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Postinflammatory Hyperpigmentation - Causes, Symptoms, Diagnosis, and Management

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Postinflammatory hyperpigmentation is a condition that causes the darkness of the skin due to an injury or inflammation. Read below to learn about the same.

Medically reviewed by

Dr. Dhepe Snehal Madhav

Published At May 26, 2023
Reviewed AtDecember 13, 2023

Introduction

Postinflammatory hyperpigmentation (PIH) is when the skin becomes darkly pigmented due to an injury or inflammation. PIH can develop after various skin injuries or conditions, such as acne, cuts, burns, insect bites, rashes, and even certain medical procedures, such as laser treatments or chemical peels. This condition can affect people of all races, but it is most common in individuals with darker skin tones.

What Are the Causes of Postinflammatory Hyperpigmentation?

Postinflammatory hyperpigmentation (PIH) is when the skin becomes darkly pigmented due to an injury or inflammation. The causes of PIH can be divided into intrinsic and extrinsic.

  • Intrinsic Causes: It includes genetics, hormonal imbalances, and certain medical conditions, such as Addison's disease or Cushing's syndrome. These conditions can cause an increase in the production of melanin, which can result in the development of PIH.

  • Extrinsic Causes: They are related to external factors, such as skin injury or inflammation. Some common extrinsic causes of PIH include:

  1. Acne: Picking at or popping pimples can cause skin injuries, leading to PIH. In addition, the inflammation associated with acne can also increase the production of melanin, leading to PIH.

  2. Burns: Burns, whether caused by fire, chemicals, or sunlight, can result in skin injury and inflammation, leading to PIH.

  3. Rashes: Rashes, such as eczema or psoriasis, can cause skin inflammation, which can increase melanin production and result in PIH.

  4. Cuts and Abrasions: Any injury to the skin, such as cuts or abrasions, can cause skin inflammation and increase melanin production, leading to PIH.

  5. Medical Procedures: Certain medical procedures, such as laser treatments or chemical peels, can result in skin injury and inflammation, which can cause PIH.

  6. Sun Exposure: Prolonged sun exposure can cause skin injury and inflammation, increasing melanin production and resulting in PIH.

What Are the Symptoms of Postinflammatory Hyperpigmentation?

The most common symptoms of PIH are as follows:

  • Discoloration: The affected skin will appear darker than the surrounding skin, and the discoloration can be patchy or uniform. Sometimes, the affected skin may be lighter or darker than the surrounding skin.

  • Location: PIH can affect any skin area, but it is most commonly seen on the face, neck, arms, and legs.

  • Size: The size of the affected area can vary, ranging from a small spot to a large patch of skin.

  • Texture: The affected skin may sometimes feel rough or bumpy.

  • Symmetry: The discoloration associated with PIH usually equally affects both sides of the body.

  • Duration: The discoloration associated with PIH can last for months or even years after the original injury or condition has healed.

How to Make a Diagnosis of Postinflammatory Hyperpigmentation?

Postinflammatory hyperpigmentation (PIH) diagnosis is usually made based on a physical examination and a review of the patient's medical history. During the physical examination, a dermatologist will examine the affected skin to assess the discoloration's location, size, and appearance.

In addition to the physical examination, a dermatologist may ask the patient about any past skin injuries or conditions, such as acne, burns, rashes, or medical procedures. This information can help the dermatologist determine the cause of the PIH and rule out other potential causes of discoloration, such as melasma or sun damage.

In some cases, a dermatologist may also perform a biopsy of the affected skin to confirm the diagnosis of PIH. A biopsy involves removing a small skin sample and examining it under a microscope to determine the presence and extent of hyperpigmentation.

What Is the Treatment of Postinflammatory Hyperpigmentation?

Postinflammatory hyperpigmentation (PIH) treatment can vary depending on the condition's severity and the discoloration's underlying cause. Here are some of the most common treatments for PIH:

  • Topical Lightening Agents: Topical agents, including hydroquinone, kojic acid, azelaic acid, and arbutin, can help to reduce the appearance of PIH. In skin, they inhibit the production of melanin. These products can be applied directly to the affected skin and should be used under the supervision of a dermatologist.

  • Chemical Peels: Chemical peels, including glycolic acid or salicylic acid peels, remove the top layer of the skin, which can reduce the appearance of PIH. A dermatologist can perform these peels and it requires multiple treatments to gain the desired results.

  • Laser Treatments: Laser treatments, such as IPL (Intense Pulsed Light) or Q-switched lasers, can help to break down the excess melanin in the skin, which can reduce the appearance of PIH.

  • Microdermabrasion: Microdermabrasion is a type of minimally invasive procedure. It uses a special device to remove the top layer of skin. This treatment reduces the appearance of PIH by removing the affected skin cells and allowing new, healthy skin cells to grow.

  • Sun Protection: Wearing a broad-spectrum sunscreen with at least SPF 30 can help to protect the skin from further sun damage, which can worsen PIH. Limiting sun exposure and wearing protective clothing, such as a hat and long-sleeved shirt, when spending time outdoors is also important.

What Are the Complications of Postinflammatory Hyperpigmentation?

Some complications can affect the appearance and health of the skin. Following are some of the complications associated with PIH:

  • Persistence: In some cases, the discoloration associated with PIH can persist for months or even years after the original injury or condition has healed. This can be frustrating for individuals seeking to improve their skin's appearance.

  • Worsening of Discoloration: PIH can worsen with sun exposure, which can cause further damage to the skin and make the discoloration more noticeable. It is essential to prevent the skin from sun exposure and to use a broad-spectrum sunscreen with at least SPF 30 to reduce the risk of worsening PIH.

  • Development of New PIH: In some cases, individuals with PIH may develop new discoloration as a result of additional injuries or conditions to the skin. This can make it challenging to achieve an even skin tone and require additional treatments to improve the appearance of the skin.

  • Scarring: In some cases, the injury or condition that led to PIH can result in scarring, which can affect the appearance and texture of the skin. Scarring can be difficult to treat and may require additional treatments, such as laser treatments or dermal fillers, which help in the improvement of the appearance of the skin.

  • Emotional Impact: The appearance of PIH can have a significant emotional impact on individuals, leading to feelings of self-consciousness, embarrassment, and frustration. It is important for individuals with PIH to seek support from family and friends and to work with a dermatologist to develop a comprehensive treatment plan to help improve the appearance of the skin.

Conclusion

Postinflammatory hyperpigmentation is a common condition caused by various skin injuries or conditions. While the discoloration associated with PIH can be challenging, several treatment options are available, including topical lightening agents, chemical peels, and laser treatments. It is important to consult a dermatologist to know the best treatment.

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Dr. Dhepe Snehal Madhav
Dr. Dhepe Snehal Madhav

Venereology

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