Post Inflammatory Hyperpigmentation - Dark Skin

Pigmentation and Post Inflammatory Hyperpigmentation - PIH is a common problem in dark skin types.

This also includes patients of mixed backgrounds who have more darkly pigmented skin. Darker skin type people represent a significant and growing group of patients seeking aesthetic procedures. This is because of the increased awareness of safe, affordable aesthetic procedures. These procedures include amazing new lasers that are colour blind and are less invasive than previous generations of lasers. Yet special concerns have to be addressed when treating skin of color.

People with darker skin tones are prone to certain skin problems. One of the most common is hyperpigmentation, or dark spots. These spots are caused by an insult to deeply pigmented skin, such as acne, a cut, or a disorder such as psoriasis.

Melanocytes are very sensitive cells and can either stop producing color- hypopigmentation or produce excessive color in cases of inflammation- post inflammatory hyperpigmentation PIH which is most commonly seen in areas where acne blemishes heal, leaving a dark spot behind. These too will fade with time; however, it can be quite persistent.

Skin Renewal Tip - Post Inflammatory Hyperpigmentation PIH

The traditional way to treat Post Inflammatory Hyperpigmentation or PIH has been to bleach the darkened pigment using hydroquinone based products which in South Africa is only available by doctors prescription. Still, despite best efforts with bleaching agents and exfoliation treatments, pigment from PIH can be stubborn and long lasting. There is a ‘something’ missing in conventional fading creams. Most have side effects.

For most people with dark skin, treating pigmentation is like taking one step forward and one step back. The challenge is to take care of dark skin, fade the dark spots / pigmentation and heal it without further causing rebound hyper pigmentation which results from irritation of the skin

Videos on Hyperpigmentation in Dark Skin Types

Frequently Asked Questions

Treatment for Post Inflammatory Hyperpigmentation or PIH in black skin is available in Johannesburg at FourwaysParkhurstMorningside, BedfordviewWest Rand, Waterfall and Illovo as well as in Pretoria at Brooklyn and Irene and in the Western Cape at Cape QuarterClaremontConstantiaStellenboschWillowbridgePaarl, and in KwaZulu-Natal at BallitoDurban & Umhlanga.

Skin Renewal is pleased to be able to offer the “something” missing in conventional fading creams. The following new topicals are available at Skin Renewal and can be used on ALL Skin types.

  • At Skin Renewal we offer the gold Standard for pigmentation, Hydroquinone which is available on prescription. The use of HQ is strictly controlled at Skin Renewal.
  • To prevent sensitivity from Hydroquinone, we include products which prevent the irritation that occurs with HQ in our prescription pigmentation corrective creams.
  • We offer the highly effective depigmentation topical creams: Dermamelan Maintenance Cream and Cosmelan 2
  • We offer pigmentation serums with recent advances in pigmentation technology-pigmentation peptides in our home care products. This includes the Brighter Concentrate and Luminesce ranges by Lamelle. Brighter concentrate uses peptide technology to reduce melanin at eight points in its production, as opposed to just one point as with other traditional lightening treatments.
  • Lymixyl, decapeptide pigmentation topical , developed at Stanford University is also available
  • Pigmentation ranges by top cosmeceuticals houses Neostrata are available at all Skin Renewal branches.
  • In House topical brightening agents have been specially developed for Skin Renewal. The Skin Renewal brand includes traditional brightening products such as Kojic, Arbutin, Nicotinamide amongst others.
  • Topical anti oxidants that protect against infra red A, a newly discovered deep wavelength which causes accelerated ageing and pigmentation, is also available at all Skin Renewal branches.
  • At Skin Renewal it is mandatory that one of the home brightening products mentioned above be used routinely for 2 weeks on the entire problem area before any exfoliation treatment is done such as peels. A visit to one of our doctors who are experienced in treating skin of colour is mandatory before any procedure. The cost of the consultation will be redeemed after your first peel/treatment at Skin Renewal.

In Office Treatments available at Skin Renewal;

  • Superficial peels. At Skin Renewal we have twenty different kinds of superficial peels on offer which improve pigmentation. With a series of peels you can quickly achieve substantial improvement in the uneven pigmentation, while making your skin look and feel softer, smoother, and more radiant. Please see our peel chart which indicates which peels can be done on your skin type.
  • The Yellow peel is a full epidermal peel for PIH that is resistant to treatment with normal superficial AHA and BHA peels.
  • Transdermal Mesotherapy with prescription Brightening products done straight after our peels improves the final result by removing deep dermal pigment.
  • Cosmelan and Dermamelan mask treatments together with the home maintenance products offer superior results for resistant pigmentation.
  • Laser Genesis: The epidermis renews itself every six weeks, by six months, any pigment from PIH is probably in the dermis. Traditional skin rejuvenation treatments such as peels, microdermabrasion and bleaching agents are not successful for pigment such as PIH that has leached into the dermis. That is when the use of certain lasers such as the long pulsed Nd Yag become effective to safely treat darker skin including skin type 6. The Laser Genesis procedure by Cutera gently heat the dermis, causing cavitation bubbles, which disrupt the unwanted dermal pigment, breaking it into smaller particles which are able to move upward to the epidermis where it can be easily removed with exfoliation.
  • PDT Red Light post peel reduces inflammation and evens out skin tone.
  • Our Brightening Intravenous infusions with brightening anti oxidants such as glutathione which work intracellularly to remove resistant pigment. An overall lighter and even skin tone can be expected.

What we need to know for sure to be able to help you is the following:

1) Is the ringworm completely cleared?

