Ask Curology: Post-inflammatory hyperpigmentation

Welcome to Ask Curology, penned by one of our in-house dermatology providers in response to your questions about all things skincare. This week: Hyperpigmentation. Dark spots and patches are one of the most common skin concerns—and they can last long after breakouts clear.

Dear Curology,

Over the years, my skin has seen some stuff. For a long time, I thought my skin was scarred, but then I learned about hyperpigmentation. I’d really like to fade some of these marks on my skin left behind by too much acne and sun and fun (if you know what I mean). How do you treat different types of unwanted spots (including deep hyperpigmentation)?

Signed,

See Spot Fade

Dear S.S.F.,

We hear you, and you’re definitely not alone. Our skin is with us every day; it protects our body so all the things inside of us can keep on ticking. Those little patches of pigment are a natural consequence of existing in a body!

If they bug you, there are steps you can take to work toward a complexion with the glow that’s right for you. But first, it’s important to understand what hyperpigmentation is, some of the different types, and its potential causes.

What is post-inflammatory hyperpigmentation (PIH)?

Post-inflammatory hyperpigmentation (PIH) is a common condition wherein the skin becomes darker in areas that have been injured or experienced inflammation (e.g., acne). Sometimes incorrectly referred to as “acne scars,” these are marks left on the epidermis after an inflammatory disorder (such as acne) or an injury (such as a burn) has cleared.¹ It happens when the skin produces too much melanin (pigment) in response to this inflammation, leaving behind a dark spot.²

This can happen to anyone, but it happens more often in people with skin of higher melanin content. It’s easy to diagnose PIH; often, it simply requires a skin examination by a dermatologist or medical provider. Hyperpigmentation may cover large or small areas of the body, but it typically isn’t harmful.

Other types of hyperpigmentation

When it comes to hyperpigmentation, did you know there are different types? Understanding the various kinds of hyperpigmentation is essential to figuring out the best course of action for your unique skin.

Sunspots

These dark spots on the skin, including freckles and age spots, are usually the result of prolonged sun exposure.³ Commonly referred to as solar lentigines, sunspots are seen on the areas of your body frequently exposed to the sun, including the face and hands. Typically small and flat, sunspots are considered a sign of aging. 

Melasma

This pigmentation, typically characterized by brown or gray patches, has a range of causes ranging from hormones to environmental triggers.⁴ It can occur during pregnancy, often on the stomach and face. You may also be more likely to have it if you’re taking oral contraceptives.⁵ Factors like darker skin tone, genetics, and UV radiation may increase your risk of developing melasma.⁶

What are the contributing factors to hyperpigmentation?

Are you noticing more dark spots on your skin lately? From UV rays to inflammatory conditions like acne vulgaris, there are a handful of reasons why these may be cropping up more often. Here are a few factors that may contribute to PIH, melasma, or sunspots: 

Sun exposure

As noted above, exposure to the sun’s UVA and UVB rays may contribute to sunspots. Sun exposure is also a primary factor in the development of melasma.⁷ Here at Curology, we recommend always, always, always wearing broad-spectrum sunscreen with SPF 30 or higher! 

Skin inflammation

Several inflammatory skin conditions (dermatoses) may contribute to developing post-inflammatory hyperpigmentation. These include acne, atopic dermatitis, and contact dermatitis.⁸ The first step to treating PIH is addressing the underlying inflammatory skin condition that may be causing it.⁹

Hormonal changes

If you take oral contraceptive pills, use a birth control ring or patch, or are pregnant, you may be more likely to develop melasma. Hormone replacement therapy may also be linked to this type of hyperpigmentation. If you develop melasma after starting oral contraceptives, experts recommend discontinuing the medication.¹⁰

How to treat hyperpigmentation

If you’re noticing dark spots on your skin, it’s a good idea to chat with your dermatology provider; they’ll help you figure out what’s happening. Once you know what you’re dealing with, several treatment options are available to help prevent new dark spots and fade the appearance of existing ones.

Just remember, getting rid of hyperpigmentation is about the journey, not the destination. It may take a little time, but with the right plan, you’ll get there. Here are a few ways to treat hyperpigmentation: 

Use sun protection

No matter what kind of hyperpigmentation you have, sun protection is important. UV damage can worsen every type of hyperpigmentation. Protecting your skin from the sun’s harmful rays increases the chance your treatment will help you achieve your skin goals.

