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Postinflammatory Hyperpigmentation (PIH)

Darkening of skin (epidermal or dermal melanin deposition) following any inflammatory or injurious skin event such as acne, eczema, dermatitis, burn, or trauma — most prominent in skin of color.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Postinflammatory Hyperpigmentation (PIH)?

Postinflammatory hyperpigmentation (PIH) is acquired hypermelanosis occurring after a primary cutaneous inflammatory or traumatic event, more prominent in Fitzpatrick skin types III-VI.

Pathophysiology involves disrupted basal cell layer with melanin transfer to dermal macrophages (dermal melanosis) and increased melanocyte activity (epidermal melanosis). Both contribute to brown to gray-brown patches at sites of prior inflammation.

Common triggers include acne, eczema, contact dermatitis, lichen planus, fixed drug eruption, insect bites, burns, abrasions, and laser or chemical peel procedures. Treatment focuses on resolving the underlying inflammation, photoprotection, and topical/procedural lightening.

Symptoms

Brown to gray-brown patches at sites of prior inflammation
Hyperpigmented macules following acne lesions
Darkening after eczema, dermatitis, or insect bites
Pigmentation in scar areas or after trauma/burns
More prominent in pigmented skin (Fitzpatrick III-VI)
Response to UV exposure with worsening pigmentation
Slow fading over months to years without treatment

Risk Factors

Darker skin types (Fitzpatrick III-VI)
Acne, eczema, atopic dermatitis (active inflammation)
Picking, squeezing, scratching of lesions
Sun exposure without photoprotection
Aggressive cosmetic procedures (laser, chemical peel without proper preparation)
Drug-induced eruptions (fixed drug eruption)
Inflammatory dermatoses (lichen planus, contact dermatitis)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent dark patches after resolution of acne or dermatitis
  • Worsening pigmentation despite avoidance of triggers
  • Difficulty differentiating PIH from melasma or other pigmentary disorders
  • Need for prescription-strength depigmenting therapy
  • Consideration of chemical peel or laser treatment
  • Cosmetic concern affecting quality of life
  • Recurrent inflammatory dermatosis requiring treatment to prevent further PIH

Treatment Methods

01
Treat underlying inflammation (acne, eczema, dermatitis)
02
Strict daily broad-spectrum sunscreen SPF 50+ with iron oxides for visible light
03
Topical hydroquinone 2-4% (alone or in triple combination with retinoid + steroid)
04
Topical retinoids (tretinoin 0.025-0.1%, adapalene)
05
Azelaic acid 15-20%, kojic acid, niacinamide, tranexamic acid
06
Glycolic acid or salicylic acid chemical peels (low strength, gradual)
07
Q-switched lasers or fractional non-ablative lasers in resistant cases (caution in dark skin)

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.