If you’ve ever noticed dark spots or patches appearing on your skin after acne, an injury, or another skin condition has healed, you’re likely dealing with post-inflammatory hyperpigmentation (PIH). This stubborn discolouration can affect people of all skin types, but it’s particularly prevalent in those with darker skin tones. Many people seek solutions for this persistent issue, which can linger long after the initial skin problem has resolved.
Dr Dalia, a dermatologist with a lot of experience in pigmentation disorders, has helped countless patients regain their confidence by addressing their PIH concerns.
Post-inflammatory hyperpigmentation (PIH) is a common skin condition characterised by the appearance of dark spots or patches on the skin following inflammation or injury. To fully grasp PIH, it’s essential to understand how it differs from other types of hyperpigmentation and why it occurs.
Unlike melasma, which is primarily triggered by hormonal changes, or sun spots, which result from cumulative sun exposure, PIH is a direct consequence of skin trauma or inflammation. When your skin experiences injury or inflammation, it responds by producing excess melanin—the pigment responsible for your skin colour. This overproduction of melanin leads to the darkened areas you see as PIH.
You might notice PIH occurring in various areas of your body, but it’s most common in regions prone to acne, injury, or inflammatory skin conditions. Typical locations include face, neck, chest, back and arms.
While PIH can affect anyone, regardless of skin tone, it’s particularly prevalent and often more noticeable in people with darker skin. This is because darker skin types naturally have more active melanocytes—the cells responsible for producing melanin. As a result, your skin may be more prone to developing PIH if you have a medium to dark complexion.
You should know that PIH isn’t harmful to your health, but it can be a source of cosmetic concern and emotional distress for many.
To effectively address PIH, you should understand its causes. Here are the primary factors that can lead to the development of post-inflammatory hyperpigmentation:
When you visit Dr Dalia for concerns about PIH, she follows a thorough process to diagnose and assess your condition accurately. Here’s what you can expect:
Professional evaluation is important because PIH can sometimes be confused with other skin conditions. An accurate diagnosis ensures that you receive the most appropriate and effective treatment plan tailored to your specific needs.
Preventing PIH is often easier than treating it, so incorporating these strategies into your skincare routine can help you avoid or minimise its occurrence:
Proper Skincare Routine:
Sun Protection:
Early Treatment of Underlying Skin Conditions:
Avoid Picking or Irritating the Skin:
Healthy Lifestyle Choices:
Be Cautious with New Products:
While prevention is ideal, if you’re already dealing with PIH, there are effective treatment options available. The best approach often involves a combination of therapies tailored to your specific skin type and concerns.
Hydroquinone and its alternatives:
Hydroquinone has long been considered the gold standard for treating hyperpigmentation. It works by inhibiting melanin production. However, due to potential side effects with long-term use, we often recommend alternatives or use it in short cycles. Alternatives include:
These ingredients offer similar lightening effects with fewer potential side effects.
Retinoids:
Prescription-strength retinoids like tretinoin or adapalene can be highly effective in treating PIH. They work by increasing cell turnover, which helps fade dark spots more quickly. Over-the-counter retinol products can also be beneficial, though they’re typically less potent.
Vitamin C and other antioxidants:
Vitamin C is a powerful antioxidant that can help brighten skin and reduce hyperpigmentation. It also helps protect against further sun damage. Other beneficial antioxidants include:
Kojic acid and azelaic acid:
These ingredients have both skin-lightening and anti-inflammatory properties, making them excellent choices for treating PIH. Azelaic acid is particularly useful for those who also struggle with acne.
Chemical peels involve applying a solution to the skin that causes the outer layers to exfoliate, revealing fresher, more evenly toned skin underneath. Different types of peels can be used depending on your skin type and the severity of your PIH:
These treatments are typically performed in a series for best results, and it’s important to have them done by a qualified professional to minimise the risk of further pigmentation.
This treatment uses tiny crystals or a diamond-tipped wand to gently exfoliate the skin’s surface. It can help fade mild PIH and improve overall skin texture. Multiple sessions are usually required for noticeable results.
Some laser and light treatments can effectively target pigmentation:
Often, the most effective approach involves combining multiple treatments. For example, Dr Dalia might recommend a series of chemical peels along with a customised at-home skincare regimen using topical treatments. The specific combination will depend on your skin type, the severity of your PIH, and your treatment goals.
While professional treatments are often most effective, some natural remedies may help improve mild PIH:
Keep in mind that while these natural options can be helpful, they’re typically not as potent as professional treatments and may take longer to show results.
When undergoing treatment for PIH, you should have realistic expectations and understand that results take time. Here’s what you can generally expect:
Typical treatment durations:
Potential side effects and how to manage them:
The importance of patience and consistency:
While diet alone can’t cure PIH, some nutrients may support skin health and potentially aid in reducing hyperpigmentation. Foods rich in vitamins C and E, such as citrus fruits, berries, and nuts, can support collagen production and provide antioxidant benefits. Omega-3 fatty acids found in fish and flaxseeds may help reduce inflammation. Some studies suggest that oral supplements might offer additional protection against sun damage and hyperpigmentation.
PIH can occur year-round, but it may be more noticeable or prone to worsening during summer months. This is primarily due to increased sun exposure, which can darken existing PIH and trigger new areas of hyperpigmentation. Additionally, some people may experience more acne breakouts in summer due to increased sweating and oil production, potentially leading to more PIH. Conversely, in winter, drier air can cause skin irritation, which might also contribute to PIH in some people.
While makeup itself doesn’t typically cause PIH, certain practices related to makeup use could potentially exacerbate the condition. Using expired products or not properly cleaning makeup brushes can lead to bacterial growth, potentially causing skin irritation or acne that could result in PIH. Additionally, aggressively removing makeup or using harsh makeup removers might irritate the skin. It’s best to use non-comedogenic, hypoallergenic makeup products and remove them gently with mild cleansers to minimise the risk of irritation.
Yes, PIH can occur on the scalp and other hair-bearing areas, although it’s less commonly discussed. Conditions like folliculitis, psoriasis, or even harsh hair treatments can cause inflammation on the scalp, potentially leading to PIH. In beard areas, ingrown hairs or razor bumps can result in PIH. Treatment for PIH in these areas may require special consideration due to the presence of hair. Medicated shampoos, scalp treatments, or adjustments to hair care routines might be necessary alongside traditional PIH treatments.