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Post Inflammatory Hyperpigmentation

Post inflammatory hyperpigmentation (PIH) is a frustrating by-product of inflammation in the skin. Acne is a common culprit of producing PIH, but many other conditions can cause it. PIH appears as those pesky dark spot that lingers after a pimple is long gone— an unwelcome after image of old acne that can be more distressing than the acne itself. Although aesthetically disconcerting, these spots do not represent scarring and are not permanent.  Certain steps can be taken to prevent these lesions and help get rid of them faster!

What does PIH look like?

PIH appears as a flat area of red, brown, or black spots on the skin. They follow in the wake of healing skin after inflammation has resolved. They will appear in the shape and size of the initial injury to the skin. These stubborn spots can linger for months after the initial event is long gone. In inflammatory conditions like acne, these long lasting pigmented lesions hang out long after the acne itself has improved.

What causes PIH?

Your skin naturally produces a pigment known as melanin to protect itself from ultraviolet light. After an inflammatory event, the production of melanin increases. Not only is there more pigment, but the pigment can become trapped in the deeper layers of the skin. In these deeper layers, the body has a more difficult time disposing of the melanin.

Who gets PIH?

PIH can develop in all skin types, affecting both men and women equally. However, those with darker skin tones, with more underlying pigment in the skin, are at a higher risk of developing PIH after inflammation has occurred. PIH can also take longer to resolve in those with darker complexions. Exposure to sunlight also stimulates pigment production. Combine this with inflammation, and the effects on pigment production are multiplied. Although acne is a common source of PIH, anything that causes inflammation can result in it.

What are the treatment options for PIH?

PIH will improve gradually with time, assuming the inflammation that initiated the process has stopped. However, it can take months to years for some spots to resolve. But there are a few steps that can be taken to help your skin’s natural process:

Do not engage in any activity that would increase the inflammation in the skin, like picking or popping a pimple.

Avoiding exposure to ultraviolet light.

Ultraviolet light, and even visible light, signal to the skin to produce more pigment. A daily sunscreen, preferably containing zinc or titanium, is important to prevent further darkening of lesions.

Topical creams

There are numerous substances that can aid in the improvement of PIH. Creams containing kojic acid and azelaic acid can disrupt the process by which melanin is produced. Topical vitamin C reduces the amount of free radical damage after sun exposure. Topical steroids decrease inflammation in the skin. Topical retinoids increase the exfoliation rate of the top layers of the skin, removing pigment with it. Used in various combinations, these therapeutic agents are a useful addition.

Chemical peels

Chemical peels can help remove upper layers of the skin that contain excess pigment.

Microneedling

Microneedling is a minimally invasive therapy option that can even out the skin’s complexion and disperse clusters of melanin in hyperpigmented spots. Combined microneedling with both chemical peels and PRP has been shown to be even more beneficial for improvement of hyperpigmentation.

Laser therapy

Targeting of the underlying melanin with low energy laser light can also be an effective modality when used with other therapies.

When treating PIH, multiple therapies are often used in combination to achieve optimal results. Schedule an appointment with Dr. Schuering for evaluation and consideration for a treatment regimen that best suits you.


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