Post-Inflammatory Hyperpigmentation (PIH)

What is Post-Inflammatory Hyperpigmentation (PIH)?

Post-inflammatory hyperpigmentation is a darkening of the skin that persists after an inflammatory skin condition. Purple, brown, or tan-sometimes with a blue or grey tint- flat spots or patches appear on the skin surface. PIH seems to occur at similar rates in men as well as women, however there is some evidence that women are more likely to seek medical care.

How is PIH identified?

PIH develops in areas where there was inflammation in the skin, and this is often obvious.

When the body determines that the threat has passed, the natural inflammatory response shuts down, and the swelling and pain diminish. Redness typically subsides gradually. However, in some instances, rather than return to the skin’s natural colour, redness can change to dark shades of brown, purple, tan, or even grey. These skin markings can be persistent, and are known as post-inflammatory hyperpigmentation or PIH. However, sometimes the connection between PI and inflammation can be less clear.

PIH can persist long after acne lesions have cleared or a bug bite has healed, for example, and even the patient may not link the skin discoloration to that initial insult.

How is PIH Diagnosed?

There is no test to diagnose PIH. Doctors are familiar with the condition and can often identify it based on a visual assessment. The skin consists of multiple levels. PIH may be mostly located in the upper or epidermal level or may be present in the deeper dermal level. Doctors can use a special light called a Wood’s lamp to help see into the skin levels to determine where the pigmentation resides.

What Causes Post-Inflammatory Hyperpigmentation?

Among potential causes of skin inflammation are:

Injury, such as cuts, scrapes, and burns, that damage the skin

Bug bites

Irritants and allergens (such as poison ivy, nickel exposure, etc.)

Inflammatory skin conditions, such as acne, eczema, psoriasis, lichen plans, and Pseudo folliculitis barbae (razor bumps)

Skin infections

Diseases that manifest on the skin, such as Chicken Pox.

Scratching, picking or popping acne lesions

Is PIH Permanent?

PIH is not permanent and can go away even if it is left untreated. However, full clearing of PIH can take months to years in some individuals.

What can I do to prevent and treat PIH?

Some helpful strategies include:

Limit sun exposure. Cover skin or seek shade as much as possible, and use a sunscreen with high SPF.

Avoid scratching or picking at the skin and try not to squeeze or pop lesions.

Cyspera® intensive pigment corrector, the first and only topical cream containing cysteamine 5% to diminish the appearance of stubborn skin discoloration.