Medically reviewed by Minimalist Health Specialist -  Written by Sritama Dutta  on 28th Oct 2020

Post-inflammatory Hyperpigmentation (PIH) can be controlled. Here's how

How To Control Post-inflammatory Hyperpigmentation

If you are distressed by dark spots and patches on your skin, you are not alone. Skin discoloration is a prevalent skin condition that occurs due to various causes and equally affects men and women. One of the most common reasons for such spots and patches is post-inflammatory Hyperpigmentation or PIH. Although hyperpigmentation does not cause any severe damage to the skin, dealing with it can be quite frustrating and result in low self-esteem.

Every two people among three have experienced postinflammatory hyperpigmentation some time in their life. The severity of the condition may vary from person to person, and so do the treatment modalities. In this article, we will aid/help you understand what is Post-inflammatory Hyperpigmentation and how you can deal with it effectively.  

What is Post-inflammatory Hyperpigmentation? 

Post-inflammatory hyperpigmentation is the marks or discolored patches that any inflammatory wound leaves behind on the skin after it heals.

Though it can occur following any inflammation, it is most commonly noticed on acne-prone skin after the inflammatory acne-like pimples and pustules degenerate. PIH can be more stubborn and aggressive than the acne itself. Both men and women are susceptible to it, and all types of skin can be affected by it. However, it is more prevalent in a darker skin tone. 

What are the symptoms? 

Post-inflammatory hyperpigmentation usually appears as flat, irregular discolored patches on the skin of color ranging from white, pink, red, purple, brown, or black. The intensity/complexity of the discoloration depends on the skin tone and its severity. 

What can be the causes? 

PIH can occur from any inflammatory wound on the skin. Scrapes, rashes, skin irritations, breakouts, or pimples are some of the common reasons for post-inflammatory hyperpigmentation. The inflammation on the skin can trigger the melanocytes, which alter the average rate of melanin production at certain spots in the dermal layer.

Excessive melanin formation at those spots, after the inflammation subsides, darkens the areas. These spots can remain on the skin long after the wounds have completely healed. Also, though it does not cause PIH, exposure to sun rays can aggravate PIH symptoms.

It is commonly seen that the more severely inflamed the breakouts on your skin are, the more stubborn and darker the PIH spots are. Popping or squeezing the inflamed pimples can also aggravate the intensity of post-inflammatory hyperpigmentation.  

Time Heals Everything!

Most cases of post-inflammatory hyperpigmentation fade with time on its own, without any treatment. Moreover, the duration depends on the severity of the condition and how dark the spots are. The bigger and darker the patches are, the longer it takes to deplete. The time required may range from a few weeks to up to 24 months. Few cases may take even longer.

But, not all types of PIH disappear on their own. Some are more stubborn and are not easily delible. However, some topical treatments might prove to be of help. They can considerably lighten the marks and erase them gradually. For more subtle cases of Post-inflammatory hyperpigmentation, external application of certain remedial ingredients can speed up the fading process if you aren't willing to wait for long.  

How can you treat Post-Inflammatory Hyperpigmentation? 

For less aggressive cases, over-the-counter products can be beneficial. However, medical assistance is recommended if you are experiencing chronic or aggravated issues of PIH. Let's look into the different available treatment options; 

Over-the-counter Treatments Options:

Several ingredients are available easily in the market that can help you alleviate the symptoms of post-inflammatory hyperpigmentations.  

Alpha-Hydroxy Acids (AHAs) 

Alpha-hydroxy acids, such as Mandelic acid and glycolic acid, gently exfoliate the superficial epidermal cells and promote need cell turn over, which eventually fades the PIH spots and gives a smoother and even skin tone. Mandelic acid derived from almond is an effective remedy for PIH in darker skin tones and helps treat photodamage.  

Hydroquinone 

Hydroquinone might be the most effective remedy against hyperpigmentation. It reduces the melanocytes count in your skin cells and thus decreases melanin production. It bleaches the skin to give an allover lighter skin tone. However, if you have sensitive skin, using hydroquinone may cause dryness and irritation. Hydroquinone works best on fairer skin tones to fade away dark spots.

If you have a medium-to-dark tone/complexion, there remains a risk of hypopigmentation on using hydroquinone. 

Topical Retinoids 

Retinoids block the transcription of tyrosinase, an enzyme responsible for melanogenesis, which reduces the epidermal melanin. It also peels off the epidermal cells and promotes cell turnover, revealing newer and evenly toned skin. Retinoids are also able to disperse keratinocytes pigment granules. However, some cases have reported that topical application of retinoid serums can cause retinoid dermatitis, which induces post-inflammatory hyperpigmentation.  

Azelaic Acid 

Azelaic acid is a naturally occurring substance that is derived from grains like wheat and rye. It has incredible anti-bacterial and anti-inflammatory properties and is used in the treatment of acne and rosacea. Its acidic nature gently peels of superficial skin cells and boosts cell turnover. Azelaic acid also slows down melanin synthesis, which reduces PIH and gives you an even skin tone.

In a study, azelaic acid demonstrated that it could facilitate the healing of existing inflammatory acne and fade away hyperpigmentation triggered by such acne.  

