The Many Faces of Post-Inflammatory Hyperpigmentation (PIH)

Our new series, “The Many Faces of”, showcases side-by-side images of some of the most commonly seen dermatology conditions in an array of skin tones and briefly highlight nuances in clinical presentation.  All images featured in the series are part of The Full Spectrum of Dermatology: A Diverse and Inclusive Atlasa resource developed by co-editors Misty Eleryan, MD, MS, and Adam Friedman, MD, and published by SanovaWorks and Educational Testing & Assessment Systems.

We continue our series with a look at post-inflammatory hyperpigmentation (PIH). Post-inflammatory hyperpigmentation affects all skin tones, but occurs more frequently and severely in darker skin tones. The degree of discoloration depends on the intensity of the preceding inflammation or injury, with a wide range of presentation from light tan to dark blue-gray.

post-inflammatory hyperpigmentation

Primary lesions such as bullae may be admixed with post-inflammatory hyperpigmentation (PIH). In absence of primary lesions, PIH will present as pink to dark brown hyperpigmented macules and patches in the distribution of the prior trauma or inflammatory insult to the skin.

Nuances to Highlight

Pigment deposited in the dermis will appear with gray-brown to blue-gray discoloration. In contrast to dermal involvement, pigment in the epidermis tends to be tan to dark brown, more responsive to topical treatment, and is accentuated with a Wood’s lamp. Pigment can obscure erythema, especially in darker skin tone, therefore be mindful not to miss an acute or active flare in the setting of this dyschromia.

Further Reading

If you would like to read about treatment options for post-inflammatory hyperpigmentation, check out the following articles:

https://nextstepsinderm.com/derm-topics/superficial-chemical-peels-expert-pearls/ 

https://nextstepsinderm.com/jdd-corner/tranexamic-acid-to-prevent-and-treat-post-inflammatory-hyperpigmentation/

Acknowledgements

We thank co-editors Misty Eleryan, MD, MS, and Adam Friedman, MD for reviewing the content of this article.

Reference

Eleryan, Misty, and Adam Friedman. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas. SanovaWorks, 2021.

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