Hyperpigmentation (PIH)

What is postinflammatory hyperpigmentation (PIH)?

Postinflammatory hyperpigmentation – or PIH – is a challenging condition to treat. It most commonly occurs in patients with skin that is rich in pigment. Following an injury to the skin (acne, surgery, a burn), the skin heals with more pigment at the site of injury. 

The sun makes PIH worse, and so sun avoidance and use of skin care is essential. PIH improves by itself very slowly over time, and so watchful waiting is a definite possibility. 

The initial injury and the site on the body where PIH occurs changes the timeline of improvement. Involvement on the face tends to improve faster than when hyperpigmentation occurs on the arms or legs, for instance. 

What treatments are available for this condition?

Strict sun protection is key. Beyond time and skin care, combining prescription retinoids, prescription brightening agents (hydroquinone) and a gentle form for picosecond laser (“picotoning”) . Sometimes watchful waiting may be the best option, since treatments carry their own small risks of causing further darkening.