Managing Postinflammatory Hyperpigmentation

Postinflammatory hyperpigmentation (PIH) is a common sequela of inflammatory dermatoses and a potential complication of cosmetic procedures in patients with skin of color. Traditionally, management of PIH involves treating the underlying dermatosis (if applicable), recommending sun protection to avoid exacerbation from UV radiation induced melanogenesis, and allowing time for spontaneous resolution of the hyperpigmentation. Although these methods still constitute the fundamental treatment approach, in my experience patients frequently are dissatisfied with a regimen that does not include active treatment of the PIH, which is understandable given the cosmetic disfigurement that patients often experience with pigment alterations. Therefore, application of topical skin-lightening agents and in-office procedures such as chemical peels usually are required to hasten the resolution of PIH, thus improving patient satisfaction. Although this column will discuss several effective treatment options for PIH, none of them provide as rapid a resolution as patients typically desire; therefore, managing patient expectations is an important component in the treatment of PIH. Cover-up cosmetics can be useful adjuncts, allowing patients to conceal lesional skin in the weeks to months leading up to PIH resolution.