Post-inflammatory Hyperpigmentation

After an acne breakout has come and gone, you may notice marks or color changes in the skin. Post-inflammatory hyperpigmentation or PIH, is a darkening or discoloration of the skin at the site of a healed acne lesion. PIH develops when a wound, rash, pimple, or other stimuli causes skin inflammation, which triggers the skin to spill melanin particles called melanosomes into the upper dermis. PIH typically appears as a flat area of discoloration that may vary in color from, brown, purple to black.

Common symptoms of post-inflammatory hyperpigmentation include:

  • Flat area of discoloration that may vary in color from pink, red, brown, purple or black
  • Pigmented areas will fade over time
  • Commonly affects people with darker complexions

Inflammatory acne is the main culprit. An inflammatory reaction will cause the cells called melanocytes to leak melanosomes into the upper dermis which are then eaten by the cleaning up ‘garbage collecting cells’ called macrophages leading to discoloration. Eventually the macrophages transport the excess pigment away from the skin.

Keep the skin clean and clear during breakouts in order to control and diminish the effects of acne. Consider a regimen that includes skin-care products containing salicylic acid to help promote skin cell shedding and unclog pores, or a glucosamine complex to even out and brighten your skin tone. After cleansing, use an oil-free moisturizer to keep the skin adequately hydrated. Another way to prevent acne is to use cosmetics specially designed for acne prone skin, that are either oil-free or non-comedogenic. Oil-free cosmetics mean products that contain little or no isopropyl myristate, isopropyl esters, oleic acid, stearic acid, petrolatum and lanolin (especially acetylated lanolin, alcohol’s and lanolin fatty acids). For severe or persistent cases of acne, the best course of action is to consult with a dermatologist to determine the right solution for your specific skin needs.

The most effective way to prevent post-inflammatory hyperpigmentation is to not irritate the skin during an acne outbreak. Absolutely do not pick at or rupture whiteheads, blackheads or pimples. Avoid any activities that may cause the skin to become inflamed.

OTC
Over-the-counter products containing active ingredients such as Alpha-Hydroxy acids are helpful in combating infection and reducing inflammation. Camouflaging creams can mask the appearance of PIH.

Prescription
Treating the underlying cause of the inflammation is important to avoid PIH. Selecting the appropriate therapy for darker skinned individuals is also critical to minimize the risk of PIH. To prevent scarring, a doctor may inject a corticosteroid into a cyst to decrease inflammation. A doctor may also prescribe a topical cream, such as Tretinoin, which encourages collagen production, in many cases improving the appearance of scarring. To prevent acne from developing, medications that contain ingredients such as retinoids, are effective for unblocking the pores of oil glands. They are generally considered to be the first choice of treatment for whiteheads and blackheads (comedones). Your physician can choose the one that is best suited to your needs. If you have severe acne, consult with a dermatologist to find out which treatment option may be best for you. Oral anti-inflammatories and anti-bacterials may be used to treat infection and inflammation, and for cases of cystic acne, or acne that doesn’t respond well to other treatments, Isotretinoin may also be used.