What is Post-Inflammatory Hyperpigmentation?

This article is originally published on Proven Skincare.

Dr. Yuan

Post Inflammatory Hyperpigmentation (or PIH) is a very common skin condition that affects the face and body. It’s caused by increased melanin production; the pigment that defines the color of a person’s skin. PIH can appear as dark spots or affecting pigmentation in the sites of prior inflammation.

What cases PIH?

The inflammation can be caused by almost anything including injuries, acne, rashes, too much sun exposure or picking or manipulating the areas affected. The inflammation triggers melanocytes (melanin-producing cells) that release pigment granules. These granules will darken and discolor making post-inflammatory hyperpigmentation or dark spots (sometimes identified as lentigines or macules) more visible on skin .

Who gets PIH?

PIH can occur at any age, can affect any gender, but more commonly occurs in darker skin types. Causes can be any of those listed above.

Will PIH ever go away?

Unlike acne scars, PIH is not permanent, though it may take anywhere from months to years to fade. The more the inflammation, the more obvious the discoloration. And, when the area is manipulated with abrasive treatments or picking the area, the longer the recovery.

What can I do to improve PIH?

Choose Cosmetics and Skincare Products carefully.

• Using the right makeup and personal care products. Makeup Foundations and products with SPF will help protect skin, especially lighter skin, from sun exposure which can further exacerbate PIH.

Appropriate skincare and camouflage are essential to improving the appearance of PIH. Find gentle primers, foundations and concealers that are slightly darker than your baseline skin tone to even out the appearance of PIH.

Choose products that have Broad Spectrum UVA and UVB coverage. Always test new products on your arm before using them on your face and stop using any products that burn, itch, or sting.

Go easy on blush, highlighting powders and shimmer oils. Skin is already prone to sensitivities. Use antibacterial makeup brushes and clean them between uses. Use only fingertips to gently apply makeup.

Avoid waxing any areas with PIH as this may make it worse.

Protect Yourself from the Sun.

• Treat the underlying cause of inflammation to prevent further PIH. This is usually acne. Products with retinoids, salicylic acid, hydroxy acids or retinols are all can helpful depigmenting agents as part of a regular skincare routine.

Sun protection is the single most important lifestyle change you can make for healthier skin and your PIH. Use sunscreens that protect against both UVA and UVB rays (often labeled broad-spectrum sunscreen on products). The vast majority of the sun’s radiation that reaches the earth is actually UVA so choose sunscreens with zinc or titanium dioxide and silicones (listed as dimethicone, orcyclomethicone, or cyclomethicone). These ingredients are less likely to irritate your skin and provide the best overall coverage and protection.

Sunscreen should be worn year around and on cloudy days as damage from the sun can occur every day of the year and despite clouds. The objective is to avoid skin cancer. This should be part of your daily skincare routine.

For more protection or if you aren’t able to reapply sunscreen repeatedly throughout the day, try UPF (ultraviolet protection factor) clothing lines such as Coolibar, Mott50, Naviskin, etc. These brands create light weight shirts, pants, shorts, swimsuits, wraps, dresses, and skirts to protect your skin from the summer sun.

Wear a wide brimmed hat whenever you are outside (even for that quick walk into the grocery store). Always wear your sunscreen as well because light reflects off the ground and can cause damage, even with a hat on.

UVA rays come right through most house and car windows, so consider installing UV blocking film on your car and home windows. 3M is a reliable brand and many auto shops offer this service. Consider purchasing blue light blocking films for your electronics as more and more studies are showing detrimental effects of blue light on skin.

Avoid exposure and activities outside during the sun’s peak hours: 10am to 5pm in the summertime and 11am to 2pm in the wintertime. Stop any and all tanning bed use. Tanned skin may look good, but it is a sure sign of damage (often permanent) to your skin.

Practice Self-Care.

When you take care of your physical and mental self, you are taking care of your skin and helping to prevent Rosacea flares. Here are some small changes you can make in your life to produce big effects on your skin down the road.

Try to reduce stress in your life. This means something different to everyone. Take time out of your day just for you, spend time with friends, go for a short walk, or consider meditation. If you are unable to deal with your stress on your own, consider speaking with a close friend, find a support group or consult a health care professional.

