What Is Post-Inflammatory Hyperpigmentation?
Post-Inflammatory hyperpigmentation occurs when the skin produces excess melanin after inflammation, trauma, or irritation. During the healing process, melanocytes become overstimulated and deposit pigment in the epidermis (surface layers) or deeper in the dermis.
- Unlike melasma, PIH is always triggered by a preceding inflammatory event.
- Unlike sunspots, it can affect individuals of all ages and skin types, though it is more common and more intense in darker skin tones.
PIH is not a disease, but rather a response of the skin’s pigment-producing cells to inflammation, and it requires a targeted, combination-based treatment approach for optimal results.
What Causes PIH?
PIH develops as a secondary response to inflammation. The deeper and more prolonged the inflammation, the darker and longer-lasting the pigmentation tends to be. Common triggers include:
- Acne breakouts and cystic acne
- Insect bites or allergic reactions
- Eczema, psoriasis, or dermatitis
- Skin infections or rashes
- Aggressive skincare, over-exfoliation, or burns
- Cosmetic procedures performed incorrectly
- Picking, squeezing, or scratching the skin
PIH in Darker Skin Types
Post-Inflammatory Hyperpigmentation is particularly common in Fitzpatrick skin types IV–VI, where melanocytes are naturally more active. In darker skin tones, even mild inflammation can trigger excessive pigment production, making PIH more noticeable and slower to resolve.
This is why inappropriate treatments, harsh peels, or incorrect laser settings can worsen PIH instead of improving it. A doctor-led, skin-type-specific approach is essential.
What Does PIH Look Like?
PIH presents as:
- Flat discolouration (not raised or textured)
- Brown, dark brown, grey, or purple marks
- Patches that follow the pattern of the original inflammation
- Areas that darken with sun exposure
PIH can fade gradually over time, but without intervention, it may persist for months or even years.
How Is PIH Different from Melasma or Sun Damage?
While PIH, melasma, and sun damage all fall under the pigmentation umbrella, they differ in cause and behaviour:
Accurate diagnosis is critical, as treatments effective for one form of pigmentation may aggravate another.
Why PIH Requires a Professional, Doctor-Led Approach
PIH is not a one-size-fits-all condition. Incorrect treatments can:
- Darken pigmentation
- Trigger rebound hyperpigmentation
- Cause further inflammation
A professional assessment ensures:
- Correct diagnosis
- Safe treatment selection
- Reduced risk of recurrence
- Long-term pigment control
Can PIH Be Prevented?
While not all PIH can be prevented, the risk can be significantly reduced by:
- Treating acne and inflammatory skin conditions early.
- Avoid picking or squeezing the skin.
- Using gentle, barrier-supportive skincare.
- Protecting the skin daily from UV and visible light.
- Seeking professional advice before cosmetic treatments.
Treatment Options for Post-Inflammatory Hyperpigmentation
Successful PIH management relies on treating both the pigment and the underlying cause of inflammation. A layered approach delivers the best outcomes.
Treatment Category | Purpose | Clinical Notes |
Medical-Grade Topical Treatments | Regulate melanin production and support skin repair. | Includes tyrosinase inhibitors to suppress pigment formation, anti-inflammatory ingredients to calm the skin, and barrier-repair actives to reduce recurrence. |
Chemical Peels (Correctly Selected) | Accelerate cell turnover and assist pigment clearance. | Superficial to medium-depth peels are selected based on skin type and pigment depth to minimise irritation and post-inflammatory hyperpigmentation. |
Energy-Based Treatments | Target pigment using controlled light or laser energy. | Advanced laser and light-based devices, such as Pico Toning, are used selectively and cautiously, particularly in darker skin types, to minimise post-treatment hyperpigmentation. |
Skin Barrier & Inflammation Control | Prevent the formation of new PIH while treating existing marks. | Active acne, eczema, or sensitivity must be stabilised to reduce ongoing inflammation and melanocyte stimulation. |
Sun Protection (Essential) | Prevent worsening and recurrence of PIH. | Daily broad-spectrum sunscreen with protection against UVA, UVB, visible light, and infrared radiation is non-negotiable for PIH management. |
