What is Post Inflammatory Hyperpigmentation?

Medically Reviewed by Stephanie S. Gardner, MD on February 21, 2024
3 min read

Post-inflammatory hyperpigmentation (PIH) happens when your skin makes extra melanin after it has been irritated or injured. Melanin is a natural pigment that is responsible for the color in our hair, skin, and eyes.

PIH can affect either your epidermis, which is your skin’s surface level, or your dermis — a deep layer of your skin.

When your skin cells react to damage or irritation by making extra melanin, post-inflammatory hyperpigmentation is the result. This skin condition shows up as tan, brown, dark brown, or even blue-gray patches and spots on your skin.

The most common causes are acne, eczema, and impetigo, but any type of trauma or irritation to the skin has the potential to cause PIH. Other commonly reported post-inflammatory hyperpigmentation causes include:‌

Some medical or cosmetic procedures can also cause PIH. Laser or light therapies, radiation therapy, cryotherapy, and chemical peels have been linked to post-inflammatory hyperpigmentation. 

Post-inflammatory hyperpigmentation can happen to both men and women. It affects people of all ages but is more common in people with darker skin.

Identifying the source of inflammation and treating it may help your PIH heal more quickly and be less severe. Areas of hyperpigmentation might also fade on their own without treatment.

To help speed up the process, there are several different types of topical medication that can reduce PIH skin spots: 

  • Skin lighteners such as hydroquinone and azelaic acid to help reduce melanin production
  • Retinoids and steroids to increase skin cell turnover
  • Chemical peels like salicylic or glycolic acid to remove skin cells with extra melanin 

Deeper dermoid PIH is more difficult to remove and can be treated with stronger chemical peels or certain types of laser therapy. Some methods of treating PIH have the potential to cause irritation and even make the problem worse, so it’s important to be mindful of your skin’s condition.

There is no quick fix for PIH. Even with treatment, it can take a long time for your skin to return to normal. Epidermal PIH can last for 6 to 12 months or more. Dermal PIH can take years to fade, and spots may be permanent. There is also a chance new spots can show up, or that your PIH will come back again after fading.

Treatment for post-inflammatory hyperpigmentation often involves more than one method. Your doctor might suggest a combination therapy that includes a topical steroid, a retinoid, and hydroquinone. 

Living with PIH doesn’t cause any serious physical health problems on its own, but it can affect your mental health. If your skin is causing you stress or hurting your self-esteem, covering your hyperpigmentation from acne with makeup can help you feel more confident. There are many excellent makeup brands on the market to suit your skin type and tone. Some tips for picking products to effectively cover up post-acne marks and other types of PIH are:

  • Choose makeup that looks natural and matches your skin tone.
  • Know if your skin is dry, normal, or oily, and choose products for your skin type.
  • Find a product that does not feel greasy and is non-comedogenic — meaning it won’t clog your pores. 
  • Look for makeup that is waterproof or advertises long-lasting coverage. 
  • Pick a product that is easy to apply every day. 
  • Use color correctors under foundation or concealer for better coverage.

The sun’s UV rays can have a big impact on PIH. Proper UV protection is important to prevent PIH skin spots from darkening and new ones from forming. Avoid the sun when possible, wear protective clothing, and use a broad-spectrum sunscreen with a minimum SPF of 30 and 8% zinc oxide every day, reapplying every 80 minutes. If you’re concerned about vitamin D levels from lack of sun, foods like salmon and supplements can help you get the amount that you need without damaging your skin.