Postinflammatory hyperpigmentation

Last updated
Postinflammatory hyperpigmentation
Specialty Dermatology

Postinflammatory hyperpigmentation (PIH) is a skin condition characterized by the darkening of the skin (hyperpigmentation) following an inflammatory injury, such as acne, dermatitis, infectious disease, or trauma. Less frequently, it may occur as a complication of a medical procedure performed on the skin. It is a common cause of skin discoloration and can affect individuals of all skin types. [1]

Contents

Symptoms and signs

PIH manifests as areas of increased pigmentation or darkened skin. The color can range from light brown to deep brown or grey to black. Individuals with darker skin typically develop lesions that are darker and last longer compared to people with lighter skin color. Without any treatment, PIH usually fades in the 6-12 months following its appearance, until it is no longer visible. [2]

Causes

Postinflammatory hyperpigmentation develops after the original symptoms of an inflammatory skin condition disappear. Common triggers include acne lesions, cuts, burns, or skin conditions like eczema. [1] Additionally, UV sun exposure and sunburn are involved in the development, darkening, and expansion of hyperpigmented skin lesions. [2] Some medical procedures performed on the skin can cause an inflammatory reaction, which may lead to hyperpigmentation, even if the inflammation itself is temporary. [3]

The exact pathogenesis of PIH is poorly understood. [3] It is known to be driven by cytokine-mediated paracrine interactions between keratinocytes and melanocytes, eventually stimulating the melanocytes to dramatically increase production of melanin, which then deposits in the skin. [4]

Diagnosis

A diagnosis of postinflammatory hyperpigmentation is established based upon its clinical presentation coupled with a recent history of inflammation over the same area. Diagnostic tests are not required, but can rule out some other conditions, such as Addison's disease or systemic lupus erythematosus. Wood’s lamp evaluation can be used in the diagnosis as well. [1]

Treatment

Treatment for postinflammatory hyperpigmentation may include topical agents like hydroquinone, retinoids, ascorbic acid, and azelaic acid, as well as chemical peels or laser therapy to promote skin renewal and reduce pigmentation. Sun protection is also crucial to prevent further darkening of the affected skin. In severe or recurrent cases, combination therapy of hydroquinone plus one or more additional topical agents is common. [2] [3]

Topical medications and other non-procedural treatments are preferred over chemical peels, laser therapy, dermabrasion, and other "destructive therapies". This is because the topical treatments are often very effective in managing PIH and typically cost less, while also having lower potential for side effects or worsening of the condition. Some patients (especially those with darker skin) have been known to experience worsening of their PIH with destructive therapy, rather than improvement. The reason for this is often not known. [3]

See also

Related Research Articles

<span class="mw-page-title-main">Vitiligo</span> Skin condition where patches lose pigment

Vitiligo is a chronic autoimmune disorder that causes patches of skin to lose pigment or color. The cause of vitiligo is unknown, but it may be related to immune system changes, genetic factors, stress, or sun exposure. Treatment options include topical medications, light therapy, surgery and cosmetics. The condition can show up on any skin type as a light peachy color and can appear on any place on the body in all sizes. The spots on the skin known as vitiligo are also able to “change” as spots lose and regain pigment; they will stay in relatively the same areas but can move over time and some big patches can move through the years but never disappear overnight.

<span class="mw-page-title-main">Acne</span> Skin condition characterized by pimples

Acne also known as acne vulgaris, is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily affects skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to lack of confidence, anxiety, reduced self-esteem, and, in extreme cases, depression or thoughts of suicide.

<span class="mw-page-title-main">Rosacea</span> Skin condition, usually on the face

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

<span class="mw-page-title-main">Hyperpigmentation</span> Darkening of an area of skin or nails due to increased melanin

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

<span class="mw-page-title-main">Periorbital dark circles</span> Dark blemishes around the eyes

Periorbital dark circles are dark blemishes around the eyes. There are many causes of this symptom, including heredity and bruising.

<span class="mw-page-title-main">Melasma</span> Medical condition

Melasma is a tan or dark skin discoloration. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. Although it can affect anyone, it is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy medications.

<span class="mw-page-title-main">Pseudofolliculitis barbae</span> Medical condition

Pseudofolliculitis barbae (PFB) is a type of irritant folliculitis that commonly affects people who have curly or coarse facial hair. It occurs when hair curls back into the skin after shaving, causing inflammation, redness, and bumps. This can lead to ingrown hairs, scarring, and skin discoloration. PFB can be treated with various methods, including changing shaving habits, using topical creams or ointments, and undergoing laser hair removal. Prevention measures include proper shaving techniques, using sharp razors, and avoiding too close a shave.

<span class="mw-page-title-main">Comedo</span> Medical condition

A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.

<span class="mw-page-title-main">Ochronosis</span> Medical condition

Ochronosis is a syndrome caused by the accumulation of homogentisic acid in connective tissues. The condition was named after the yellowish (ocher-like) discoloration of the tissue seen on microscopic examination. Macroscopically, though, the affected tissues appear bluish-grey because of a light-scattering phenomenon known as the Tyndall effect. The condition is most often associated with alkaptonuria, but can occur from exogenous administration of phenol complexes such as hydroquinone. It was first described by Rudolf Virchow in 1865.

