Post inflammatory hyperpigmentation what to know

Post-inflammatory hyperpigmentation, shortened as PIH is a common skin condition that occurs after skin inflammation whether this is after acne, eczema or psoriasis. It is characterised by flat, dark spots, with colours ranging from pink to black, depending on your skin tone.

Although PIH eventually fades away on its own, several treatment options are available to help speed up the process. Preventive measures like wearing sunscreen can also prevent PIH from worsening.

In this article, we will tell you everything you need to know about post-inflammatory hyperpigmentation: what it is, what it looks like, what causes it, and how it is treated. We will also discuss how long it takes for PIH to heal and what it could mean if the dark spots are not fading at all.

What is post inflammatory hyperpigmentation?

PIH happens when your skin is discoloured after it has been inflamed (from atopic dermatitis, allergic contact dermatitis, acne), injured after accidental burns, laser procedures or chemical peels), or irritated. Melanin-producing cells called melanocytes get triggered as part of the skin’s inflammatory response, and they may produce too much melanin during the healing process particularly in darker skin types. Melanin is the pigment that gives colour to your skin, eyes, and hair.

Depending on the previous inflammation, PIH can appear as a series of small dark spots or a singular spot of discoloured skin. The degree of discolouration also depends on your skin type and which layer the excess melanin was produced.

Although general hyperpigmentation and PIH have a similar appearance (i.e. the skin is discoloured), there is one key difference: PIH occurs after a wound or inflammation has healed. General hyperpigmentation can occur for various reasons that do not involve any inflammatory skin conditions, such as pregnancy or hormone changes.

What does post inflammatory hyperpigmentation look like?

PIH typically appears on the same spot where the skin irritation or inflammation occurred. For example, if you recently had an acne breakout on your cheeks, you may find dark spots in the same area once the acne heals. How PIH looks depends on three things:

• Skin tone: Darker-skinned individuals are more likely to suffer from PIH
• Depth of discolouration: There are two locations where excess pigment may be produced, which in turn affects the colour: PIH occurring on the epidermis (the outermost layer of your skin) will produce spots that look tan, brown, or dark brown. PIH on the dermis (the middle layer of your skin) will have a darker, blue-grey appearance. These can often be harder to clear.
• Cause of injury or inflammation: The size and number of discoloured spots you have depends on what initially caused the skin injury. For instance, if you have a recently healed cut, you may see one patch of discoloured skin. But if you have had several insect bites, there may be several discoloured spots.

What’s the difference between hyperpigmentation and PIH?

You may see the terms “hyperpigmentation” and “post inflammatory hyperpigmentation” used interchangeably. Though it is generally acceptable for the most part, it is still important to distinguish between the two:

• Hyperpigmentation refers to general skin discolouration caused by excess melanin. The production of excess melanin can be due to various reasons, which include: Hormone changes during puberty or pregnancy, overexposure to the sun and ultraviolet rays, genetics (e.g. freckles), certain types of drugs, ageing and in rare cases, adrenal disorders, such as Addison’s disease.
• Post inflammatory hyperpigmentation is a form of hyperpigmentation caused by skin irritation, injury, or inflammation. Some may consider PIH a form of scarring.

With a GetHarley consultation for hyperpigmentation, your practitioner can determine the cause of your dark spots based on your lifestyle and medical history. From there, you will receive a bespoke skincare plan designed to reduce the appearance of your dark spots.

What causes post inflammatory hyperpigmentation?

Any type of skin irritation or injury can cause dark spots or uneven skin tone, but here are some of the common causes of PIH:

• Acne, especially when the pimples are picked or popped
• Cuts or scrapes
• Insect bites
• Allergic reactions, especially ones that develop pustules or rashes
• Skin conditions like eczema or psoriasis
• Burns

You may also experience PIH when receiving treatment for specific skin conditions, such as acne scars. If this is the case, inform your practitioner during your consultation so they can recommend the right medical grade product to help with the dark spots.

Should I be worried about having PIH?

