Post inflammatory hyperpigmentation is one of the most common skin discolorations that affect people of color. It can be difficult to resolve because many ingredients and methods used to treat the excess pigmentation can actually make the condition worse.
Even skin care products can cause irritation that can lead to increased melanin production (the cause of the dark spots and patches). There can be darkening of the skin after a skin condition, such as acne, has healed and the healed acne lesions can leave dark marks that sometimes look worse than the acne itself.
There are a number of causes of hyperpigmentation. Treatment begins with determining the source of the inflammatory condition, the depth and location of the excess pigmentation and resolving or at least managing it through various therapies.
A dermatologist might use chemical and natural skin lightening agents and topical tyrosinase inhibitors in topical gels and creams. Tyrosine is a nonessential amino acid made by the body that helps in the production of melanin. Tyrosinase is an enzyme that converts tyrosine by oxidation into melanin.
Common Treatments and Therapies for PIH
Skin lighteners and tyrosinase inhibitors
- Arbutin (bearberry extract)
- Licorice extract
- Mulberry extract
- Burner/burdock root extract
Early treatment is important, in addition to using sunscreen to avoid creating HP or making existing dark discolorations worse.
The effectiveness of the course of treatment also depends on the location of the excess pigment, i.e. whether the discoloration is on the surface or has penetrated to deeper layers of the skin. This is the reason why some products fade dark spots and even out skin tone in some individuals and for others it provides very little or no change.
Epidermal hyperpigmentation is located in the surface layer of the skin and is easier to treat. Epidermal HP is often due to tanning and melasma. Over the counter (OTC) skin lightening creams and lotions with kojic acid and hydroquinone and other topical therapy might be effective for PIH. Epidermal HP is tan, brown or dark brownish in color and may take several months to years to fade without treatment.
Dermal hyperpigmentation is located deeper within the dermis. OTC creams and lotions are not likely to work. Treatment involves more invasive lightening treatments or the change might be internal (as in discontinuing birth control bills, or after pregnancy as in the case of melasma). Dermal hyperpigmentation can be in the form of birthmarks, age spots, tanning from prolonged sun exposure and melasma. Treatments like chemical peeling or laser therapy might be needed, but these therapies and treatments need to be used with caution on skin of color to prevent irritation and the worsening of PIH. Dermal HP has a blue-gray appearance and can be permanent or fade over a longer period of time if left untreated.
A Note About Hydroquinone
Hydroquinone is a skin-lightening ingredient used in several products to treat skin discolorations because it inhibits the growth of melanin and tyrosinase—two things responsible for skin pigmentation. It’s often used in conjunction with AHA, tretinoin or other ingredients to increase the penetration and effectiveness. Many dermatologists and skin care professionals that work closely with clients with skin of color now avoid using this ingredient. Hydroquinone is banned in Europe, Japan and South Africa. It is believed to contribute to dermal toxicity and damage to melanocytes, collagen and internal organs, particularly to the liver, as well as being carcinogenic. It shouldn’t be used every day for prolonged periods of time because it can actually turn the skin darker.
To avoid treatments that aggravate pigmentation in darker skin, it’s is important that you see someone who has experience in treating ethnic skin for skin care problems like hyperpigmentation.