Hyperpigmentation

There are quite a few known causes of acquired hyper-pigmentation.

Below we will explore some of the more common causes, and some of the more successful treatments for eliminating the dark spots and blotchy skin associated with hyperpigmentation, and returning your skin to it’s youthful, glowing, even skin tone.

Post Inflammatory Hyper Pigmentation

One of the primary causes of post inflammatory hyperpigmentation is acne. After acne has cleared up and left your skin, it can leave behind a dark red, brown or even pink spot behind where your acne lesion once was.

Doctors and people in the ‘biz’ refer to Post Inflammatory hyperpigmentation as PIH. That’s the acronym given by dermatologists to refer to the darkening and discoloration of the skin that comes after a wound that has healed. It is most prevalent after the skin has been subjected to an inflammatory condition and thus called ‘post inflammatory’.

According to the medical journals, PIH presents itself as a “flat area of discoloration on the skin (macule) ranging from pink to red, purple, brown or black, depending on your skin tone and depth of the discoloration.” Of course, anyone who has ever had anything as simple as a pimple has experienced PiH on their own skin, and cuts and scar healing are another common example that most readers will be familiar with.

As it turns out, PiH is the product of the same thing that is blamed for age spots, sun spots and liver spot development — too much melanin production in the skin. Melanin is a protein that determines the color of one’s skin, and when produced in abundance can create a darkened area on the epidermis near the area of the inflammation. As anyone knows who’s had PIH, the dark spots can last long after the original sore has healed and disappeared.

If you have or have had acne, and especially if you have a darker skin type you’ve probably had to deal with dark spots on your skin. As it turns out, however, post inflammatory hyperpigmentation is not a form of scarring and it is a condition that can be reversed. Even severe spotting, due to extreme cases of acquired hyper-pigmentation can enjoy smooth skin tone once again. The trick, is to remove the deposits left behind by the over production of melanin. The challenge, is that this takes place beneath the top layers of the skin, and something must be used to gently remove the pigmentation, or, you risk starting the whole inflammatory cascade again, and being back to square one. Because of the requirement to find a gentle solution, many of the treatments and topical ointments, creams and formulations do not fit the bill. Don’t lose hope however, we have found a few products that deliver on their promise. More on these later in this article. First, let’s learn more about the causes of acquired Hyper-pigmentation so you’ll have a clearer understanding of what will and will not work to remove your spots.

PIH and Acne

A post inflammatory hyperpigmentation macule often is the remnant of an inflamed acne lesion. PIH macules can follow relatively minor pimples and papules, in addition to more serious lesions. However, the more inflamed a breakout, the larger and darker the PIH macule tends to be. Picking or popping a pimple increases the chance of developing post inflammatory hyperpigmentation.

You can identify post inflammatory hyperpigmentation by carefully examining the skin. PIH macules can be a range of colors, however, the skin will not be pitted or depressed. It may look like a discolored freckle on the skin, or it may present as a larger, dark discoloration of the skin. PIH macules may look shiny, or like “new skin.”

Treating PIH

Most acne sufferers are relieved to learn that post inflammatory hyperpigmentation is not scarring. PIH will fade away over time, even without treatment. It can take three to 24 months for PIH to fully fade, although in some cases it may take longer. The length of time it takes for PIH to fade depends on how dark the PIH macule is compared to your skin tone. The bigger the contrast between the macule and your natural skin tone, the longer it will take to fade.

There are treatment options available to help fade post inflammatory hyperpigmentation more quickly. However, your acne should be under control before beginning any treatment for PIH. Otherwise, each new pimple could cause another PIH macule, reducing the effectiveness of treatment.

Whatever treatment option you choose, understand that improvement will take time. Think in terms of months rather than weeks. Also, many dermatologist recommend using a broad-spectrum sunscreen daily. The sun may darken the discolorations and increase fading time.

Over-the-Counter Treatments

Mild cases of post inflammatory hyperpigmentation may respond well to over-the-counter products. There is a plethora of “brightening” treatment products on the market today. Many use a combination of alpha and beta hydroxy acids (including glycolic acid), vitamin A, vitamin C, and other ingredients to exfoliate the skin. Others, such as M.D. Forte Skin Bleaching Gel, use lightening agents to fade discolorations.

There has been some indication that N-acetyl glucosamine and niacinamide may reduce post inflammatory hyperpigmentation. However, more studies must be completed to verify these findings. N-acetyl glucosamine and niacinamide can be found in products such as Olay® Definity®.

Hydroquinone

Hydroquinone is a widely used treatment for post inflammatory hyperpigmentation. It is available over-the-counter at 1% to 2% strength, and in 3% to 4% prescription creams. Hydroquinone works by blocking the enzyme responsible for melanin production, thereby lightening the skin.

Hydroquinone creams often contain additional lightening ingredients, such as kojic acid, glycolic acid, tretinoin and other retinoids, or vitamin C. These combination creams can give you better results than using hydroquinone alone.

Hydroquinone creams should be carefully applied to darkened areas only, to prevent the unwanted lightening of your natural skin color. Hydroquinone may cause irritation in sensitive individuals. It’s worth talking to your doctor before beginning hydroquinone treatment.

Topical Retinoids

Retinoids, such as tretinoin and tazarotene, are often prescribed to acne patients. Retinoids help clear acne by speeding up cell turnover rates. It is this rapid exfoliation that can also help clear PIH. Retinoid creams include Retin-A, Tazorac, and Differin. The fact that they lessen post inflammatory hyperpigmentation as they treat acne breakouts is an added benefit for many people.

Obvious results may not be apparent for several weeks to several months after beginning treatment. Topical retinoids may cause excessive dryness, redness, and/or irritation, which may in turn increase hyperpigmentation. Let your doctor know right if you experience any of these side effects.

Glycolic Acid

Glycolic acid is an alpha hydroxy acid found in many skin care products. It effectively exfoliates the skin, helping to lighten post inflammatory hyperpigmentation. Available in cleansers, creams, and gels, glycolic acid not only helps improve postinflammatory hyperpigmentation, but also leaves your skin smooth and soft.

Cleansers, gels, pads, and lotions containing glycolic acid are available over-the-counter. Higher concentrations are available with a prescription only. As with all products, improvement may not be seen for several months. Monitor your skin for irritation, and inform your doctor if it occurs.

Azelaic Acid

Azelaic acid is used to treat acne as well as PIH. Available by prescription only, azelaic acid works by decreasing inflammation and speeding up cell turnover rates. Some studies have shown azelaic acid to be as effective as hydroquinone at treating hyperpigmentation. It is a good alternative for those who may be unable to use hydroquinone.

Azelaic acid is available in cream and gel form, and is sometimes used in conjunction with glycolic acid or tretinoin. As always, monitor your skin for redness and irritation and let your doctor know right away if you experience these side effects.

Procedural Treatments

More persistent cases of post inflammatory hyperpigmentation can be treated professionally at skin spas, medi-spas, or your dermatologist’s office. Procedural treatments include various chemical peels and microdermabrasion. A series of treatments is needed to adequately fade PIH. Your doctor can help determine which of these treatments, if any, would be right for you.