2) Are the marks completely flat and smooth? OR

3) Are the marks uneven (raised or sunken) and do they have a different texture to the surrounding skin? If the marks are smooth and feel the same as the surrounding skin, then we need to deal with your case as PIH (Post Inflammatory Hyperpigmentation). If the marks are raised or sunken or differing in texture the chances are that there may be a bit of scarring and so we would need to follow a slightly different approach, based on the severity of the scarring. In order to have any success with helping you, we need to know exactly what we are dealing with. 

Marks left on the skin after an acne breakout is commonly known as PIH, Post Inflammatory Hyperpigmentation. These pigmentation spots form due to the inflammatory response that occurred in the area. The good news is that these marks are quite easy to treat as this pigment normally lies superficially in the skin. There are 3 steps to treating these spots ; 1. Daily use of an SPF 50, unprotected sun exposure will induce more pigment to form and the spot may become darker. We recommend Heliocare 360, this SPF will not only protect your skin from UVA and UVB, but also from visible and infra-red light. 2. We need to speed up your cellular turnover rate, to get the pigment out. This can be done by the use of exfoliating ingredients such as Retinol or AHA’s (Alpha Hydroxy Acids). 3. We need to ensure that the pigment cells don’t produce any more pigment. This is done by the use of pigment suppressing ingredients. So, in a nut shell we need to Protect, Exfoliate and Suppress.

The Neostrata Enlighten range will suit your skin, not only is the main ingredients in this range pigment suppressors, but is also contains AHA’s and Retinol to speed up the cellular turnover. I would also recommend that you visit a Skin Renewal branch, one of our Medical professionals can do a thorough skin analysis and also make their recommendation with regards to homecare products as well as in clinic treatments, such as chemical peel, laser therapy as well as skin needling.


As for the stretchmarks, when our bodies go through sudden weight gain or weight loss, our dermis (the deeper layer of our skin) tear and this shows as stretchmarks on the skin. We need to increase collagen production in the area to rebuild the dermis again. Carboxy therapy is an excellent treatment option for this as it encourages collagen induction in the area. Carboxy can be combined with Laser genesis to improve the appearance of the skin in the area. Skin Needling is also a good option to stimulate new collagen production by releasing certain growth factors and encouraging our bodies own wound healing response. It is important to note that multiple sessions may be needed to get the desired result. I would recommend that you visit one of the Skin Renewal branches to have a thorough consultation, from there we can customize a treatment plan for your needs and budget.


In a case like this, it would really be very helpful for us to be able to see what your skin looks like and see exactly what we’re dealing with. We have to assess the extent and the depth of the damage that has occurred in order to be able to help you correctly. Unfortunately in a case like this, you could be developing PIH and the best immediate advice I can give you is to ensure that you are doing the following 3 things until we can see you or at least look at your problem more closely:

1) You need to be applying a good facial SPF every day 

2) You need to be using a pigmentation inhibitor to prevent more pigment from being produced in those areas; and lastly, you need to make sure that your skin’s barrier is functioning properly in order to ensure that you aren’t developing inflammation which would worsen the problem, so something that is gentle and moisturising and will soothe and hydrate the skin is also very important. 

Our online store can help you with a variety of product options to consider should you wish to start with topicals before considering any further treatment. Definitely, do not continue applying bleaching agents to the skin as these can be very damaging. 

In most cases like this, the pigmentation is caused by constant scratching or rubbing or the constant use of tissue paper to wipe and blow the nose. What course of action to take as far as treatment goes, would depend on how severe the pigmentation is, so I would need to examine the area or at least see a picture to be able to advise you better. You need to remember that the pigmentation will simply re-occur as long as the trigger is still there. The ENT would most likely be able to advise you regarding the treatment and management of your sinus issue. If you can get that under control, and get the itching under control as a result, you are going to have more success in targeting the pigmentation. To start off with, I would simply advise that you begin by ensuring you are using a very good facial SPF every day, and that you are using a good pigmentation inhibiting product morning and night. That will at least be a good starting point. 

Pigmentation is quite tricky, because in order to treat it, you need to know if it is dermal, superficial, hormonal or a combination. So it’s quite difficult to help you if we do not know what we are dealing with. The best course of action is to have a thorough consult which takes into account an examination of your skin and a collection of your medical history so that the likely cause may be established and the right course of treatment prescribed. There is nothing more disheartening than spending loads of money on pigmentation products and treatments, only to find that you are not using the correct products for the type of pigmentation that you have and therefore get no result. Rather invest your money in finding the right answers and starting on the correct treatment plan from the get go. 

Unfortunately, toothpaste is not very good for the skin at all, as it can be mildly abrasive, given the fact that it is made to clean your hard teeth. So unfortunately, what has happened is that you have stripped the skin of its barrier where the toothpaste has been applied, and then you get an inflammatory response in that area and then this develops into post inflammatory hyperpigmentation as a result of this. If the skin is still peeling, I would suggest applying a VERY thin layer of Vaseline to create a “temporary barrier” in that area (just for a day or 2), followed by a good SPF. If you are wanting to prevent dark marks from forming on your skin then it is vital to at LEAST use a good SPF every single day. If you simply want a very cost effective "multi-purpose" moisturiser, I would suggest you in vest in a good facial SPF to use every morning. Good quality facial SPF products moisturise and protect the skin and prevent dehydration. Once your skin is healed, I would suggest you reassess what it looks like and then take it from there.


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*Please note results may vary by individuals.
Review -Experiencing excellent results and treatments
Reviewed on 2 September 2014 by Yasmin Hoosen

Experiencing excellent results and treatments. The therapist (Candice) is excellent. She explains very well before and after therapy. She is very patient and I have had good results with her treatment. Thank you Candice- Well done and keep up the good work and great sense of humour.

Sharon Izak Elaine Chat staff ) WhatsApp