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Post-Inflammatory Pigmentation

Post-inflammatory hyperpigmentation is increased pigment production at sites of skin inflammation or injury.

Post-Inflammatory Pigmentation

Post-Inflammatory Pigmentation (PIH)


What is PIH?


Post-inflammatory hyperpigmentation is increased pigment production at sites of skin inflammation or injury.


It is also called Post-Inflammatory Pigment Alteration (PIPA).


This can occur following trauma, a wound, or a skin treatment such as a chemical peel.


Unfortunately, once triggered, PIH can persist for up to two years or more.


Where can PIH occur?


PIH can occur anywhere on the body but is most apparent on the face, chest and back of the hands.


What are the causes of PIH


There are multiple causes of PIH, but here is a list of the most common ones:

  • As a response to acne or psoriasis.

  • After laser skin treatments

  • After chemical peels

  • Following skin damage or trauma

  • Certain drugs, such as tetracyclines

  • Following hair removal

  • Following a skin burn

  • Skin infections such as impetigo

  • Insect bites

What does PIH look like?


PIH is an area of the skin darker than the surrounding skin.


Who is at high risk of PIH?


Although PIH can occur in all skin types, it is more common in people with darker skin.


Why do you get PIH?


When the skin is injured, it triggers Inflammation. Inflammation is a potent trigger to stimulate the pigment cells to produce more pigment due to a process known as oxidative stress.

The greater the inflammation and the deeper it is, the more severe the pigmentation and the more difficult it is to treat.


Relevance of PIH to aesthetic treatments


Anyone contemplating an aesthetic treatment must be aware of the risk of PIH.


What aesthetic treatments are associated with PIH?


The risk of PIH should be mentioned to anyone considering the following treatments

  • Chemical Peels

  • Laser treatment

  • Micro-Needling

  • Dermal Fillers

Why is PIH important?

  • It is distressing.

  • Incurring pigment changes significantly impact the quality of life.

  • Specific treatments, such as chemical peels, PIH, can largely be prevented by preparing the skin.

How do you treat PIH?


Treatment of PIH can be difficult. The catch-22 is that some of the treatments for PIH can cause PIH themselves.


How long does it take for PIH to fade on its own?


Fortunately, PIH does not cause scarring, and even with no treatment, it will improve with time. Without treatment, PIH takes anything from 3-24 months to fade.


Treatment for PIH


Treatment of PIH includes topical agents, chemical peels, laser or cosmetic camouflage. Any treatment that can cause irritation, thereby worsening PIH, should be avoided.


Managing PIH should start with focusing on the underlying inflammation.


Prompt treatment for PIH is essential, which may avoid further darkening.


As with any treatment for skin pigmentation, avoiding the sun is one of the most essential strategies to reduce pigmentation.


Applying sunscreens should be the most important part of the daily skincare routine for anyone with PIH.


Any of the following treatments can be used to improve the appearance of PIH. More details can be found in Pigmentation Treatments.


Conventional treatments for PIH

  • Hydroquinone

  • Triple combination therapy - hydroquinone, retinoid, and steroid.

  • Retinoids such as tretinoin or adapalene.

  • Superficial chemical peels such as glycolic acid, kojic acid, salicylic acid or Jessner’s.

  • Antioxidants Vitamin C and E.

  • Laser therapy.

  • Tranexamic acid.

  • Platelet Rich Therapy

PRP for PIH


In addition to existing therapies, Platelet-rich plasma (PRP) is a potential therapeutic option in treating pigmentation by directly inhibiting pigment formation.

References

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