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Number 3 Pigment & Lesion Disorders

A. Acquired Pigment Disorders

Number 1 Skin Cancer & Pre-Cancer Care
Number 1 Medical Dermatology
(Chronic & Inflammatory Skin Diseases)
Number 3 Pigment & Lesion Disorders

A. Acquired Pigment Disorders

B. Birthmarks & Congenital Lesions

Number 4 Non-Cancer Growth
Number 5 Surgical Dermatology (Non-Cancer Procedures)
Number 6 Cosmetic Dermatology
Post-Inflammatory Hyperpigmentation PDF

• Post-Inflammatory Hyperpigmentation (PIH)

(Dark marks that appear after acne, eczema, irritation, or injury)

1. What Is PIH?

Post-Inflammatory Hyperpigmentation (PIH) is darkening of the skin that happens after inflammation or injury. It’s your skin’s natural response: inflammation can signal pigment-producing cells to make extra melanin, leaving a brown, gray-brown, or even blue-gray mark where the skin was irritated.

PIH is not dangerous and not contagious, but it can take time to fade—especially without the right plan.

2. What Causes PIH?

PIH can follow almost any inflammatory skin event, including:

  • Acne (especially picked or cystic acne)

  • Eczema / dermatitis

  • Insect bites

  • Rashes or allergic reactions

  • Cuts, scrapes, burns

  • Waxing, threading, shaving irritation

  • Procedures (if the skin becomes inflamed afterward)

PIH is more common and often more noticeable in medium to deeper skin tones, but it can affect anyone.

3. What Does PIH Look Like?

PIH is usually:

  • Flat (not raised)

  • Located exactly where the original bump/rash/injury was

  • Brown to dark brown most commonly

  • Sometimes gray or blue-gray (often indicates deeper pigment)

Tip: If a spot is raised, scaly, bleeding, changing rapidly, or not linked to a prior rash/blemish, it should be evaluated.

4. PIH vs Melasma

They can look similar, but they’re different:

  • PIH: follows inflammation (acne, eczema, bite) and matches the shape/location of the prior spot.

  • Melasma: tends to be symmetric patches on cheeks/forehead/upper lip and is strongly linked to sun + hormones.

Many people can have both.

5. How We Treat PIH

PIH treatment works best in layers: prevent new marks, fade existing marks, and protect the skin barrier.

5. a) Sun protection (foundation of PIH care)

Sun exposure can darken PIH and slow fading.

  • Daily broad-spectrum sunscreen

  • Hats / shade when outdoors

  • Consider protection from heat/visible light if you’re very pigment-prone

5. b) Treat the cause

If acne or eczema is still active, we focus on controlling it to prevent new marks.

 

5. c) Gentle brightening + skin barrier support

Common approaches include:

  • Prescription or medical-grade brighteners

  • Gentle retinoid routines (when appropriate)

  • Barrier repair moisturizers to reduce irritation

5. d) In-office options (selected patients)

When appropriate and safe for your skin type:

  • Chemical peels (carefully selected)

  • Other targeted procedures

Important: Over-treating or irritating the skin can worsen PIH—especially in pigment-prone skin—so we choose treatments carefully.

6. Pre-Op Instructions

(Not surgery—these are “before starting treatment or procedures” tips.)

Before your PIH visit

  • Bring a list (or photos) of current skincare products

  • Tell us if you have a history of dark marks after irritation or prior procedures

  • Avoid tanning/sunburn before your visit

  • If you’re treating acne: avoid picking/squeezing (a major PIH trigger)

If you’re scheduled for an in-office procedure (peel, etc.)

  • Avoid waxing/threading on the area beforehand (we’ll give timing)

  • Stop harsh exfoliants/strong acids/retinoids as directed

  • Let us know about:

    • Recent breakouts, eczema flares, or skin irritation

    • Pregnancy/breastfeeding (may change treatment options)

7. Post-Op Instructions

After starting topical treatment

  • Use products exactly as directed—more is not better

  • Expect gradual improvement over weeks to months

  • If you develop burning, significant redness, peeling, or worsening darkening, stop the product and contact the office

After an in-office treatment

  • Be strict with sun protection

  • Use gentle cleanser + bland moisturizer until healed

  • Avoid picking, scrubbing, or exfoliating until cleared

  • Call if you have increasing pain, swelling, blistering, pus, or fever

8. How Long Does PIH Take to Fade?

It depends on:

  • How deep the pigment is

  • Your skin tone and how reactive your pigment cells are

  • Ongoing sun exposure

  • Whether inflammation (acne/eczema) is still active

Some marks fade in weeks, others take months—and deeper gray/blue pigment can take longer.

Frequently Asked Questions

Is Post-Inflammatory Hyperpigmentation (PIH)a scar?

Usually no. PIH is a color change, not a texture change. True scars cause indentation or thickening.

Inflammation stimulates pigment production. Picking, deeper acne, and sun exposure can make marks darker and longer-lasting.

Often, yes. The best prevention is:

  • Treat acne/eczema early

  • Avoid picking/scratching

  • Daily sunscreen

  • Gentle skincare that protects the barrier

Some lightening ingredients can help, but “strong” or unregulated products can irritate skin and worsen PIH. It’s safest to use a dermatologist-guided plan.

They can help in selected patients, but they must be chosen carefully—especially for pigment-prone skin—because irritation can trigger more PIH.

If the skin becomes irritated or inflamed, pigment can increase. This is why we focus on gentle, consistent treatment and barrier repair.

Schedule evaluation if a spot is:

  • Growing, bleeding, crusting, painful, or changing quickly

  • Not connected to a prior pimple/rash/injury

  • A new dark lesion that looks different from others