II. Definitions
- Postinflammatory Hyperpigmentation
- Hyperpigmentation response to inflammation on dark skin
III. Pathophysiology
- Common complication following Trauma or inflammation in darker skin type (3 to 6)
- Local inflammation results in Prostaglandin, Leukotriene and Thromboxane release
- Epidermal Melanocytes hypertrophy, synthesizing increased Melanin (reactive hypermelanosis)
IV. Causes: Common precipitating lesions
- Inflammation
- Acne Vulgaris (more than half of cases)
- Psoriasis
- Atopic Dermatitis
- Contact Dermatitis
- Lichen Planus
-
Trauma
- Laser therapy or Light Therapy
- Cryotherapy
- Chemical Peels
- Skin Trauma
- Insect Bites
V. Signs
- Irregular, dark Macules and patches at sites of injury or inflammation
VI. Management
-
General
- Most important management concept is to treat the underlying inflammatory condition
- Sunscreen with SPF 30 prevents darkening of Postinflammatory Hyperpigmentation
- See prevention below
- Topical specific protocols below are not necessary
- Epidermal Postinflammatory Hyperpigmentation fades in 6-12 months without treatment
- Deeper Postinflammatory Hyperpigmentation may take years to fade
- Topical specific treatments have potential risks
- Hydroquinone is carcinogenic in rats (when ingested)
- Hydroquinone causes exogenous ochronosis (progressive skin darkening where applied)
- Bleaching agents may result in Hypopigmentation
- Peels and Keratolytics may worsen Postinflammatory Hyperpigmentation
- Medications
- Bleaching agents (risk of blotchy Hyperpigmentation)
- Hydroquinone (Eldoquin Forte) 4% applied once to twice daily for 3 months
- Chemical Peels
- Salicylic acid
- Glycolic Acid peel
- Keratolytics
- Azelaic Acid (Azelex) 20% cream applied twice daily
- Tretinoin (Retin-A) 0.025-0.050% applied at bedtime
- Tazarotene (Tazorac) 0.1% cream applied at bedtime
- Bleaching agents (risk of blotchy Hyperpigmentation)
- Medication Adverse Effects
- Desquamation
- Burning or stinging
- Dry Skin
- Pruritus
- Protocol: Single agent for 3 months
- Hydroquinone 4% is preferred first line agent
- Protocol: Combination agents for 3 months
- Most effective protocol is to use these agents in combination
- Compounded products (bleaching agent, Keratolytic, Corticosteroid)
- Individual agents used together
- Hydroquinone 2% with Glycolic Acid 10% applied twice daily
- Tretinoin (Retin A) applied at bedtime
- Protocol: Other Management
- Laser Therapy
- May be used with caution, starting with small treatment areas
- Risk of dyspigmentation and scarring
- Laser Therapy
VII. Prevention
VIII. Course
- Hyperpigmentation changes can persist for years
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Pathologic Function (T046) |
| ICD10 | L81.0 |
| SnomedCT | 201282009, 55519009, 238699007 |
| Dutch | postinflammatoire hyperpigmentatie, hyperpigmentatie; postinflammatoir, postinflammatoir; hyperpigmentatie, Postinflammatoire hyperpigmentatie |
| French | Hyperpigmentation post-inflammatoire |
| German | Hyperpigmentation nach Entzuendung, Postinflammatorische Hyperpigmentierung |
| Italian | Iperpigmentazione post-infiammatoria |
| Portuguese | Hiperpigmentação pós-inflamatória |
| Spanish | Hiperpigmentación postinflamatoria, hipermelanosis posinflamatoria, hiperpigmentación posinflamatoria (anomalía morfológica), hiperpigmentación posinflamatoria (trastorno), hiperpigmentación posinflamatoria |
| Japanese | 炎症後色素沈着亢進, ｴﾝｼｮｳｺﾞｼｷｿﾁﾝﾁｬｸｺｳｼﾝ |
| English | Post-inflamm hypermelanosis, Post-inflamm hyperpigmentation, postinflammatory hyperpigmentation (diagnosis), Post inflammatory hyperpigmentation, Post-inflammatory hypermelanosis, Post-inflammatory hyperpigmentation, Post-inflammatory hyperpigmentation (disorder), Postinflammatory hyperpigmentation (morphologic abnormality), hyperpigmentation; postinflammatory, postinflammatory; hyperpigmentation, Postinflammatory hyperpigmentation |
| Czech | Pozánětlivá hyperpigmentace |
| Korean | 염증후 과다색소침착 |
| Hungarian | Gyulladás utáni hyperpigmentatio |
