Post-inflammatory hyperpigmentation or PIH is caused as a direct result of an injury or inflammation to the skin. It can be triggered by conditions such as acne or something as simple as waxing.
a) What are the symptoms of post-inflammatory hyperpigmentation?
Post-inflammatory hyperpigmentation appears as dark patches or spots on the skin. The condition may appear after suffering an inflammatory skin condition such as acne. It’s more prevalent in deeper skinned individuals due to larger melanosomes which create a greater quantity of melanin.
Post-Inflammatory hyperpigmentation or PIH as it’s abbreviated is also known as acquired melanosis and is usually temporary. Patches can fade or become lighter over time. PIH can also be persistent and remain long after a wound has healed. PIH can further darken through skin aggravation, certain medications and prolonged sun exposure without protection.
The good news is, PIH is relatively superficial. Hyperpigmentation acquired at birth or last-standing problems are difficult to treat. Such blemishes usually extend deep within the skin. They will in many cases require invasive treatments such as laser resurfacing. PIH on the hand can successfully be treated with low to moderate skin regenerative treatments such as chemicals peels and micro-needling.
b) What can I do to prevent post-inflammatory hyperpigmentation?
Inflammation is the first stage of the natural healing process. Unless we are permanently free of skin inflammation PIH will exist. It is our bodies way of healing itself. So whilst we can’t prevent PIH there are steps we can take to lessen its occurrence.
- Identify skin type – By using the correct skincare products our skin we will be less prone to irritation with less chance of PIH caused by stress.
- Avoid picking – This goes without saying. Picking at spots or wounds whilst they are still healing will, sure enough, leave a mark ie PIH.
- Use sun protection – Given the fact a large portion of a deeper skin aesthetic complaints will be pigmentary in nature, many deeper skins do not use sun protection. PIH will worsen unprotected in the sun.
- Be proactive – Always assume PIH will not fade on its own. Once we’ve suffered an injury or a few spots have healed, we should embark on a skincare routine that includes exfoliation and lightening. We should access regenerative skin treatments to expedite cell turnover and skin renewal. The quicker PIH is treated, the greater chance of positive results.
c) What skin treatments are good for post-inflammatory hyperpigmentation?
Two aesthetic treatments come to mind in the treatment of PIH. Those are chemical peels and micro-needling. Both are a form of control wound healing. We damage or break down the old blemished skin and encourage new brighter skin to the surface.
Chemical peels, although as the name suggests are not chemicals. They are natural substances derived from milk, sugar cane, willow bark and citrus fruit amongst others. Chemical peels work by breaking down the keratin protein in dead skin cells destroying them and subsequently they flake away. The effect is fairly subtle and so we describe superficial to medium depth chemical peels as progressive. The greatest results will be achieved over 3-6 treatments.
The complete removal of the epidermis or outer layer of skin is known as an ablative treatment. You may have seen DIY chemical peels on social media, users have peeling skin with the underlying significantly lighter than the natural skin tone. This is incorrect and very risky for deep skinned individuals. Many professionals would not choose to perform such as aggressive treatment on coloured skin.
If we think back to what causes PIH, it’s the injury and healing of wounds. This level of treatment could trigger the worse possible and sometimes irreversible burns and hyperpigmentation.
As deep skinned individuals with PIH we want a gradual controlled wound healing that encourages newer, fresher and brighter skin to appear. If the wounded is too great or too fast, there is a significant risk of worsening the problem. Mandelic acid is one of the best agents to use on PIH.
Micro-needling is a skin regenerative treatment which triggers healing mechanisms of the skin. The healing process stimulates new collagen, elastin and water-retaining hyaluronic acid deep within the skin. skin regeneration produces a finer, smoother complexion and as a result, post-inflammatory hyperpigmentation and scarring are significantly improved.
As with chemical peels, micro-needling is progressive. Greater results are achieved over time. Micro-needling is especially good for PIH when it is accompanied by acne scars such as box scars.
Microdermabrasion is a mechanical exfoliation procedure for superficial skin resurfacing which utilises a refined abrasive element, such as a diamond-tipped pad aerosolised crystals, to gently remove the outermost skin layers. This controlled wounding process stimulates cell renewal with the regeneration of a healthier and even skin tone.
d) What skincare products are good for post-inflammatory hyperpigmentation?
Sample skincare routine for pigmentation with The Ordinary
Skincare for AM
Alpha Arbutin 2% + HA – Apply AM & PM
Niacinamide 10% + Zinc 1%
Magnesium Ascorbyl Phosphate 10%
Skincare for PM
Azelaic Acid Suspension 10%
If you intend to receive professional chemical peels as a means of treating hyperpigmentation, the de-pigmentation kit from Mesoestetic will aid in prepping the skin for the best treatment outcome.
De-pigmentation Skin Preparation Kit
- Optimises your results.
- Ensures even penetration.
- Reduces the risk of adverse reaction or PIH
- Encourages cell turnover.
- It will start to treat the problem.
- Introduces the skin to quality result-lead ingredients.
Ultimate W+ whitening foam. Cleanses and purifies the skin in-depth, effectively removing make-up and eliminating dead cells and impurities. ACTIVE INGREDIENT: Glycolic & Lactic Acid, AHA’s to encourage skin regeneration and boost the skin’s natural barrier function. Aloe Vera has a powerful moisturising, soothing and whitening effect.
Brightening Peel Booster. Renewing and lightening gel for hyperpigmentation, uneven tone, imperfections and signs of photo-ageing. It reduces melanogenic activity. ACTIVE INGREDIENT: Glycolic Acid 10% AHA to stimulate cell renewal and significantly increase moisture in the dermis. Phytic Acid 2% De-pigmenting and anti-oxidant effects
Ultimate W+ essence. Intensive whitening and anti-oxidant serum. Prevents and reduces dark spots. ACTIVE INGREDIENT: the [meso] white complex® to inhibit melanin synthesis and Garden Cress, a strong phytonutrient that inhibits binding of a-MSH to its receptor, reducing the appearance of dark spots and providing whitening benefits.
Light Water Anti-Aging Veil SPF50+. Very high sun protection for normal and combination and dry skins. Combines physical and chemical UVA, UVB filters with biological HEV + IR filters. Antiaging Action