Post Inflammatory Hyperpigmentation

Post Inflammatory Hyperpigmentation (PIH) presents as areas of brown, poorly defined patches, and can be dermal or epidermal. It is possible to distinguish the location of the problem using a Woods Lamp.

This can be done in our clinic.

Consultations are FREE and can be arranged on 01564 702344

This problem much more common in darker skinned individuals of Asian or African origin and follows many common inflammatory diseases such as eczema, psoriasis, laser treatment or acne. Acne scarring can leave a noticeable, psychological reminder of the problem, long after the active acne has resolved. Where erythema (redness) is seen in white individuals, pigmentation occurs in dark skinned individuals.

Causes are many but can include:

• Inflammatory skin conditions Any inflammatory skin condition involving the dermo-epidermal junction can cause hyperpigmentation e.g. eczema, psoriasis, lichen planus, acne, systemic lupus erythematosus, chronic dermatitis
• Trauma – such as cuts or surgery scars
• Allergic reactions
• Iatrogenic (caused by a medical treatment) – Hyperpigmentation can be a complication of treatment with a fully ablative laser device in dark skinned patients. (This risk can be reduced by the use of fractional CO₂ laser). It can also follow laser hair removal, if incorrect parameters are selected. Rebound PIH can also follow skin peels and other procedures
• Drugs – Chlorpromazine, Minocycline and arsenic are all common culprits. Other drugs which occasionally cause hyperpigmentation include tetracycline, antimalarial drugs, St Johns Wort, and hormones (e.g. oestrogen).
• Exposure to ultraviolet light
• Idiopathic – Occasionally no cause can be identified

Treatments are varied, but often PIH will resolve spontaneously without intervention. A high factor SPF is essential to prevent the condition from worsening or recurring. It should be noted that the condition will be slow to resolve and will usually take at least 9-12 months, even when actively treated.

Other treatments include products for home use, such as Kojic Acid (a mushroom derivative favoured in bygone days by Japanese Geisha Girls) found in products like SkinCeuticals Pigment Regulator, or prescription only medicines, such as hydroquinone and tretinoin, found in creams such as Pigmanorm and the Obagi Nu-Derm System.

To purchase prescription products such as Pigmanorm or Obagi Nu-Derm tretinoin, please call us on 01564 702344.