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Postinflammatory Hyperpigmentation
Aka: Postinflammatory Hyperpigmentation
- See Also
- Dermatologic Conditions in Skin of Color
- Hyperpigmentation
- Pigmentation Disorder
- Definition
- Hyperpigmentation response to inflammation on dark skin
- 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 Melanin
- Causes: Common precipitating lesions
- Inflammation
- Acne Vulgaris
- Psoriasis
- Atopic Dermatitis
- Contact Dermatitis
- Lichen Planus
- Trauma
- Laser therapy or Light Therapy
- Cryotherapy
- Skin Trauma
- Signs
- Irregular, dark Macules and patches at sites of injury or inflammation
- Management
- General
- Most important management concept is to treat the underlying inflammatory condition
- Sunscreen with SPF 30 is required to prevent darkening of Postinflammatory Hyperpigmentation
- 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
- Single agents
- Hydroquinone 4% is preferred first line agent
- Combination agents
- Most effective protocol is to use these agents in combination
- Compounded products (bleaching agent, Keratolytic, Corticosteroid)
- Kligman's Formula (Hydroquinone 2%,Tretinoin 0.025%, Mometasone 0.1%)
- Tri-luma (Hydroquinone 2%, Tretinoin 0.05%, Flucinolone 0.01%)
- Individual agents used together
- Hydroquinone 2% with Glycolic Acid 10% applied twice daily
- Tretinoin (Retin A) applied at bedtime
- Bleaching agents (risk of blotchy Hyperpigmentation)
- Hydroquinone (Eldoquin Forte) 2-4% applied twice daily
- 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
- Course
- Changes can persist for years
- References
- Burns (1997) Dermatol Surg 23(3): 171-5 [PubMed]
- Davis (2010) J Clin Aesthet Dermatol 3(7): 20-31 [PubMed]
- Plensdorf (2017) Am Fam Physician 96(12): 797-804 [PubMed]