What is post-inflammatory hyperpigmentation/hypopigmentation?
Post-inflammatory hyperpigmentation or hypopigmentation (PIH) is a common change in skin pigmentation that occurs after there is irritation to the skin, with the area of skin involved turning either darker or lighter in color. PIH can occur in response to skin conditions like rashes and pimples or even in the setting of cosmetic treatments, like laser therapy or chemical peels. If you have ever had a pimple or a scrape of your skin that subsequently healed with lighter or darker discoloration, you have experienced PIH. This condition can occur in any skin type, but it most commonly affects individuals with darker skin complexions, including African Americans, Hispanics/Latinos, Asians, Native Americans, Pacific Islanders, and those of Middle Eastern descent.

Dr. Shive is an expert in performing cosmetic procedures in people with skin of color, for whom PIH is a particularly common occurrence, and it is important to seek care with a dermatologist experienced with the prevention and management of PIH.

What can I do to prevent PIH?
Sun protection of the skin is one of the most important steps to preventing the development of PIH. Please follow the advice of your dermatologist regarding sun protection after your procedure. Dr. Shive may also pre-treat your skin with a prescription bleaching cream before certain cosmetic procedures, in order to reduce the risk of PIH.

How can I improve the appearance of PIH?
It can sometimes take several months or longer for PIH to fully clear. However, there are a variety of treatment options that can speed up the process. PIH can be limited to the top layer of skin (epidermal PIH), or it can involve deeper layers of skin (dermal PIH). Epidermal PIH is the most responsive to treatment and if it happens, is usually the type of PIH seen after cosmetic procedures. UV-rays can cause PIH to darken, therefore it is important follow sun protective-measures (e.g., sunscreen, hats, long sleeve shirts, etc.).

Treatment options include:

Topical:

  • Hydroquinone
  • Azelaic acid
  • Cysteamine cream
  • Vitamin C cream
  • Tretinoin cream

Ask your dermatologist which treatment combination is right for your skin.

Sources:
Lucas, C. Post-Inflammatory Hyperpigmentation (PIH). Skin of Color Society 2022.
Ngan, V. Postinflammatory hyperpigmentation. DermNet NZ 2022