Monitor your diet. Make better choices. Avoid processed foods. Cook at home as much as possible but especially avoid chain restaurants as the ingredients are more likely to be heavily processed. Visit local farmer’s markets where everything is fresh and good for you.

Sleep reduces stress. Go to bed and wake up at the same time every day. Dim or remove any lights that are on in your bedroom while sleeping, including lights from chargers, night lights, phones, television or clocks. Try black out curtains and eye shades. Limit noise in your bedroom. Put your phone on silent. Try a white noise machine, a fan, or ear plugs to block out noise you can’t control.

Limit daytime naps and avoid stimulants like nicotine and caffeine within 8 hours of your bedtime. Avoid eating and limit alcohol two hours before bedtime to avoid symptoms of reflux.

Consult a Dermatologist.

Consider seeing a board-certified dermatologist who can diagnose PIH which is sometimes confused with contact dermatitis. Once confirmed as PIH, you can discuss available treatment options including:

Topical medications such as 15 to 20% Azelaic Acid, Cysteamine, Kojic Acid, and Hydroquinone can all improve the appearance of PIH. Hydroquinone has rare, but serious side effects including skin lightening, so please discuss these with a provider before using.

For milder cases, a dermatologist may recommend anti-inflammatory, antioxidant-fueled Vitamin C skincare products with brightening benefits.

Stronger prescription-strength chemical peels can be very helpful for treatment of hyperpigmentation and microdermabrasion may be recommended for milder cases. Laser treatments or laser therapy such as laser resurfacing or intense pulsed light (IPL) can also be helpful, though they usually require several visits before significant improvement is noticeable. These treatments are popular in the United States and are becoming more mainstream in some global countries.

More severe cases may require a prescription such as Tretinoin or adding an over-the-counter supplement such as vitamin-packed glucosamine, niacinamide, arbutin for overall dermis or skin health.

Choose gentle and effective skincare personalized for your skin needs and issues.

Gentle skincare is key to good PIH treatment. Some basic tips to follow:

• Use only lukewarm water on your face as both hot and cold water can cause flareups.
• Use soap free cleansers that are pH balanced such as a personalized Proven cleanser.
• Apply all topical treatments including cleansers, products and cosmetics, gently with fingertips. Never rub, pull, or scrub. Gently pat face dry with a soft cloth. Avoid waterproof cosmetics and heavy foundations that are difficult to remove without scrubbing.
• Bacteria on the skin can irritate PIH, so use only antibacterial makeup brushes, cleaning them between uses.
• Avoid peels or dermabrasion as these will exacerbate PIH.
• Always test products on an area of your body other than your face first.
• Keep skin hydrated. This will trap water in your skin, reduce irritation, and make your skin feel more comfortable. Choose creams over lotions or gels.
• Avoid personal care products that contain these irritating active ingredients: alcohol, camphor, peppermint, fragrance, urea, sodium laurel sulfate, menthol, lactic acid, and glycolic acid. Also avoid toners, astringents, and abrasive exfoliators.
• Fewer products are better than many when it comes to skincare regimen as many products can irritate areas affected by PIH. Try these:

A gentle daily cleanser to wash away dirt and oil, allowing pores to breathe, lessening redness and irritation. And, with our newest fashion accessory, facial masks, more sweat and dirt will get caught in pores.

Moisturizer. Skin is losing moisture from interior, dry air, facial masks or change in diets. Apply moisturizer after cleansing. If your skin tends to be oilier, a little less moisturizer might be helpful at this time to avoid an increase in clogged pores or acne flare ups. Use a day moisturizer with a Broad-Spectrum SPF and a bedtime moisturizer specifically formulated for nighttime use.

PROVEN SKINCARE formulates products based on a person’s individual needs based on living environment, lifestyle, diet, stress levels, frequency of travel, as well as skin sensitivities and conditions, that will be most effective on skin affected by Post-Inflammatory Hyperpigmentation. Go to provenskincare.com to take the complimentary skin quiz to discover your personalized skincare formulations.