Vitamin C

Vitamin C is a nature-derived skin lightening ingredient that has rich antioxidant properties. It busts the free radicals responsible for causing hyperpigmentation and effectively fades away the marks and spots on the skin. Its mild acidic property gently exfoliates the superficial layers of the skin and gradually reduces the post-inflammatory hyperpigmentation spots. 

Kojic Acid 

Kojic acid is considered to be a natural skin lightening agent. It is derived from a fungus known as Aspergillus flavus and is a safer alternative for skin bleaching than other inorganic chemicals. Kojic acid is used in an ester form, which can reduce photodamage effects and diminishes hyperpigmentation. It inhibits L-tyrosine, an amino acid responsible for melanogenesis, which suppresses the excess melanin production in the dermal layers and helps to fade away dark spots and patches.

Niacinamide

Niacinamide is a form of Vitamin B3 (niacin and nicotinamide), widely used in skincare products. Recent studies have shown that regular topical application of niacinamide has a significant effect in reducing melanin production. In a clinical trial done on patients with hyperpigmentation, it was seen that 2% niacinamide could cause 35-68% inhibition of melanin formation in four weeks. 

Niacinamide 5% + Hyaluronic Acid 1%
Niacinamide 5% + Hyaluronic Acid 1%

Niacinamide 5% + Hyaluronic Acid 1%

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For dry, sensitive skin
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How can your dermatologist help you? 

If you are experiencing persisting PIH for a long time and the condition has not shown any alleviation or has worsened, it is best to consult with your dermatologist. They would be able to advise you on an effective remedy for the condition. Apart from the topical treatment options, some other in-office approaches can be adopted to treat hyperpigmentations that need medical assistance. They are; 

1. Chemical Peels 

Chemical peel therapy refers to using acidic ingredients on the skin, which helps to slough off the superficial skin cells to reveal the smoother and younger dermal layer underneath. The chemical peel used for treating PIH is generally composed of Alpha-hydroxy acids, such as glycolic acid, or beta-hydroxy acid, such as salicylic acid.

These acids are used in relatively higher concentrations than OTC products; thus, medical assistance is essential.

While lower concentration OTC serums only peel off the epidermis, these chemical peels penetrate deeper skin layers and help lessen the too stubborn PIH spots. 

Salicylic Acid 2%
Salicylic Acid 2%

Salicylic Acid 2%

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A daily gentle exfoliant with 2% salicylic acid that wards off blackheads and keeps your oils in check for that flawless matt look everyone dreams.
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2. Laser Treatment 

Laser treatment uses light energy to treat severe cases of PIH. Intense light waves are pulsed on the skin, which gently peel off the superficial dermal layers. In between appointments, newer skin cells grow, and the skin is resurfaced. With some time, the skin will be more even tone and appear spotless and radiant. However, laser therapy has proved to be more effective on lighter skin complexion than darker-toned skin. 

3. Microdermabrasion 

Microdermabrasion is a physical process of peeling the dermal cells. It uses micro-crystals or a diamond-tipped handpiece that vibrating at high speed removes the epidermis. It may need a few weeks of intermittent treatment and is only done in clinics by a dermatologist. This treatment, too, works best on fair-toned skin.  

How can you Prevent PIH? 

The only way you can avoid the aggravation of post-inflammatory hyperpigmentation is by protecting your skin from sun rays. It has been found that exposure of skin to the sun's harmful radiations can worsen PIH's existing condition.

If you are already undergoing dermatological treatment for PIH, such as chemical peeling or laser therapy, photoprotection is the only solution for preventing exacerbation of post-inflammatory hyperpigmentation.

Applying a considerable amount of sunscreen on your skin before you step out in the sun is recommended.  

Acne-scars vs. Post-inflammatory Hyperpigmentation: How are they different?

Acne scars and post-inflammatory hyperpigmentation may sometimes look the same, and it is easy to get confused between the two. Despite their similar appearance, there are some fundamental differences between the two. Their treatment modalities are also very different. Thus, it is essential to distinguish between the two and go for the correct treatment approach.

Scarring is usually of two types that follow after the healing of acne: atrophic and hypertrophic. Hypertrophic scarring can occur if there is an overgrowth of tissue in an area, which leaves a raised scar. Atrophic scarring occurs if there is a loss of tissue in a room, which results in a pitted or depressed scar.

PIHs are not real scars. They are entirely flat, non-invasive, dark marks on the skin, sometimes referred to as "pseudo-scars." Some treatment approaches like laser resurfacing can be beneficial for both conditions.  

Words of Wisdom from Minimalist: 

When you have browsed through all the options you have for treating your post-inflammatory hyperpigmentation, there are some things that you must keep in mind before you begin with the treatment.

As a general rule of thumb, if you have acne-prone skin, it's necessary to bring the acne under control before starting treatment. Because new acne might get inflamed and tubes rise to new PIH spots. Over-the-counter products will help you in treating mild acne along with reducing the PIH.

Make Sunscreen your best friend! Whether you are using OTC products or undergoing dermatological treatment, your skin gets more susceptible to photodamage, which might worsen the skin condition. Thus, it is of utmost importance that you protect your skin from sun rays.

Every individual has a unique skin type. It's always wise to consult with your dermatologist first before beginning with any OTC ingredients because they know your skin the best.