Post-inflammatory hyperpigmentation (PiH) is a common condition that occurs after inflammation or injury to the skin. It appears as a discolored patch or area visible on the surface that’s left behind after the wound has healed.
Sometimes this post-inflammatory pigmentation can be even more distressing and frustrating to deal with than the inflammatory condition itself.
The reason for this is because post-inflammatory hyperpigmentation usually takes much longer to heal and fade even though the state of the inflammation might have been mild and didn’t last long.
What Causes Post-Inflammatory Hyperpigmentation?
The main cause of post-inflammatory hyperpigmentation (PiH) is the increased melanin production. Melanin is the brown pigment that is mainly responsible for our skin color.
Inflammation in the epidermis such as a scrape, rash, or wound stimulates melanocytes to increase melanin production and to transfer the dark pigment to surrounding cells to be carried on the surface of our skin.
These can range in color from pink to red, brown, or black, depending on skin tone and the depth of discoloration, and can remain there for long after the initial trauma has recovered.
Who Can Acquire Post-Inflammatory Hyperpigmentation?
This condition can develop in all skin types, but it tends to be more pronounced and longer-lasting in people with medium to dark complexions in whom the color tends to be more intense and persist for a more extended period than in lighter skin colors.
This is due to melanosomes being larger and more abundant in dark skin tones which means that when melanosomes are triggered the flare is more prominent and takes longer to fade.
Acne And Post-Inflammatory Hyperpigmentation
While acne is one of the causes of PiH, this condition isn’t considered to be acne scarring. True acne scarring is divided into two categories:
Atrophic Scarring:
A loss of tissue or damage to the pore and deeper in the follicle leaving a pitted or depressed area. There are a few different types – icepick, rolling or boxcar scars.
Hypertrophic Scarring:
An overgrowth or excess of tissue leaving a raised scar and often called a keloid.
PiH, on the other hand, is flat and darker than the surrounding area and it is commonly referred to as “pseudo scarring” because although it leaves a discolored mark on the skin for a period of time, it does not actually damage the follicle to leave a scar.
What Can Make Post-Inflammatory Hyperpigmentation Worse?
Whilst not the cause of PiH, the sun can aggravate this condition because it will darken the affected patches as the sun is also closely associated with other forms of hyperpigmentation such as age spots. This will also increase fading time.
There are also some instances where the contraceptive pill can worsen this condition and this takes us back to the melanocytes, which are stimulated by the female sex hormones estrogen and progesterone.
When taking the pill, those hormone levels change, which may result in hyperpigmentation or aggravating the PiH already present on the skin.
Treating Post-Inflammatory Hyperpigmentation.
Reducing sun exposure is one method, to begin with. Using sunscreen daily and avoiding direct sun exposure will prevent PiH from darkening.
Incorporating vitamin A derivatives – Retinol/Retinoids and Alpha hydroxy acids in your daily skincare routine will encourage skin cell turnover and even out and even lighten post-inflammatory hyperpigmentation.
These powerful agents can also reduce the appearance of fine lines and wrinkles as well as treat acne breakouts. I always like to advise that building a patch test and building tolerance is essential before you begin treating the condition at hand.
There are many lightning ingredients that will aid in fading PiH. Some of them are:
- Aloe vera
- Vitamin C
- Alpha arbutin
- Kojic acids (always patch test before using kojic acid as it’s commonly associated with allergies.)
- Rice/rice water
- Azelaic acid
- Niacinamide (vitamin B3)
My name is Simone and I am a certified skin specialist. I created this website to teach my readers how to take great care of their skin and I also like to occasionally share my honest opinions on skincare products I’ve tried. You can learn more about me here.
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Does PIH after a wound injury go away permanently?
It will definitely fade with treatments such as hydroquinone, kojic acid, glycolic acid, lactic acid. You also need to protect your skin with a high SPF daily to help it heal.
Post-inflammatory pigmentation, or hyperpigmentation, is one of the most common and frustrating skin problems. Generally speaking, it’s the inflammation in your skin that causes discoloration and dark spots.
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