PIH is common, and not harmful. Fortunately, the dark spots caused by hyperpigmentation don’t hurt, and the discolouration typically fades away after 6 to 12 months. Hyperpigmentation treatments can help expedite this process. That said, if your practitioner determines that PIH is in your dermis, discolouration may take longer than 12 months to fade and may take several years.

If having uneven skin tone affects your quality of life and causes you to worry, colour-correcting concealers and/or foundation can provide you with some peace of mind.

Important: If your dark spots are bleeding, causing pain, or are growing larger, let your practitioner know. It is important it is checked out by a dermatologist to rule out anything suspicious. During a consultation with GetHarley, you can get your symptoms and medical history assessed to determine the issue and the best treatment.

How is post inflammatory hyperpigmentation treated?

Here are some of the most effective treatments for PIH:

• Chemical peels, such as salicylic or glycolic acid, work by removing the affected skin layer
• Laser treatment uses high-energy light to break down excess melanin, this can be very useful for changes in the dermis (deeper in the skin)
• Medical-grade topical products, such as hydroquinone or retinol, help slow down melanin production or depigment the skin.
• Microneedling utilises a specialised tool like a pen device or needling roller to create micropunctures and promote the skin cell renewal process. This is a more targeted delivery system of product into the skin which will hopefully replace the pigmented skin. Your practitioner can help develop a personalised treatment plan for your hyperpigmentation, depending on your medical history and skincare goals.

How long does it take for PIH to fade?

Post inflammatory hyperpigmentation typically lasts about 6 to 12 months before it starts fading. It may take even longer if the discolouration is on your dermis (the deeper layer of your skin). The severity of the discolouration and certain lifestyle factors may also affect how long it takes to fade. However, it is possible to expedite the healing process with the right personalised treatment plan.

What if my PIH isn’t fading at all?

If your dark spots from PIH have not faded yet after a while, it is possible that they need more time. But if it is affecting your quality of life, consider speaking to a GetHarley Practitioner to explore a solution that is right for you. Whether you want to conceal your dark spots with makeup products or expedite the process with medical grade products, we can recommend the right treatments. You can even get them delivered straight to your door. You also must wear sunscreen during and after treatment as that prevents the skin repigmenting after treatment.

Can I avoid post inflammatory hyperpigmentation?

Here are some common steps you can take to reduce the chance of PIH:

• Wear suncream and protective clothing: Consider wearing suncream (sunscreen) at all times which is a broadband sunscreen with UVB, UVA and blue light cover and protective clothing whenever you go outside. Prolonged sun exposure and excess UV radiation can increase melanin production, especially with an ongoing skin injury or irritation. Certain medications may also cause sun sensitivity, which could cause hyperpigmentation.
• Maintain a good skincare routine: A gentle skincare routine can reduce the risk of various skin conditions, such as an acne breakout. If you are currently suffering from a skin condition that could potentially result in PIH, it is worth seeking advice.
• Do not pick or pop your spots: Popping spots can cause skin discolouration and scarring.
• Avoid triggers that irritate your skin: If your skin is prone to blemishes or rashes, consider avoiding triggers that could cause inflammation. The more you can prevent a skin reaction, the lower your chance of getting dark spots due to PIH.

In summary

Post inflammatory hyperpigmentation happens when your skin produces excess melanin in response to a skin injury or inflammation. They appear as flat, dark spots where the previous injury had been. Depending on what happened to your skin, PIH may appear as a group of discoloured spots or a singular dark patch.

PIH usually fades away on its own after 6 to 12 months, although it could take longer if excess melanin production occurs in the dermis. Medical-grade creams and treatment methods such as laser therapy and microneedling can help dark spots disappear faster.

Book an online consultation with GetHarley today and explore your PIH treatment options. During your consultation, your GetHarley Practitioner will assess your medical history and visually examine your dark spots to formulate a personalised skincare plan. Any medical grade products part of your treatment plan can be delivered straight to your door, thanks to our inventory of over 500 skincare brands.