Post-inflammatory hyperpigmentation (PIH), also referred to as post inflammatory melanosis, is a reactive hypermelanosis of the skin that develops as a consequence of cutaneous inflammation. Common triggers for PIH encompass conditions such as acne vulgaris, atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, psoriasis, and burn injuries. Furthermore, it may manifest following cutaneous injuries, including aesthetic interventions like dermabrasion, laser procedures, chemical peels, and hair epilation. PIH poses a significant frustration for affected patients and can exact a substantial psychological toll on them.
Post-inflammatory hyperpigmentation can manifest at any age and is equally prevalent in both males and females. While PIH can occur across all skin types, the likelihood of clinically significant PIH is higher in individuals with darker skin pigmentation. This risk is particularly pronounced in those classified as Fitzpatrick type III-IV. The heightened susceptibility to PIH in individuals with darker skin tones may be attributed to the increased concentration of epidermal melanin within melanosomes in the epidermis.
How Does PIH Occur?
PIH arises from an overproduction of melanin, the natural skin pigment responsible for the color of hair, skin, and eyes, or from abnormal melanin deposition in either the epidermis (the top layer of skin) or the dermis (the deeper layer of skin) following inflammation. Inflammatory mediators stimulate melanocyte (cells that produce melanin) hypertrophy and heightened activity, leading to increased melanin production in the epidermis. The coloration of PIH is influenced by the location of excess pigment within the skin. When the excessive pigment is situated in the epidermis, PIH typically appears as tan to dark brown. Conversely, excess pigment in the dermis tends to present with a dark gray or blue-gray appearance. Epidermal PIH is more responsive to treatment with topical regimens, whereas dermal and mixed PIH pose challenges due to the presence of deeper pigment.
Similar to other medical conditions, prevention of PIH is better than cure. PIH has the tendency to persist at the site of inflammation or injury long after the initial wound has healed, often resolving over the course of months to years. It is crucial to underscore the significance of controlling the underlying source of cutaneous inflammation or injury. For instance, the most prevalent cause of PIH—Acne Vulgaris—should be promptly and effectively managed to minimize the likelihood of PIH development. However, it's worth noting that achieving this goal can be particularly challenging in severe cases.
For further insights into Acne Vulgaris, you can delve into my earlier article titled "The Battle Against Acne: Understanding, Preventing, and Managing."
Topical Formulations
Several topical treatments are available to regulate melanogenesis by targeting the enzyme tyrosinase, responsible for converting dihydroxyphenylalanine (DOPA) to melanin.
Hydroquinone is one such agent that acts on this pathway, and a concentration of 2-4% hydroquinone is commonly utilized for this purpose across all skin types. Presently, hydroquinone is only accessible through prescription, and its commercial use is subject to strict regulation due to recognized complications. These complications include contact dermatitis, permanent leukoderma (a clinical sign describing a localized area of white depigmented skin due to the total loss of epidermal melanin), and exogenous ochronosis (a cutaneous disorder characterized by blue-black pigmentation). These potential complications apply to all skin types.
Cysteamine hydrochloride has been recognized for its depigmenting effects for decades. At our clinic, we offer Cyspera, a topical formulation containing its main active ingredient, cysteamine. Cyspera represents the new gold standard, free from hydroquinone, for enhancing the appearance of stubborn discoloration. This formulation is suitable for all skin types and tones, boasting potent antioxidant activity. Importantly, it is non-phototoxic, ensuring long-term safety in its use.
Chemical peels
Chemical peels, involving the application of acids, work by removing the outer layer of the skin, which contains pigmented cells. This exfoliation process facilitates the shedding of damaged and hyperpigmented skin cells, unveiling newer and lighter skin underneath. Achieving optimal results typically requires multiple treatments. Despite a long-standing myth suggesting that chemical peels are unsafe for darker skin tones, careful selection of the peel type and strength can help prevent potential complications and bring positive outcomes. Options include glycolic acid, salicylic acid, and trichloroacetic acid peels.
Laser Therapies
At Dream Clinic, we feature the Fotona StarWalker PQX laser technology, an ideal tool for achieving effective skin pigment removal without causing harm to surrounding tissue. The picosecond laser pulses induce skin remodeling in a completely non-thermal manner, ensuring a safe option for individuals of all skin types. With its exceptional energy and peak power, this laser technology enables fast and efficient treatments. It is important to recognize that the effectiveness of picosecond lasers for post-inflammatory hyperpigmentation (PIH) may vary based on factors such as the depth of pigmentation, skin type, and individual skin response to the laser.
Warm Reminder
In addition to the treatment options mentioned, it is crucial to emphasize a fundamental yet vital step to minimize the darkening of post-inflammatory hyperpigmentation (PIH) – sun protection and the daily application of broad-spectrum sunscreen (SPF 30 or higher). Don't delay any further, feel free to schedule a consultation with us to experience significant improvements in PIH, restoring confidence and fostering healthier, more radiant skin.