Post-inflammatory hyperpigmentation

What causes PIH?

PIH develops through excessive production and accumulation of melanin (the pigment responsible for the colour of the skin) in response to:

• Skin inflammation: for example after acne, eczema or psoriasis.
• Cosmetic treatments: such as laser therapy, microdermabrasion, microneedling or chemical peels.
• Skin damage: for example from surgery, burns or insect bites.
• Hormonal factors: PIH can be made worse by hormonal fluctuations, such as during pregnancy or through the use of contraception.

The risk of PIH is higher in people with darker skin (Fitzpatrick skin types IV-VI), because their melanocytes are more sensitive to stimulation.

What does PIH look like?

PIH appears as flat, discoloured patches ranging from light brown to black or even greyish, depending on the depth of the pigment in the skin layers:

• Epidermal PIH: light to dark brown discolouration that lies superficially in the upper skin layers.
• Dermal PIH: greyish or bluish discolouration that lies deeper in the skin, which makes it more difficult to treat.

PIH often develops in places where the skin has been irritated or damaged and can spread over a large or small area.

Preventing PIH

Preventing PIH is important, especially after cosmetic or medical treatments. Measures to minimise PIH are:

• Sun protection: using a sunscreen with a high SPF (at least 30) is essential. Sunlight can worsen or prolong PIH.
• Appropriate aftercare: follow the recommended aftercare instructions of the doctor or specialist after a treatment. Avoid harsh products or manipulating the skin.
• Avoiding irritation: use gentle skincare products and avoid chemical or mechanical exfoliation until the skin has fully recovered.
• Use of antioxidants: serums with vitamin C or niacinamide can help protect the skin and reduce inflammation.

Treatments for PIH

Although PIH often disappears on its own, this can take months or even years. There are several options to speed up the healing process:

1. Topical treatments

• Hydroquinone: a powerful pigment-lightening ingredient that inhibits the production of melanin.
• Retinoids: such as tretinoin, which promote cell renewal and fade pigment spots.
• Vitamin C: an antioxidant that helps even out skin tone and reduce pigmentation.
• Azelaic acid: a mild ingredient that reduces inflammation and regulates melanin production.

2. Chemical peels

• Mild peels with glycolic acid, lactic acid or salicylic acid can help remove the upper skin layers and reveal new skin.

3. Laser therapy

• Fractional lasers: such as Fraxel, can treat PIH effectively by renewing the skin in a controlled way.
• Q-switched Nd:YAG laser: suitable for darker skin types, because it selectively targets the pigment without damaging the surrounding skin.

4. Microneedling with serums

Microneedling combined with skin-lightening serums can reduce PIH by improving the absorption of active ingredients.

5. Soothing treatments

Products with niacinamide or aloe vera can help reduce inflammation and restore the skin barrier.

Recovery time and prognosis

The time needed for PIH to fade varies depending on the severity and depth of the pigmentation:

• Epidermal PIH can improve within a few weeks to months with treatment.
• Dermal PIH can persist for months to years and is more difficult to treat.

Patience and consistency in skincare are essential when tackling PIH. It is important to understand that even the best treatments need time to show results.

Please note: Kliniek het Bolwerk does not perform these treatments

At Kliniek het Bolwerk we do not treat post-inflammatory hyperpigmentation (PIH) and we do not perform skin therapy treatments, such as chemical peels, laser therapy or microneedling aimed at reducing pigmentation. We do, however, think it is important that you are well informed about skin conditions and possible treatment options. That is why we share this information in our knowledge base.

If you suffer from PIH, we advise you to contact a specialised skin therapist or dermatologist. They can assess your skin, determine the cause of the pigmentation and draw up a tailored treatment plan that suits your skin type and situation.

When should you see a doctor?

If PIH does not improve after six months of treatment or if the pigmentation gets worse, it is wise to consult a dermatologist or skin specialist. They can recommend more advanced treatments or rule out underlying conditions.

Although PIH is often seen as a cosmetic problem, it can affect self-confidence. With the right care and treatment it is possible to even out the skin again and restore a healthy appearance.

Want to know what we do in this area? Read about Removal of skin imperfections or having a mole removed.