Pigmentation

Post Inflammatory Hyperpigmentation 101

Are you tired of playing hide-and-seek with those pesky dark spots?

Well, you’re not alone!

Whether it’s the aftermath of a stubborn pimple or the remnants of a scar.

Dealing with post-inflammatory hyperpigmentation (PIH) can be tricky.

In this article, we will explore the causes and how you can say goodbye to those dark spots.

So, pull up a seat and grab your magnifying glass.

What is post inflammatory hyperpigmentation (PIH)?

Post-inflammatory hyperpigmentation (PIH) occurs when your skin is traumatised or inflamed.

Typically, it manifests as darkened areas on your skin that will often appear after an injury or inflammation is healing.

One example is the dark mark left behind once that pesky breakout resolves.

These dark spots often vary in colour, ranging from tan to brown, pinkish, or even black, and they typically appear flat on the surface of your skin.

While post-inflammatory hyperpigmentation is associated with acne and breakouts, it can also develop following other forms of skin trauma, such as surgery, cuts, and grazes; some existing skin conditions, like eczema, can also cause post-inflammatory hyperpigmentation.

They can also occur due to poorly performed in-clinical treatments like those outlined in these case studies.

Unlike other types of hyperpigmentation, it is not limited to your face and can occur anywhere on your body.

What causes post inflammatory hyperpigmentation

Various factors can cause post-inflammatory hyperpigmentation (PIH); some people are more prone to developing it than others.

For instance, if you have a dark skin tone, particularly if it is classified as a Fitzpatrick skin type IV or above, you are at higher risk of post inflammatory hyperpigmentation.

This heightened susceptibility is attributed to your skin’s increased melanin production, the pigment responsible for skin colouration. Personal factors like ethnicity can also influence your likelihood of getting PIH on your skin.

We frequently see this condition in many of our clients who come to us with acne. This is why the correct acne management treatment is important to minimise the risk of post-inflammatory pigmentation getting out of hand.

We find that early intervention to reduce skin irritation and inflammation during active acne episodes can significantly help prevent scarring and subsequent inflammatory hyperpigmentation.

This is also why it is really important not to pick your acne lesions or breakouts.

Protective measures such as pimple patches, like the COSRX Clear Fit Master Patch, can help you prevent picking at your skin. They work by acting as a physical barrier between your skin and fingers, helping to minimise trauma and inflammation in your skin.

It’s important to note that while hyperpigmentation presents as brown patches, skin cancer may manifest as red or brown lesions; if you are concerned about pigmented lesions, you should seek evaluation by a skin specialist to rule out any underlying health issues.

Causes of post inflammatory hyperpigmentation

Acne

If you have inflammatory acne lesions, such as papules, pustules, and cysts, it is important to realise that these can lead to PIH. Melanocytes can become hyperactive when your skin experiences inflammation due to acne breakouts, resulting in localised hyperpigmentation once the acne lesions heal.

Trauma or injury 

Any form of skin trauma or injury, including cuts, burns, insect bites, or surgical incisions, can induce inflammation and stimulate melanocyte activity in your skin. Excess melanin can be deposited as your skin heals, leading to hyperpigmented areas.

Dermatitis

Inflammatory skin conditions like eczema, allergic contact dermatitis, or irritant dermatitis can lead to post inflammatory hyperpigmentation. Chronic inflammation associated with dermatitis disrupts the normal melanin production in your skin, leading to pigmented patches in affected areas.

Skin resurfacing treatments

Specific cosmetic procedures aimed at skin resurfacing, such as chemical peels, laser treatments, and microdermabrasion, can trigger inflammation and post-inflammatory hyperpigmentation as part of the healing process.

This is particularly common in those with darker skin tones, so proceed with caution if this sounds like you, especially if you are considering having a chemical peel treatment.

Excessive sun exposure

if you are a sun worshipper, it is important to note that ultraviolet (UV) radiation from the sun can stimulate melanocytes to produce melanin as a protective response.

So, if you like sunbathing, remember that spending prolonged time in the sun can lead to sunburns and subsequent inflammation in your skin, which in turn can lead to hyperpigmentation, particularly in areas exposed to the sun, such as your face, arms, and décolletage.

Hormonal changes

Hormonal fluctuations, such as those occurring during pregnancy, can lead to chloasma. They can also occur as a side effect of hormonal medications like oral contraceptives. These hormonal changes can stimulate melanocytes to produce excess melanin, leading to hyperpigmented patches on your skin.

Inflammatory skin conditions

Other inflammatory skin conditions, such as psoriasis or lichen planus, can cause PIH. These conditions can lead to chronic inflammation in your skin that disrupts melanin production, resulting in hyperpigmentation in affected areas.

Understanding the triggers

The excess production of melanin in the affected area of your skin can lead to a darkened appearance, which is characteristic of post-inflammatory hyperpigmentation.

