Post-inflammatory Hyperpigmentation - Causes and Symptoms

Introduction:

Several people worldwide are distressed by dark patches on their skin. Skin discoloration is a common skin condition that affects people due to various causes. Men and women are equally affected. The most common cause of patches or skin spots is post-inflammatory hyperpigmentation. Generally, the condition does not cause severe skin damage; it causes low self-confidence and frustration in the affected people. The article discusses post-inflammatory hyperpigmentation, its causes, symptoms, diagnosis, treatment, and prevention.

What is Hyperpigmentation?

Hyperpigmentation is a common skin condition that affects due to sun exposure, pregnancy, medications, and medical conditions. It may appear as small patches or cover large areas. It may affect the entire human body. The common types of hyperpigmentation include:

• Melasma: This type of hyperpigmentation, caused by hormonal changes, affects pregnant women. It may affect any part or area of the body, but the face and stomach are commonly affected.

• Sunspots: These usually appear on the sun-exposed areas, such as the hands and face. These are also called liver spots and occur due to excess sun exposure over time.

• Post-Inflammatory Hyperpigmentation: This occurs due to an injury or inflammation of the skin.

What Is Post-inflammatory Hyperpigmentation?

Post-inflammatory hyperpigmentation (PIH) is a temporary condition affecting wound skin. The wound or inflamed skin becomes dark because of extra melanin production. Melanin is a natural pigment that gives skin, hair, and eyes color. PIH can affect any layer of the skin, such as the skin surface or deep skin layer. It usually occurs on the acne-prone skin after the acne degenerates. It can affect any skin type, but it mostly affects the darker skin tone. Pigmentation usually occurs in people with sun-induced conditions, such as lichenoid dermatoses (inflammatory skin condition).

What Are the Causes of Post-inflammatory Hyperpigmentation?

Post-inflammatory hyperpigmentation occurs from any skin wound. Common reasons for post-inflammatory hyperpigmentation include scrapes, skin irritations, rashes, pimples, or breakouts. The condition damages the dermal and epidermal skin layers with melanin deposition within the keratinocyte or skin cells. Epidermal inflammation stimulates melanocytes to increase melanin production and transfer the melanin pigment to the surrounding skin cells. Melanin pigment is released and trapped by macrophages in the papillary dermis if the dermal layer or skin basal layer is damaged or injured.

Excessive formation of melanin in the affected area after the inflammation subsides darkens the skin. The dark skin or spots can remain on the skin after the wound is completely healed. It does not lead to the development of post-inflammatory hyperpigmentation. However, excessive sun exposure or harmful sun rays can aggravate the post-inflammatory hyperpigmentation symptoms.

Inflamed breakouts are more common on the skin. These are stubborn and appear as darker spots. If an individual pops or squeezes, these inflamed breakouts or pimples may aggravate the condition.

What Is the Difference Between Acne Scars and Post-inflammatory Hyperpigmentation?

Acne scars and post-inflammatory hyperpigmentation are not related, but they may look similar. Acne scars are the scars left on the skin after acne is relieved. These are pitted or depressed areas, or there is tissue overgrowth leaving a raised scar. PIH is a flat area in which the skin is darker than the surrounding area.

What Are the Signs and Symptoms of Post-inflammatory Hyperpigmentation?

PIH looks like a flat area of skin discoloration. Based on skin tone, it appears as light brown to deep brown or gray to black. Although it affects all skin types, the condition affects people with medium and dark complexions. The condition may resolve on its own and the dark skin or spots fade away within six to 12 months without any treatment.

How Is Post-inflammatory Hyperpigmentation Diagnosed?

The healthcare provider may diagnose the condition by taking a careful medical history. The doctor may further physically examine the patient's skin. The specific skin color, such as gray-brown-black, provides the diagnosis. A dermatoscopy can be used to get a closer look at the skin and to differentiate PIH from other skin diseases. In addition, a skin biopsy is performed if other conditions are suspected. The doctor may further identify the triggering factors, such as eczema (inflammatory conditions) or injuries.

How Is Post-inflammatory Hyperpigmentation Treated?

PIH usually resolves independently, but it takes several months to fade without any treatment. Treatment interventions cure the condition early.

Topical Treatment: The topical treatment options for PIH are as follows:

• Alpha Hydroxy Acids: Alpha hydroxy acids, such as glycolic and mandelic acids, exfoliate the skin, fade away the PIH spots, and provide a smoother and even skin tone. They are a common ingredient in many brightening treatments, lotions, creams, and gels. Other over-the-counter ingredients that manage hyperpigmentation include Niacinamide, N-acetyl glucosamine, and vitamins A and C.

• Hydroquinone: It is a most effective remedy and widely used treatment option for hyperpigmentation. It decreases melanin production and provides a lighter skin tone. People with sensitive skin may experience dryness or irritation. It mainly works on people with fair skin.

• Topical Retinoids: Retinoids are mainly prescribed to treat acne. They peel off the epidermal skin cells and promote cell turnover, providing an even skin tone. The dermatologist may prescribe topical retinoids, such as Tretinoin cream.

• Azelaic Acid: It is a medication prescribed to treat acne. It reduces inflammation and speeds up cell turnover. It is derived from wheat and rye. It has antibacterial and anti-inflammatory properties. It slows down melanin synthesis and provides an even skin tone.

• Vitamin C: It is a natural skin-lightening ingredient with antioxidant properties. It fades away marks and spots on the skin. Vitamin C’s acidic properties gently exfoliate the skin's superficial layer and reduce PIH spots.

• Kojic Acid: It is an alternative treatment to bleaching. It reduces hyperpigmentation and photodamage, suppresses melanin production, and fades away dark spots.

Hospital Treatment: The dermatologist may recommend the following treatment to manage PIH.

• Chemical Peels: Chemical peels are treatments in which the chemical is used to exfoliate the skin surface deeply. The chemical breaks the skin bond between the skin cells and causes them to shed away. The ingredient generally comprises alpha-hydroxy acids, such as glycolic acid, and beta-hydroxy acid, such as salicylic acid.

• Laser Treatment: Laser resurfacing is a skin care treatment that improves the signs of aging. The procedure reduces wrinkles and acne scarring. It gently peels off the superficial layer of the skin and allows new skin cells to grow, providing an even skin tone.

• Microdermabrasion:Dermabrasion is a surgical procedure for removing wrinkles or scars. It removes the upper skin layer and allows new skin to grow to replace the damaged skin.

How to Avoid Post-inflammatory Hyperpigmentation?

People should follow the following recommendations at home to prevent the condition. PIH can be avoided by following strategies.

• Wear protective clothing to protect the skin from harmful sun rays.

• Apply sunscreen.

• Use over-the-counter acne products to manage mild acne.

Conclusion:

Post-inflammatory hyperpigmentation is a dark spot on the skin after a pimple heals. It does not cause raised scars. It appears as a flat spot on the skin and heals within a few months without any treatment. The dermatologist may prescribe topical retinoids and creams containing alpha-hydroxy acid and vitamin C. In-office treatment includes laser treatment, dermabrasion, and chemical peel. People should wear sunscreen and protective clothing to protect the skin from sun damage.