Post-inflammatory Hyperpigmentation: A Science Backed Approach
Post-inflammatory Hyperpigmentation: Treatment & Management
If you’ve ever noticed dark spots or marks left behind after a pimple has healed, then you have experienced what’s known as post inflammatory hyperpigmentation. This discoloration can often be more of a nuisance and more distressing than the pimple was to begin with.
Post inflammatory hyperpigmentation is the skin’s natural response to an inflammatory wound. While these marks and spots may be frustrating to deal with, there are plenty of treatments available that can help you to manage them more easily.
What is Post Inflammatory Hyperpigmentation and Who Gets It?
Post inflammatory pigmentation, also known as acquired melanosis, is a temporary pigmentation that will follow an injury, like a thermal burn, or an inflammatory disorder of the skin, like dermatitis or an infection. It’s possible for anyone to experience post inflammatory hyperpigmentation, but it is most common in individuals with darker skin tones as the color tends to be more intense and lasts for a longer period than in lighter skin tones. In addition, the pigmentation will also tend to be more pronounced in sun induced skin conditions such as a sunburn.
What Causes Post Inflammatory Hyperpigmentation?
Whenever a wound or irritation, such as a scrape, rash, or pimple, causes the skin to become inflamed, it’s possible for post inflammatory hyperpigmentation to develop. As the skin heals itself, it may end up producing too much melanin, which is the protein found in the skin that gives it its color. This excess melanin is what darkens and discolors the skin. This discoloration would remain even after the wound has healed completely.
Most people that have acne will have some degree of post inflammatory hyperpigmentation. It's not just the big blemishes that can cause these spots either, as hyperpigmentation can often follow even the most relatively minor pimples and papules.
However, it’s most typical that the more inflamed a breakout is, the larger and darker the pigmentation spots will tend to be. Picking or popping a pimple will increase the amount of inflammation and will therefore increase the chances of developing post inflammatory hyperpigmentation. Other causes of post inflammatory hyperpigmentation can include sunburns, chemical peels, dermabrasion, and laser resurfacing.
Does Post Inflammatory Hyperpigmentation Fade?
Even without treatment, post inflammatory hyperpigmentation will fade away over time. However, this time can vary wildly depending on the specific details of the situation. It may take anywhere between three and 24 months for the hyperpigmentation to fade, in some cases it can even last longer.
The length of time that it will take to fade will depend on how dark the spot is compared to the surrounding skin. The bigger that the contrast is between the macule and your natural skin tone, the longer it will take to fade away.
In some extreme cases, post inflammatory hyperpigmentation will not fade away on its own and may require treatments to help. While they may not completely erase the dark marks, they can at least lighten them up considerably. Treatment can also help to speed up the time it takes for them to fade away, if you are wanting to get past them quicker.
If you are experiencing post inflammatory hyperpigmentation, don’t worry -- it’s not “true” scarring. In fact, it’s often called “pseudo scarring” because despite leaving a mark on your skin for a period of time, it doesn’t actually do any damage to the skin follicles.
Acne scars, on the other hand, will occur when there is either a loss of tissue, which causes a pitted or depressed area, or an overgrowth of tissue, resulting in a raised scar. Post inflammatory hyperpigmentation is neither pitted nor raised -- it’s simply a flat marking that’s darker than the surrounding skin.
What Are The Treatments For Post Inflammatory Hyperpigmentation?
There are plenty of over the counter products that can be beneficial in fading some of the more subtle marks.
For deeper marks or any that have been around for a long time, you may need a prescription cream to help. Talk to a dermatologist if you cannot get rid of the discolorations yourself or believe they are too much to handle without help.
Another thing to remember: if you stop having acne then you will most likely stop having post inflammatory hyperpigmentation issues as well. That may be easier said than done, but it’s worth discussing with a dermatologist in order to prevent possible issues in the future.
