Dermatology Book


Postinflammatory Hyperpigmentation

Aka: Postinflammatory Hyperpigmentation
  1. See Also
    1. Dermatologic Conditions in Skin of Color
    2. Hyperpigmentation
    3. Pigmentation Disorder
  2. Definition
    1. Hyperpigmentation response to inflammation on dark skin
  3. Pathophysiology
    1. Common complication following Trauma or inflammation in darker skin type (3 to 6)
    2. Local inflammation results in Prostaglandin, Leukotriene and Thromboxane release
    3. Epidermal Melanocytes hypertrophy, synthesizing Melanin
  4. Causes: Common precipitating lesions
    1. Inflammation
      1. Acne Vulgaris
      2. Psoriasis
      3. Atopic Dermatitis
      4. Contact Dermatitis
      5. Lichen Planus
    2. Trauma
      1. Laser therapy or Light Therapy
      2. Cryotherapy
      3. Skin Trauma
  5. Signs
    1. Irregular, dark Macules and patches at sites of injury or inflammation
  6. Management
    1. General
      1. Most important management concept is to treat the underlying inflammatory condition
      2. Sunscreen with SPF 30 is required to prevent darkening of Postinflammatory Hyperpigmentation
      3. Topical specific protocols below are not necessary
        1. Epidermal Postinflammatory Hyperpigmentation fades in 6-12 months without treatment
        2. Deeper Postinflammatory Hyperpigmentation may take years to fade
      4. Topical specific treatments have potential risks
        1. Hydroquinone is carcinogenic in rats (when ingested)
        2. Hydroquinone causes exogenous ochronosis (progressive skin darkening where applied)
        3. Bleaching agents may result in Hypopigmentation
        4. Peels and Keratolytics may worsen Postinflammatory Hyperpigmentation
    2. Single agents
      1. Hydroquinone 4% is preferred first line agent
    3. Combination agents
      1. Most effective protocol is to use these agents in combination
      2. Compounded products (bleaching agent, Keratolytic, Corticosteroid)
        1. Kligman's Formula (Hydroquinone 2%,Tretinoin 0.025%, Mometasone 0.1%)
        2. Tri-luma (Hydroquinone 2%, Tretinoin 0.05%, Flucinolone 0.01%)
      3. Individual agents used together
        1. Hydroquinone 2% with Glycolic Acid 10% applied twice daily
        2. Tretinoin (Retin A) applied at bedtime
    4. Bleaching agents (risk of blotchy Hyperpigmentation)
      1. Hydroquinone (Eldoquin Forte) 2-4% applied twice daily
    5. Chemical Peels
      1. Salicylic acid
      2. Glycolic Acid peel
    6. Keratolytics
      1. Azelaic Acid (Azelex) 20% cream applied twice daily
      2. Tretinoin (Retin-A) 0.025-0.050% applied at bedtime
      3. Tazarotene (Tazorac) 0.1% cream applied at bedtime
  7. Course
    1. Changes can persist for years
  8. References
    1. Burns (1997) Dermatol Surg 23(3): 171-5 [PubMed]
    2. Davis (2010) J Clin Aesthet Dermatol 3(7): 20-31 [PubMed]
    3. Plensdorf (2017) Am Fam Physician 96(12): 797-804 [PubMed]

Postinflammatory hyperpigmentation (C0333616)

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, エンショウゴ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
Derived from the NIH UMLS (Unified Medical Language System)

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