Ever experience inflamed acne blemishes that, after healing, leave behind dark patches? If so, you’ve dealt with a condition known as PIH, or post-inflammatory hyperpigmentation. 

Post-inflammatory hyperpigmentation is just one of three primary types of hyperpigmentation, which also include melasma and sunspots. Melasma usually occurs on the face, often during pregnancy. The other two types can occur anywhere on the body. 

Before we get into how to treat hyperpigmentation on the body, first things first: It’s very common, but there are things you can do to help prevent it. And we’re here to help!

What are the types of hyperpigmentation?

Three of the most common types of hyperpigmentation are sunspots, melasma, and PIH. Here’s a closer look at each of these: 

• Sunspots are also called age spots and liver spots. Even freckles (ephelides) are a type of sunspot. They can show up anywhere your skin is exposed to the sun, most commonly on the face and hands. 

• Post-Inflammatory hyperpigmentation (PIH) is more common in people with darker skin tones. It results from injury to the skin that causes inflammation. Inflammation can cause melanocytes to overproduce, leading to skin discoloration.¹

• Melasma is a skin condition that predominantly affects the face, and it’s often triggered by sun exposure and hormones. It’s also common during pregnancy.²

Who can hyperpigmentation affect

Hyperpigmentation can affect anyone—it’s not choosy! But each type of hyperpigmentation has an affinity toward some people over others. For example, melasma is more common in people taking hormonal medications such as birth control, or pregnant people. And freckles—a type of sunspot—are more common in those with fair skin. Here are some of the more common types of hyperpigmentation: 

Sunspots

• Often occur in older adults and people who’ve spent extended time in the sun. 

• Appear as brown, black, or tan spots on skin exposed to the sun. 

Post-inflammatory hyperpigmentation 

• Occurs in people who’ve had an injury or inflammatory condition, like acne, eczema, or an insect bite.

• Can appear anywhere on the body as spots or patches of darker skin.

Melasma

• Occurs predominantly in women, people who are pregnant, and people taking hormones such as birth control. It’s also more common in those with medium to darker skin. 

• Appears in symmetrical patterns on the face, mainly on the cheeks, forehead, and upper lip.

Some contributing factors to hyperpigmentation

Melanin is responsible for skin color, hair color, and eye color—all are directly related to how much or little melanin you have. In addition to giving your skin, hair, and eyes their unique (and beautiful!) color, melanin also helps protect you from UV rays. It works to absorb ultraviolet light to protect your cells from sun damage, and also acts as an antioxidant to eliminate free radicals that can lead to premature aging and diseases like cancer.³ 

But when your body produces too much melanin, it can lead to dark spots. Here are the common contributors to an overproduction of melanin: 

• UV exposure. Sun’s the big one! And even though melanin absorbs UV rays and helps protect your skin from sun damage, it’s not enough. Regardless of your skin tone, you still need to use a broad-spectrum sunscreen with SPF 30+ daily. Not only will it help protect you from sunspots, but it will also help protect you from other signs of premature aging and skin cancer. 

• Skin inflammation. Skin inflammation is the primary contributing factor to PIH. Anything that causes an inflammatory reaction on the skin can lead to an overproduction of melanin and hyperpigmentation. That includes insect bites, cuts, bruises, eczema, and acne. Once the skin has healed, dark spots can remain. 

• Medications. Certain prescriptions, like tricyclic antidepressants, can also cause hyperpigmentation.⁴ If you suspect a medication is the cause of your hyperpigmentation, consult your medical provider. Do not stop taking a prescribed medication without talking to the prescribing provider first. 

• Medical conditions. Several can lead to hyperpigmentation. One example is hemochromatosis, which can occur when the body holds onto iron, resulting in diffuse hyperpigmentation.⁵

Treating hyperpigmentation

One of the best treatments for hyperpigmentation is an alpha-hydroxy acid, used in combination with plenty of sun protection. But there are other ingredients to try—and some to watch out for. That’s why we recommend hyperpigmentation treatment by a dermatologist or licensed dermatology provider. Treatment options your dermatology provider may prescribe include:

• Hydroquinone: Hydroquinone is a dark spot-lightening agent that can be effective—in small doses. It can fade hyperpigmentation by inhibiting an enzyme called tyrosinase, which is needed for the production of melanin.⁶  

• Retinoids are vitamin A derivatives commonly used to treat acne, fine lines, and wrinkles. They exfoliate beyond the epidermis and into the dermal layer of the skin and have been shown to be effective in treating hyperpigmentation. One retinoid we love at Curology is tretinoin, which is a prescription-strength retinoid that treats acne, hyperpigmentation, and other signs of aging.⁷ It should generally be applied in limited doses over smaller areas, like the face and/or small areas of the body.

• Chemical peels are performed by a dermatology expert and can be an effective hyperpigmentation treatment for Black skin and other skin types.⁸ The American Academy of Dermatology classifies peels into three distinctive types: superficial, medium, and deep. Within these three types are common peels including alpha-hydroxy acid (AHA) peels, beta-hydroxy acid (BHA), trichloracetic acid (TCA), and phenol peels. Superficial chemical peels using AHAs, such as glycolic acid, lactic acid, and mandelic acid, are effective in evening skin tone with minimal downtime. Glycolic acid is one of the most effective chemicals peeling agents for hyperpigmentation with few side effects.⁹ Some ingredients used in chemical peels are available OTC, like salicylic acid (BHA) and several AHAs. The strength of the OTC products is less but they still work as gentle chemical exfoliants. You might consider their use as a facial exfoliant for hyperpigmentation treatment at home. 

• Intense pulsed light therapy is a non-ablative laser treatment effective in treating uneven skin tones and flat spots. IPL has been shown to also reduce the appearance of wrinkles, blood vessels, and other signs of aging. IPL works by evoking collagen synthesis in the treatment area.¹⁰

Does Curology treat hyperpigmentation?

We do! Curology offers hyperpigmentation treatment for the face designed by dermatologists. Best of all, you can incorporate your formula into your existing skincare routine. Curology offers expert skincare guidance from licensed dermatology providers and customized treatment options to address your skin concerns. We’re service-first and with you every step.

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

1. Silpa-archa, N., et al. Post Inflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique. Journal of the American Academy of Dermatology. (October 2017).

2. Sheth, V.M, et al. Melasma: A comprehensive update, part I. Journal of the American Academy of Dermatology. (October 2011).

3. Moddodi, N, et al. Shining light on skin pigmentation: The darker and brighter side of effects of UV Ratiation.Photochemisatry and Photobiology. (2012, April 12).

4. Milionis, H.J., et al. Hypersensitivity syndrome caused by amitriptyline administration. Postgraduate Medical Journal. (June 2000).

5. Porter, J.L., et al. Hemochromatosis.StatPearls. (2022, June 11).

6. Chelsea Schwartz, Arif Jan, Patrick M. Zito. Hydroquinone. StatPearls Publishing; (2020 January).

7. Mukherjee, S., et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety.Clin Interv Aging. (2006 December).

8. American Academy of Dermatology. Chemical peels: FAQs. (n.d.).

9. Soleymani, T., et al. A practical approach to chemical peels.Journal of Clinical and Aesthetic Dermatology. (August 2018).

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Written by

Curology Team

Medically reviewed by

Meredith Hartle, DO