POSTED: 4 Dec 2023

What Causes Post Inflammatory Hyperpigmentation & How To Actually Treat It

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 also affect any skin type, colour, gender and age although there are people who are more at risk of it 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 skin condition 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 with overproduction of 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, brown, to black, depending on an individual’s skin tone and the severity of the initial skin trauma. Its worth noting that whilst PIH can affect people of all skin types, it is more common and prominent in individuals with darker skin tones. This is due to a higher baseline melanin content.

What Does PIH Look Like?

PIH marks differ greatly in both their shape, size and severity. Their colour also varies and is dependent on skin tone. 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 in the appearance of post inflammatory hyperpigmentation marks is crucial to identify and remove them effectively.

How Long Does Post Inflammatory Hyperpigmentation Last & Does it Go Away On Its Own?

The times it takes for post inflammatory hyperpigmentation to fade varies greatly between person to person. This is affected by factors such as the severity of the initial skin trauma, the individual’s skin type and if there is ongoing trauma or irritation to the skin. Although post inflammatory hyperpigmentation can gradually diminish over time as part of the skin’s natural healing process, 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 and deep pigmentation, particularly on darker skin tones is most stubborn and may take years, to fade without proper treatment. The duration can also be prolonged further due to factors like continuous sun exposure, inflammation or injury to the skin. These can worsen the PIH by stimulating more melanin production This leads to darkening and prolonging the presence of hyperpigmented areas.

How to Treat Post Inflammatory Hyperpigmentation

There are a number of treatments that can help reduce or get rid of post inflammatory hyperpigmentation marks. These are broadly divided into topical skincare and professional treatments. We discuss these options in detail below but it’s 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 with 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 will respond well to a targeted and consistent skincare routine. Below are the best skincare treatments that will help remove post inflammatory hyperpigmentation marks:

  • Hydroquinone: A commonly used skin-lightening agent, hydroquinone works by inhibiting the production of melanin. It’s effective in reducing the appearance of 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. Whilst hydroquinone can effectively treat post inflammatory hyperpigmentation, 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 can fade PIH over time. They also improve the overall texture and tone of the skin as well as treat causes of PIH like acne.
  • Arbutin: This is a naturally occurring compound that can treat post inflammatory hyperpigmentation. Arbutin works by 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. Tranexamic acid 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 in fading pigmentation and also 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 and so can be suitable for more sensitive skin or those with rosacea.
  • Exfoliating Acids: Alpha hydroxy and beta hydroxy acids work by exfoliating 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 then, there are professional treatments which can help. These are best used in combination with a targeted skincare routine to provide faster and more visible results compared to over-the-counter options. These treatments however should be done by qualified skincare professionals who will help choose the correct and safest treatment protocol for you. These are some of the best professional treatments for PIH:

  • Chemical Peels: These involve applying a solution to the skin to remove the top layers, revealing newer, less pigmented skin underneath. Peels can range from superficial to deep and cone in a variety of different types. This treatment 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 4-6 weeks is needed to achieve visible results.
  • Laser Therapy: This can target melanin to break up pigmentation and treat PIH. The type of laser and number of treatments needed will depend on your skin type and severity of pigmentation.
  • Intense Pulsed Light (IPL) Therapy: IPL uses light energy to target and break down melanin in the skin. Similar to lasers, IPL emits multiple wavelengths of light, making it versatile for treating various skin conditions. It’s effective in treating PIH, especially in lighter skin tones.
  • Microdermabrasion: This is a less invasive procedure that involves exfoliating the top layer of skin using a special applicator with an abrasive surface. Although microdermabrasion can help to lighten PIH over time, it is not suitable for everyone in particular those with more sensitive skin or skin of colour.

LED Therapy for PIH

Light Emitting Diode (LED) therapy is a non-invasive skin treatment that can be beneficial for post-inflammatory hyperpigmentation. This is available both as a professional treatment or as at home LED masks. LED devices work by emitting various light wavelengths each has a specific impact on the skin cells. Red and near-infra red light is most beneficial for PIH. Red LED light is particularly effective for its collagen-stimulating and skin healing properties. It also aids in 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 aid in reducing inflammation, improving circulation and contributing to an even skin tone. LED therapy is however not enough by itself to treat PIH. It is best used to support targeted skincare and if necessary professional treatments. Consistent and regular treatments are necessary for noticeable results.

How to Prevent PIH

It is generally easier to preventing post inflammatory hyperpigmentation than to treat it. The first thing to do is to address the cause of the PIH. This may mean treating acne or other inflammatory skin diseases and stopping anything that is causing injury or trauma to irritation skin. Regular use of sunscreen, especially in areas prone to PIH is vital. This will stop the pigmentation from getting worse. Lastly, our skin is a reflection of our overall health. A balanced diet rich in antioxidants, effective stress management techniques and sufficient hydration all contribute to skin health. This can aid can support the skin’s natural healing process.

Whilst post inflammatory hyperpigmentation may fade on its own over time, the process can be lengthy and is impacted by various external and internal factors. The use of 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 and tailored treatment options.

At City Skin Clinic, we are fanatical about personalised skincare. Our doctors offer safe and effective treatments with prescription-strength products like Tretinoin and Hydroquinone through our online skin clinic. We treat skin conditions like acnehyperpigmentationmelasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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