<span class="mw-page-title-main">Azelaic acid</span> Organic chemical compound

Azelaic acid (AzA) is an organic compound with the formula HOOC(CH2)7COOH. This saturated dicarboxylic acid exists as a white powder. It is found in wheat, rye, and barley. It is a precursor to diverse industrial products including polymers and plasticizers, as well as being a component of a number of hair and skin conditioners. AzA inhibits tyrosinase.

<span class="mw-page-title-main">Lentigo</span> Small pigment spots on skin

A lentigo is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. It is a harmless (benign) hyperplasia of melanocytes which is linear in its spread. This means the hyperplasia of melanocytes is restricted to the cell layer directly above the basement membrane of the epidermis where melanocytes normally reside. This is in contrast to the "nests" of multi-layer melanocytes found in moles. Because of this characteristic feature, the adjective "lentiginous" is used to describe other skin lesions that similarly proliferate linearly within the basal cell layer.

<span class="mw-page-title-main">Arbutin</span> Glycoside

beta-Arbutin, also known as β-arbutin or by its International Nomenclature of Cosmetic Ingredients (INCI) name, arbutin, is a glycosylated derivative of hydroquinone. β-Arbutin is naturally present in the leaves and bark of a variety of plants, notably the bearberry plant, Arctostaphylos uva-ursi. Utilized as a biosynthetic active ingredient in topical treatments for skin lightening, β-arbutin is aimed at addressing hyperpigmentation issues. Its mechanism of action involves inhibiting the activity of tyrosinase, an essential enzyme for melanin synthesis in the human skin, thereby leading to a reduction in hyperpigmentation. It is important to distinguish β-arbutin from its structurally similar stereoisomer, α-arbutin, which exhibits similar effects in clinical applications.

Pigmentation disorders are disturbances of human skin color. There may be a loss or reduction, which may be related to loss of melanocytes or the inability of melanocytes to produce melanin or transport melanosomes correctly.

Drug induced pigmentation may take on many different appearances, one of the most common being a change in the color, or pigmentation, of the skin.

<span class="mw-page-title-main">Photoaging</span> Ultraviolet light-induced biological development over time

Photoaging or photoageing is a term used for the characteristic changes to skin induced by chronic UVA and UVB exposure. Tretinoin is the best studied retinoid in the treatment of photoaging.

Postinflammatory hypopigmentation is a cutaneous condition characterized by decreased pigment in the skin following inflammation of the skin.

Oral pigmentation is asymptomatic and does not usually cause any alteration to the texture or thickness of the affected area. The colour can be uniform or speckled and can appear solitary or as multiple lesions. Depending on the site, depth, and quantity of pigment, the appearance can vary considerably.

Infantile acne is a form of acne that begins in very young children. Typical symptoms include inflammatory and noninflammatory lesions, papules and pustules most commonly present on the face. No cause of infantile acne has been established but it may be caused by increased sebaceous gland secretions due to elevated androgens, genetics and the fetal adrenal gland causing increased sebum production. Infantile acne can resolve by itself by age 1 or 2. However, treatment options include topical benzyl peroxide, topical retinoids and topical antibiotics in most cases.

<span class="mw-page-title-main">Glyceryl octyl ascorbic acid</span> Chemical compound

Glyceryl octyl ascorbic acid (GO-VC) is an amphipathic derivative of vitamin C consisting of two ether linkages: a 1-octyl at position 2 and a glycerin at position 3. The chemical name is 2-glyceryl-3-octyl ascorbic acid. The isomer in which these two groups are swapped is also known.

Cetyl tranexamate mesylate is a bioavailable derivative of tranexamic acid for use in cosmetic formulations. Its primary use is in skincare products aimed at enhancing appearance by targeting hyperpigmentation, uneven skin tone, inflammation, dark spots, UV induced erythema, acne scars, and overall skin clarity.

References

  1. 1 2 3 Lawrence, Elizabeth; Al Aboud, Khalid M. (2024). "Postinflammatory Hyperpigmentation". StatPearls. StatPearls Publishing.
  2. 1 2 3 Collier, Sigrid M.; Krejci-Manwaring, Jennifer; Usatine, Richard P. (2019). "Chapter 207: Postinflammatory Hyperpigmentation". The Color Atlas and Synopsis of Family Medicine (3rd ed.). New York: McGraw Hill.
  3. 1 2 3 4 Chaowattanapanit, Suteeraporn; Silpa-archa, Narumol; Kohli, Indermeet; Lim, Henry W.; Hamzavi, Iltefat (Oct 2017). "Postinflammatory hyperpigmentation: A comprehensive overview". Journal of the American Academy of Dermatology. 77 (4): 607–621. doi:10.1016/j.jaad.2017.01.036. ISSN   0190-9622.
  4. Concha, J.S.S.; Afarideh, M.; Werth, V.P. (27 Dec 2021). "Postinflammatory hyperpigmentation and erythema: new insights into the pathogenesis". British Journal of Dermatology. 186 (3): 390–391. doi:10.1111/bjd.20938. ISSN   0007-0963.