How To Treat Post-Inflammatory Hyperpigmentation PIH Skin?
What is Post-Inflammatory Hyperpigmentation (PIH)?
Postinflammatory hyperpigmentation (PIH) of the skin is an increased amount of melanin pigment in the skin (as compared to your normal skin color) that occurs after skin inflammation. It is sometimes called Post Inflammatory Pigment Alteration or PIPA or dermal hypermelanosis. The definition of hyperpigmentation is when you have skin that is darker than your normal skin color. Hyperpigmentation is more common in darker skin tones such as Fitzpatrick Skin Types 4,5 and 6. 
Hyperpigmentation results in an uneven skin tone. There are 8 Baumann Skin Types that have an uneven skin tone and need skin lightening ingredients.
Is Post Inflammatory Hyperpigmentation Permanent?
Does post-inflammatory hyperpigmentation go away? Yes! Although it is not easy to get rid of post-inflammatory hyperpigmentation- it is not permanent. It will eventually fade naturally. Work with your doctor or medical provider to see if post-inflammatory hyperpigmentation treatments like chemical peels are right for you. Combining treatments, a custom skin care routine for your skin type and sun avoidance, your skin will improve.
Don't lose confidence if it doesn't clear up after just a few days! Most significant skin care regimens take a few weeks to impart their full effect, so stay consistent!
How long does post-inflammatory hyperpigmentation last?
How long it takes the discoloration to fade depends upon many factors. Fade time is significantly less if you limit sun exposure and use sunscreen diligently. Assuming you have eliminated the cause of inflammation and are using anti-inflammatory ingredients in your skin care routine, and avoiding sun exposure, the uneven skin pigment will most likely last at least 40 days for the skin to clear. This is because of the time it takes for the pigmented skin cells to exfoliate off of the skin and be replaced with skin cells of normal pigment. How to fade hyperpigmentation fast? Follow our dermatologist recommended skin care regimen advice found at this link.
The Best Post Inflammatory Hyperpigmentation Treatment?
Because PIH is very similar to melasma- follow our advice on melasma for the best skin care routine to treat post inflammatory hyperpigmentation. The skin care routine can be combined with chemical peels but make sure you find an experienced medical provider. If they burn you or use the wrong type of chemical peel, this could make the pigmentation worse.
If you have dry, sensitive skin, you are more likely to be suggested a glycolic acid peel than a salicylic acid peel. Glycolic acid leaves oils on the skin while salicylic acid removes oil.
Post inflammatory hyperpigmentation creams
It is important to identify any underlying barriers to skin health and causes of inflammation that may be worsening your skin hyperpigmentation problems. For example, If your PIH is caused by acne, the dark spots from pimples will not get better until your acne is treated. Knowing your Baumann Skin Type® will allow us to customize a skincare routine to treat your hyperpigmentation and any underlying causes.
The best skin lightening products will contain anti-inflammatory and skin lightening ingredients.
Keep in mind that there are different types of skin lightening ingredients like tyrosinase inhibitors, which block the triggers to start melanin production, and even exfoliants that mechanically remove dark spots from the surface of the skin.
The best skin lightening products use a combination of many types of skin lighteners to achieve a more profound effect.
Post inflammatory hyperpigmentation cleansers to clear dark areas of the skin.
There are so many different hyperpigmentation cleansers, so you need to know your Baumann Skin Type to choose the best. Follow the same face wash recommendations that we give for melasma because the issue is the same- too much pigment in the skin.
All cleansers are a little different, so keep in mind when you pick a cleanser for your sensitive skin that you do not choose one that is too low of a pH. products that are too acidic have a chance of irritating sensitive skin.
Look for cleansers rich in soothing linoleic fatty acids for your PIH regimen.
Vitamins, Supplements and Diet to Treat PIH
Treating hyperpigmentation from the inside naturally requires stress reduction, adequate sleep and a well balanced diet because the stress hormone cortisol makes skin pigmentation worse. You can also try antioxidants or these vitamins and supplements to treat PIH from the inside.