Understanding these triggers and features is important, helping you to manage and address your condition effectively, so let’s dive a little deeper:

Inflammatory response and melanin production

When your skin experiences trauma or inflammation from burns, acne, or other sources, your body’s immune system releases inflammatory mediators and cytokines.

These signalling molecules trigger your body’s defence mechanisms and stimulate melanocytes, the pigment-producing cells in your skin, increasing melanin production.

The role of melanocytes and keratinocytes

Melanocytes, located in the basal layer of the epidermis, your outer layer of skin, produce melanin, the pigment responsible for your skin’s colour.

During inflammation, these melanocytes become hyperactive due to the influence of inflammatory signals.

Additionally, inflammatory processes can damage basal keratinocytes, supporting and nourishing melanocytes.

This damage disrupts the normal functioning of the melanocytes and can lead to irregular melanin distribution, resulting in localised hyperpigmentation in your skin.

Impact of Inflammation on skin health

Inflammation triggers hyperpigmentation and compromises your skin’s overall health. Chronic inflammation can disrupt your skin’s barrier function, making your skin more susceptible to environmental damage, moisture loss, and even microbial infections.

Additionally, prolonged inflammation can exacerbate existing skin conditions and delay healing, further aggravating post inflammatory hyperpigmentation.

Antioxidant deficiency and melanin regulation

Your skin uses antioxidants to neutralise free radicals generated during inflammatory processes.

Free radicals are highly reactive molecules that can damage cellular structures, including DNA, proteins, and lipids.

Antioxidants act as scavengers, intercepting free radicals and preventing them from causing cellular damage.

However, if your skin lacks sufficient antioxidants, free radicals can accumulate and trigger melanocyte activity, leading to excessive melanin production and hyperpigmentation.

The vicious cycle of hyperpigmentation

The relationship between inflammation, antioxidant deficiency, and melanin regulation creates a vicious cycle in which each factor exacerbates the others.

Chronic inflammation depletes antioxidant reserves, increasing melanocyte activity and melanin production; this, in turn, can further amplify inflammation and oxidative stress, perpetuating the cycle of hyperpigmentation.

Post-Inflammatory hyperpigmentation treatment

Treating post-inflammatory hyperpigmentation will require a very personalised approach.

As estheticians with over 30 years of experience working directly with the skin, we recommend that you book a consultation with a very experienced esthetician or a medical dermatologist who will accurately assess the level of pigmentation in your skin and put together the correct protocol for your specific requirements.

A thorough consultation is important, as it will discern the type and severity of pigmentation before initiating any treatment routine.

Post-Inflammatory hyperpigmentation products

While some treatments may be restricted during pregnancy and breastfeeding, several at-home skincare products can effectively manage PIH. These include:

Sunscreen: As mentioned above, shielding your skin from UV radiation is critical; this will prevent further hyperpigmentation and maintain your skin health.

Ideally, you want to opt for a broad-spectrum SPF with UVA and UVB protection and reapply regulalry throughout the day.

Vitamin C and B serums: Our C+ skin shot will lighten and brighten your skin and help diminish post-inflammatory hyperpigmentation. Look for formulations with stabilised forms of vitamin C, such as L-ascorbic acid, and vitamin B derivatives, like niacinamide, found in B+ skin shot.

Chemical exfoliants: Alpha hydroxy acids (AHAs), such as glycolic and lactic acids, gently exfoliate the skin, promoting cell turnover and fading pigmentation.

Integrate a chemical exfoliant into your skincare routine several times weekly to unveil smoother, more even-toned skin.

However, as discussed above, we recommend doing this under the supervision of an experienced skin specialist; otherwise, you may do more harm than good.

Tyrosinase-inhibiting serums: Serums containing tyrosinase inhibitors, such as kojic acid, arbutin, and liquorice extract, can help suppress melanin production and lighten hyperpigmentation, giving your skin tone a more uniform appearance.

To conclude. The naked truth

In conclusion, post-inflammatory hyperpigmentation (PIH) is a common skin condition characterised by darkened patches that appear after skin trauma or inflammation.

While this condition is often associated with acne, it can also be caused by various other factors, such as cuts, burns, dermatitis, sun exposure, hormonal changes, and inflammatory skin conditions.

This is why understanding your triggers and the features of post-inflammatory pigmentation is so important if you want to manage this condition effectively.

Treatment typically begins with a consultation with a qualified dermatologist or dermal therapist who will assess your condition correctly. From there, they will recommend treatments such as chemical peels, laser therapies or specific tyrosinase-inhibiting topicals.

Sun protection, treatment of underlying skin conditions, and avoiding behaviours that exacerbate inflammation, such as picking or scratching your skin, are also very important to prevent this condition from worsening.

The good news is that by incorporating a well-thought-out, personalised treatment plan into your routine and prioritising your skin health, you can effectively manage your post-inflammatory hyperpigmentation and achieve a brighter, more even-toned complexion for now and many years to come.

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