WHAT IS PIH?

Post-inflammatory hyperpigmentation (PIH) is a common skin condition that appears as darkened patches or spots on the skin. It occurs after inflammation or injury to the skin, such as acne, eczema, insect bites, or cuts. PIH is particularly prevalent in individuals with darker skin tones due to heightened melanocyte (cells that produce pigment) activity in response to trauma or inflammation.PIH can occur in the top layer of the skin (epidermal), in the deeper layer (dermal), or both.

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UNIQUE CONSIDERATIONS FOR SKIN OF COLOUR

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People with skin of colour are more likely to have pronounced and persistent dark spots. PIH in skin of colour often requires longer treatment durations and may be more challenging to resolve compared to lighter skin tones. There is also a risk of post-inflammatory hypopigmentation with certain treatments, highlighting a need for cautious management. Cultural factors and psychological impact are significant, influencing treatment adherence and outcomes. Tailored approaches that account for ethnic diversity and skin sensitivity are crucial for effectively managing PIH in individuals with skin of colour.

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CAUSES AND TRIGGERS

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PIH can occur as a result of:

• Acne: Inflammatory acne lesions can leave behind dark spots or patches once healed.

• Trauma: Skin burns, insect bites, friction, even repeated rubbing or licking the skin can lead to PIH.

• Eczema, skin allergies, infections: These conditions, characterised by itching and scratching, may cause PIH.

• Other skin diseases: Any skin condition like lichen planus, pseudofolliculitis barbae, psoriasis may also lead to PIH.

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EFFECTS ON EMOTIONAL WELL-BEING

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PIH can be disfiguring, persisting for months or even years after the initial injury or inflammation. It often causes significant distress, sometimes more than the skin disease
itself. While PIH does not pose health risks, it can significantly affect emotional well-being and self-esteem.

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DIAGNOSIS

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Diagnosing PIH typically involves a visual examination by a dermatologist. The dermatologist will review your medical history and assess the appearance of the pigmented patches to confirm the diagnosis.

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TREATMENT

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Management of PIH depends on how deep in the skin the pigment is present. It requires a combination of active treatments, sun protection, and lifestyle adjustments:

• Topical Treatments: Depigmenting agents such as hydroquinone, kojic acid, azelaic acid, and retinoids are commonly used to lighten PIH. These treatments work by reducing melanin production and promoting skin cell turnover.

• Sun Protection: Daily use of broad-spectrum sunscreen (SPF 30+ with UV and visible light protection) is essential to prevent further darkening of PIH.

• Procedures: If the pigmentation is in the deeper layers of the skin, dermatological procedures such as chemical peels or laser treatments may be recommended.

These procedures should be performed by experienced dermatologists familiar with treating skin of colour to minimise the risk of complications.

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RESPONSE TO TREATMENT

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PIH can be in the top layer of the skin (epidermal), or in the Dr Rajani Nalluri deeper layer of the skin (dermal), or mixed. This can be assessed on clinical exam or with the use of Wood’s lamp examination or biopsy (removal of skin tissue for examination). The depth of the pigment affects how easily it can be treated, with epidermal PIH being more responsive to topical treatments compared to dermal or mixed PIH.

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SELF-CARE TIPS

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In addition to medical treatments, self-care practices are essential for managing PIH and promoting skin health:

• Consistency: Adhere to your treatment plan consistently to achieve optimal results over time.

• Sun protection: Minimise sun exposure and protect your skin with clothing and hats when outdoors. Repeat sunscreen application at least 3 times a day.

• Gentle Skin Care: Use mild cleansers and products, avoiding harsh scrubs or exfoliants that can irritate the skin and exacerbate PIH.

• Patience: PIH may take months or even years to resolve completely. Be patient and continue with recommended therapies under the guidance of your

• dermatologist. 

• Emotional Support: Seek support from healthcare providers or support groups to address any emotional impact associated with PIH.

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CONCLUSION

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Post-inflammatory Hyperpigmentation (PIH) is a common skin concern among individuals with skin of colour, characterised by darkened patches following skin
inflammation or injury. By understanding its causes, triggers, and effective treatment options, you can take proactive steps to manage PIH and achieve clearer, more even-toned skin.