on your skin tone and the severity of the initial trauma. It’s worth noting that whilst PIH can affect all skin types, it is more common and prominent in those with darker skin tones. This is due to a higher baseline melanin content.
What Does PIH Look Like?
PIH marks differ greatly in their shape, size and severity. Their colour also varies and is dependent on skin tone as well as the depth of the pigmentation. On lighter skin, these marks may appear red or brown. On darker skin, they can be deep brown or black, which makes them more noticeable. Understanding this variability is crucial to identifying and removing them effectively.
How Long Does Post-Inflammatory Hyperpigmentation Last & Does it Go Away on Its Own?
The time it takes for post-inflammatory hyperpigmentation to fade varies greatly from person to person. This depends on factors such as the severity of the initial trauma, your skin type, and whether there is ongoing trauma or irritation. Post-inflammatory hyperpigmentation can gradually diminish over time as part of the skin’s natural healing, but this is generally a slow journey.
In general, PIH can take months or even years to fade depending on how deep it is, especially if left untreated. More severe, deep pigmentation, particularly on darker skin tones, is the most stubborn and may take years to fade without proper treatment. The duration can also be prolonged by factors like continuous sun exposure, inflammation or injury. These worsen PIH by stimulating more melanin production. This leads to darkening and prolongs the presence of hyperpigmented areas.
How to Treat Post-Inflammatory Hyperpigmentation
There are a number of treatments that can help reduce or remove post-inflammatory hyperpigmentation marks. These are broadly divided into topical skincare and professional treatments. We discuss these in detail below, but it is worth noting that treating PIH usually involves a multifaceted approach. You will also need to be patient, as treatments can take time to show results. If your PIH is stubborn, widespread or severe, you are best off consulting a dermatologist or other skin specialist to determine the best course of action. This is especially vital for those with darker skin tones, as certain treatments can potentially worsen PIH.
Skincare Treatments for Post-Inflammatory Hyperpigmentation
The majority of people with PIH respond well to a targeted, consistent skincare routine. Below are the best skincare treatments to remove post-inflammatory hyperpigmentation marks:
- Hydroquinone: A commonly used skin-lightening agent, hydroquinone works by inhibiting melanin production. It is effective at reducing dark spots, especially when combined with retinoids like tretinoin. You should only use this prescription-only medicine for limited periods under a doctor’s guidance, as it can have serious side effects such as ochronosis.
- Retinoids: Retinol, retinal and stronger prescription retinoids like tretinoin, adapalene and tazarotene can help remove post-inflammatory hyperpigmentation. They work by accelerating skin cell turnover, which fades PIH over time. They also improve the overall texture and tone of the skin and treat causes of PIH like acne.
- Arbutin: A naturally occurring compound that can treat post-inflammatory hyperpigmentation. Arbutin works by reducing melanin production but is a gentler alternative to hydroquinone.
- Kojic acid: Derived from certain fungi, kojic acid is known for its ability to lighten hyperpigmentation. It is particularly effective when combined with other ingredients like glycolic acid or retinoids.
- Tranexamic acid: This works by interfering with the interaction between melanocytes and keratinocytes. As such, tranexamic acid reduces inflammation, which in turn reduces melanin production. It can be effective in treating melasma and some types of PIH.
- Glutathione: An antioxidant naturally produced by the body, glutathione can help brighten pigmentation marks.
- Vitamin C: A potent antioxidant, vitamin C helps fade pigmentation and protects the skin from environmental damage.
- Azelaic acid: Known for its anti-inflammatory properties, azelaic acid can reduce milder forms of PIH. It is a gentle exfoliant, so it can suit more sensitive skin or those with rosacea.
- Exfoliating acids: Alpha hydroxy and beta hydroxy acids exfoliate the skin’s surface, removing dead skin cells and promoting new cell growth. Through this, exfoliating acids can reduce the appearance of PIH.
Professional Treatments for Post-Inflammatory Hyperpigmentation
If skincare alone isn’t enough to remove post-inflammatory hyperpigmentation, professional treatments can help. These are best used alongside a targeted skincare routine, and provide faster, more visible results than over-the-counter options. They should be done by qualified professionals who can choose the correct, safest protocol for you. Some of the best professional treatments for PIH include:
- Chemical peels: These apply a solution to the skin to remove the top layers, revealing newer, less pigmented skin underneath. Peels range from superficial to deep and come in a variety of types. This should only be done by a qualified professional, as the wrong strength or type of peel can worsen hyperpigmentation and cause burns. Normally a course of peels every 4 to 6 weeks is needed for visible results.
- Laser therapy: This targets melanin to break up pigmentation and treat PIH. The type of laser and number of treatments needed depend on your skin type and the severity of the pigmentation.
- Intense pulsed light (IPL) therapy: IPL uses light energy to target and break down melanin in the skin. Like lasers, it emits multiple wavelengths of light, which makes it versatile for treating various skin conditions. It is effective for PIH, especially in lighter skin tones.
- Microdermabrasion: A less invasive procedure that exfoliates the top layer of skin using a special applicator with an abrasive surface. Microdermabrasion can help lighten PIH over time, but it is not suitable for everyone, particularly those with more sensitive skin or skin of colour.
LED Therapy for PIH
This is worth mentioning on its own because its an emerging and popular treatment. Light-emitting diode (LED) therapy is a non-invasive skin treatment that can be beneficial for post-inflammatory hyperpigmentation. It is available both as a professional treatment and as at-home LED masks. LED devices work by emitting various light wavelengths, each with a specific impact on the skin cells. Red and near-infrared light are most beneficial for PIH. Red LED light is particularly effective for its collagen-stimulating and skin-healing properties. It also aids the regeneration of pigmented skin cells, whilst its anti-inflammatory qualities can help reduce PIH. Near-infrared light penetrates deeper into the skin to further reduce inflammation, improve circulation and contribute to an even skin tone. LED therapy is not enough by itself to treat PIH. It is best used to support targeted skincare and, if necessary, professional treatments. Consistent, regular treatments are necessary for noticeable results.
How to Prevent PIH
It is generally easier to prevent post-inflammatory hyperpigmentation than to treat it. The first thing to do is address the cause. This may mean treating acne or other inflammatory skin conditions and stopping anything causing injury, trauma or irritation to the skin. Regular use of sunscreen, especially in areas prone to PIH, is vital and stops the pigmentation getting worse. Lastly, our skin is a reflection of our overall health. A balanced diet rich in antioxidants, effective stress management and sufficient hydration all support the skin’s natural healing.
Whilst post-inflammatory hyperpigmentation may fade on its own over time, the process can be lengthy and is influenced by various external and internal factors. Targeted treatments and preventive measures can substantially shorten the duration of PIH. For persistent or severe cases, it is advisable to seek guidance from a skin professional, who can provide more advanced, tailored treatment options.
At City Skin Clinic, we are fanatical about personalised skincare. Our doctors offer safe and effective online hyperpigmentation treatments with prescription-strength products like tretinoin, azelaic acid and hydroquinone through our online skin clinic. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