Curology’s mineral-based sunscreen is a silky SPF 30 formula that minimizes white cast. It’s great for everyday wear and is formulated to not clog your pores. Designed and tested by dermatologists, it’s also non-greasy. 

Don’t pick your skin

It’s tempting, but try not to mess with your face too much! Picking and squeezing your skin may injure it, potentially increasing your risk of scarring, causing further inflammation and discoloration, and prolonging the healing process. All of this could possibly exacerbate your hyperpigmentation.

Remember: Treating and healing hyperpigmentation takes time, patience, and proper skincare practices. It’s essential to be gentle with your skin and avoid further damage.

Update your skincare routine

You’ll want a skincare routine that incorporates ingredients known to help treat unwanted dark spots. Although you can find these ingredients over the counter, you may want to try prescription-strength products if your hyperpigmentation is especially stubborn.

• Tranexamic acid slows down pigment build-up and reduces inflammation to help lighten hyperpigmentation.¹¹

• Vitamin C stimulates collagen production, helps reverse hyperpigmentation, and helps neutralize skin-damaging free radicals.¹²

• Niacinamide helps reduce fine lines and wrinkles and fade dark spots.¹³

Carefully research each ingredient to determine which is suitable for your skin before making any decisions about skincare products. You can also consult with a Curology medical provider to receive a custom product for your unique skin. We can prescribe a personalized formula to help treat your dark spots and address other skin concerns simultaneously. 

Curology can help treat dark spots

PIH treatment is easier with potent products and expert advice. That’s where we come in! Curology was founded in 2014 by board-certified dermatologist Dr. David Lortscher with a mission to make effective skincare accessible. We focus on treating acne, rosacea, and anti-aging concerns—including dark spots!

We make it easy for you to get expert advice from licensed dermatology providers. If Curology is right for you, they’ll personalize a prescription formula for your unique skin and answer any questions you may have. Get started by signing up today.

P.S. We did the homework so you don’t have to:

1.  Wang, R. F., et al. Disorders of Hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders. Journal of the American Academy of Dermatology. (2022).

2.  Wang, R. F., et al. Disorders of Hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders. Journal of the American Academy of Dermatology. Ibid.

3.  Amanda Oakley. Brown spots and freckles. DermNet NZ. (October).

4.  American Academy of Dermatology. Melasma: Overview. (2021).

5.  Schwartz, C., Jan, A., Zito, PM., Hydroquinone. StatPearls. (2022). 

6.  Sheth, V.M., Pandya, A.G. Melasma: a comprehensive update: part I. J Am Acad Dermatol. (2011).

7.   Sheth, V.M., Pandya, A.G. Melasma: a comprehensive update: part I. J Am Acad Dermatol. Ibid.

8.  Desai, S. Hyperpigmentation Therapy: A Review. J Clin Aesthet Dermatol. (2014).

9.  Silpa-Archa, N., et al. Postinflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique. J Am Acad Dermatol. Ibid.

10.   Sheth, V.M., Pandya, A.G. Melasma: a comprehensive update: part I. J Am Acad Dermatol. Ibid.

11.  Seemal Desai, et. al. Effect of a Tranexamic Acid, Kojic Acid, and Niacinamide Containing Serum on Facial Dyschromia: A Clinical Evaluation. Journal of Drugs in Dermatology. (2019).

12.  Juliet M. Pullar, et. al. The Roles of Vitamin C in Skin Health. Nutrients. (2017).

13.  Jamie Zussman, et. al. Vitamins and photoaging: Do scientific data support their use? Journal of the American Academy of Dermatology. (2010).

14.  Schwartz, C., Jan, A., Zito, PM., Hydroquinone. StatPearls. Ibid.

15.  Ngan, Vanessa., Hydroquinone. DermNet NZ. Ibid.

16.  Desai, S. Hyperpigmentation Therapy: A Review. J Clin Aesthet Dermatol. Ibid.

17.  Lawrence, E., Al Aboud, K.M. Postinflammatory Hyperpigmentation. StatPearls. (2022).

* Subject to consultation. Subscription is required. Results may vary. 

Written by

Curology Team