Some of the treatment options available include:
A good starting point for treatment is to use alpha hydroxy acids, especially glycolic acid. Alpha hydroxy acids will help to speed up the skin’s natural exfoliation process, which will help to improve the look of the discoloration and hyperpigmentation. You can find these ingredients in several different over the counter “brightening” treatments.
If possible, use leave on treatments such as lotions, creams, and gels as opposed to wash off products like cleansers. Other over the counter ingredients to be on the lookout for include N-acetyl glucosamine, niacinamide, and the vitamins A and C. If these are not enough, there are stronger alpha hydroxy acid treatments available with a prescription.
Another widely used treatment for post inflammatory hyperpigmentation is hydroquinone. This is available over the counter in 1% and 2% strengths, and 3% and 4% via prescription. Hydroquinone works by blocking the enzyme that is responsible for the production of melanin, therefore lightening the skin.
These creams will also typically contain other additional “lightening” ingredients, such as kojic acid, glycolic acid, tretinoin and other various retinoids, or vitamin C. Combination creams will often give you better results than just using hydroquinone alone.
While using these creams, be sure to carefully apply only to darkened areas in order to prevent the unintended lightening of your natural skin color. Hydroquinone can cause skin irritation so it may be worth talking to your doctor before undergoing this treatment.
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One of the most common treatments for acne are topical retinoids. These retinoids help to clear acne by speeding up cell turnover rates. The rapid exfoliation can also help to fade the effects of post inflammatory hyperpigmentation. There are several different options for retinoid creams such as Retin-A (tretinoin), Retin-A Micro, Tazorac (tazarotene), and Differin (adapalene). However, with the exception of Differin, these other medications are available through prescription only.
Obvious results might not be apparent until several weeks or months after starting the treatment. Keep a close eye on excessive dryness, redness, and irritation that may occur as side effects as they can trigger post inflammatory hyperpigmentation on their own.
Another medication primarily used for treating acne is azelaic acid. This helps to treat post inflammatory hyperpigmentation by decreasing inflammation and speeding up cell turnover rates. Sometimes azelaic acid is used in conjunction with glycolic acid or tretinoin.
There are some studies that have shown azelaic acid to be just as effective at treating hyperpigmentation as hydroquinone. If you are unable to use hydroquinone for any reason, azelaic acid is a great alternative.
Azelaic acid is only available via prescription and it’s important to be on the lookout for redness or irritation if you are using it.
In the cases of severe post inflammatory hyperpigmentation, it may be necessary to treat it professionally with the help of a dermatologist. These treatments may include chemical peels, lasers, microneedling, and microdermabrasion. Typically, one treatment will not be enough to fade the hyperpigmentation and you will most likely need a series of treatments. These sessions are normally spaced out around two to four weeks apart, depending on the procedure being done.
In order to get the best results possible in the shortest amount of time, here’s some tips to incorporate into your day to day:
Get your acne under control: The best way to put out a forest fire is to get out in front of it. Chasing after it will do no good as it will continue to create havoc. Until your acne is under control, you will always be behind and chasing after the hyperpigmentation that comes as a result of it.
Use sunscreen daily: The sun plays a significant role in darkening discolorations and increasing fading time. In addition, most of the treatments listed above will make your skin more sensitive to the sun. Make sure you are protecting your skin from sun exposure as best as you can.
Monitor your skin: Most of the treatments for post inflammatory hyperpigmentation and acne have a tendency to cause irritation. If your skin gets irritated, it could result in even darker spots and an uneven skin tone.
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Post inflammatory hyperpigmentation is a fairly common issue for anyone routinely experiencing acne. While these marks can be unsightly and frustrating to deal with, they are usually only temporary and there are plenty of options for treating them.
It’s important to have a daily skincare routine in order to help prevent acne and reduce the chances of dealing with hyperpigmentation. However, even if you do end up with some discoloration, there are plenty of treatments available and, in most cases, it will fade naturally over the course of time.
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