Heliocare Supplement Capsule contains polypodium leucotomos, an antioxidant help protect the skin from inflammation due to sun exposure. If you cannot avoid the sun, this skin protective supplement is highly suggested.[[FL-0480-10">
What Are The Post Inflammatory Hyperpigmentation Causes?
Skin color is caused by many factors, but the amount of a type of melanin known as eumelanin causes most cases of skin hyperpigmentation. A suntan is a form of hyperpigmentation. There are many skin conditions that cause an increase in skin pigmentation. These are common causes of hyperpigmentation and their characteristics:
Acne
Acne dark spots
Melasma (also known as mask of pregnancy)
Skin discoloration on the face
Hyperpigmentation on the cheeks
Hyperpigmentation on the upper lip
Common in pregnancy
Seen with estrogen, hormone replacement therapy and oral contraceptives
Hyperpigmentation in pregnancy
Hormone changes in pregnancy cause skin darkening
Linea Nigra is a dark vertical line from the belly button to the pubic area
Melasma is hyperpigmentation on the face often seen in pregnancy
Hyperpigmentation due to inflammation
Seen after any “rash” or skin redness
Inflammation turns on melanocyte cells
Common in eczema, psoriasis, hypersensitive skin, allergic reactions, sensitive skin
Also called post-inflammatory hyperpigmentation
Also called PIPA or post-inflammatory pigment alteration
Phytophotodermatitis
Skin darkening after sun exposure in areas that have been in contact with a photosensitizer that makes skin more reactive to the sun
Causes by celery, limes and figs
Dark spots on skin after drinking margaritas, tequila shots or beer with lime on the beach
Dark spots on the skin after drinking Bloody Mary drinks with celery in the sun
Sun spots
Also called solar lentigos
Click here for what causes sunspots
Click here for how to treat hyperpigmentation caused by the sun
Acanthosis Nigricans
Thick velvet appearing dark patches in skin folds
Dark patch on neck
Dark patches under the arms
Can be associated with diabetes
Ochronosis
Black patches on the face
Caused by an enzyme deficiency or overuse of hydroquinone
Addison’s disease
Caused by an increase in adrenocorticotropic hormone
Dr. Leslie Baumann MD, FAAD
Best References and Scientific Publications on Treating Hyperpigmentation:
- Baumann L. Depigmenting Ingredients in Ch. 41 of Baumann's Cosmetic Dermatology Ed 3. (McGraw Hill 2022)
- Baumann, L. Chapters 32-45. Cosmeceuticals and cosmetic Ingredients (McGraw Hill 2015)
- Nordlund JJ. Postinflammatory hyperpigmentation. Dermatol Clin. 1988;6:185.
- Davis, E. C., & Callender, V. D. (2010). Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of clinical and aesthetic dermatology, 3(7), 20.
- Taylor, S., Grimes, P., Lim, J., Im, S., & Lui, H. (2009). Postinflammatory hyperpigmentation. Journal of cutaneous medicine and surgery, 13(4), 183-191.
- Chaowattanapanit, S., Silpa-Archa, N., Kohli, I., Lim, H. W., & Hamzavi, I. (2017). Postinflammatory hyperpigmentation: A comprehensive overview: Treatment options and prevention. Journal of the American Academy of Dermatology, 77(4), 607-621.
- Callender, V. D., St. Surin-Lord, S., Davis, E. C., & Maclin, M. (2011). Postinflammatory hyperpigmentation: etiologic and therapeutic considerations. American journal of clinical dermatology, 12, 87-99.
- Maghfour, J., Olayinka, J., Hamzavi, I. H., & Mohammad, T. F. (2022). A Focused review on the pathophysiology of post‐inflammatory hyperpigmentation. Pigment Cell & Melanoma Research, 35(3), 320-327.
- Callender, V. D., Baldwin, H., Cook-Bolden, F. E., Alexis, A. F., Stein Gold, L., & Guenin, E. (2022). Effects of topical retinoids on acne and post-inflammatory hyperpigmentation in patients with skin of text-align:left;">American journal of clinical dermatology, 1-13.