Post Inflammatory Hyperpigmentation (PIH), aka acquired melanosis, is a condition wherein pigmentation appears on injuries or acne sites. PIH is more common in people with darker skin tone but it affects both men and women equally.
The damage in the dermis and epidermis causes the overproduction of melanin; this protein gives the skin its color. It’s the excess melanin that darkens and discolors the skin. This discoloration remains even after the wound has completely healed. If the inflammation sits only in the epidermis, the melanin will surround only the place where the active infection is. If, on the other hand, the inflammation is on the dermis, melanophages will trap the melanin, and grey, purple or brown spots are seen deeper on the skin; hence treatment has to be more aggressive.
Acne Scars vs. Post-Inflammatory Hyperpigmentation
PIH is not true scarring. It is often called “pseudo scarring” because although it leaves a mark on the skin for a period of time, it does not actually damage the follicle.
True acne scars occur when there is either a loss of tissue, causing a pitted or depressed area, or an overgrowth of tissue leaving a raised scar. PIH, on the other hand, is flat. It’s not pitted or raised, simply darker than the surrounding skin.
What is the treatment of PIH?
The treatment of postinflammatory hyperpigmentation (PIH) tends to be difficult; this often takes 6-12 months to achieve the results of depigmentation. Above all, we should control the cause of irritation first. Then remove all ingredients that can possibly be causing redness and irritation on your skin.
- Sun protection: The use of SPF 30 or higher is key during all the healing process; it is mandatory and is part of the aftercare for each one of the following treatments.
- Topical Agents: Use ingredients that inhibit melanin production and reduce inflammation; specifically Hydroquinone, Vitamin C, Corticosteroids, Niacinamide, Kojic acid, Azelaic acid, Cysteamine.
- Chemical peelings: Use Glycolic or salicylic depending on the skin phototype. Only medical profession should perform this.
- Lasers: The recommendation is Nd: YAG
Post-Inflammatory Hyperpigmentation (PIH) is a condition that can persist for weeks or even months after the initial breakout. Some treatments can improve it; however, these can also increase the risk of pigmentation; therefore, it is essential to follow all the dermatologists’ aftercare instructions.
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