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Post Acne Hyperpigmentation: A Brief Review

October 2011
Our Dermatology Online 2(4):230-231

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Authors:

Hari Kishan Kumar Yadalla

Raja Rajeswari Medical College & Hospital, BANGALORE

Sarvajnamurthy Aradhya Sacchidanand

Bangalore Medical College and Research Institute

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230

POST ACNE HYPERPIGMENTATION: A BRIEF REVIEW

HIPERPIGMENTACJA POTRĄDZIKOWA: KRÓTKI PRZEGLĄD

Hari Kishan Kumar Yadalla

, Sacchidanand Aradhya

Department of Dermatology, M.V.J. Medical College & Research Hospital,

Hoskote, Bangalore, India

Department of Dermatology, Bangalore Medical College, Victoria Hospital,

Bangalore, India

Corresponding author: Dr. Hari Kishan Kumar Yadalla drkishanyadalla@indiatimes.com

Our Dermatol Online. 2011; 2(4): 230-231 Date of submission: 13.07.2011 / acceptance: 22.07.2011

Conflicts of interest: None

Sir,

Postinflammatory hyperpigmentation, or PIH, is

the medical term given to discoloration of the skin that

follows an inflammatory wound. It is the skin's natural

response to inflammation. PIH presents itself as a flat

area of discoloration on the skin (macule) ranging from

pink to red, purple, brown or black, depending on skin

type and depth of the discoloration. PIH is characterized

by an acquired increase in cutaneous pigmentation

secondary to an inflammatory process. Excess pigment

deposition may occur in the epidermis or in both the

epidermis and the dermis [1].

PIH is very common among acne sufferers. It

can occur in all skin types, although it is more common

in darker skin types. It affects both men and women

equally. PIH is not a true scar. Postinflammatory

hyperpigmentation may be a sequela of conditions such

as acne, allergic reactions, drug eruptions,

papulosquamous disorders, eczematoid disorders, and

vesiculobullous disorders etc [2,3].

PIH is caused by 1 of 2 mechanisms that result

in either epidermal melanosis or dermal melanosis. The

epidermal inflammatory response results in the release

and subsequent oxidation of arachidonic acid to

prostaglandins, leukotrienes, and other products. These

products of inflammation alter the activity of both

immune cells and melanocytes. Specifically, these

inflammatory products stimulate epidermal melanocytes,

causing them to increase the synthesis of melanin and

subsequently to increase the transfer of pigment to

surrounding keratinocytes. Such increased stimulation

and transfer of melanin granules results in epidermal

hypermelanosis. On the contrary, dermal melanosis

occurs when inflammation disrupts the basal cell layer,

causing melanin pigment to be released and subsequently

trapped by macrophages in the papillary dermis, also

known as pigmentary incontinence [1].

In case of Acne, papules and pustules, infection

may spread to deep skin layer called dermis. Infected

area produces more melanin than normal causing unusual

darkness. Thus, infection of hair follicles and sebaceous

glands are the real causes of Hyperpigmentation. In most

cases, if acne is not severe, it does not leave

Hyperpigmentation. Squeezing and popping the pimples

also produce Hyperpigmentation. Sun exposure is a

leading cause of acne and Hyperpigmentation.

Melanocytes are activated by sun light (ultra violet rays)

to produce excessive melanin [4].

PIH will fade away over time, even without

treatment. It can take three to 24 months for PIH to fully

fade, although in some cases it may take longer. The

length of time it takes for PIH to fade depends on how

dark the PIH macule is compared to skin tone. The

bigger the contrast between the macule and natural skin

tone, the longer it will take to fade.

There are various treatment options available to

help fade postinflammatory hyperpigmentation more

quickly [5]. However, acne should be under control

before beginning any treatment for PIH. Otherwise, each

new pimple could cause another PIH macule, reducing

the effectiveness of treatment.Whatever treatment option,

improvement will take time of months rather than weeks.

Firstly - avoid sun exposure

Ultra Violet light can cause hyper-pigmented

areas to darken further and thus prolong them. Use non-

comedogenic facial moisturisers or facial sunscreens

which contain a high SPF of at least 15+.

Topical Treatments for PIH

Typically treatments for PIH bleach pigment

OR block pigment formation OR accelerate the rate of

exfoliation OR a combination.

Letter to Editor / List do Redakcji

231

Bleachs pigment OR block pigment formation

Hydroquinone

Kojic Acid

Benzoyl peroxide

Retinoids

Azeliac Acid

Steroids

Accelerate the rate of exfoliation

The Tape Method of Exfoliation

The Vinegar Method of Exfoliation

Alpha Hydroxy Acid (i.e. Lactic Acid, Malic Acid, Fruit

Enzyme etc.)

TCA, GA, SA chemical peels

Mandelic Acid

Non-topical Treatments for PIH

Microdermabrasion and non ablative lasers are

being used specifically for treating pigmentation

problems. These treatments may be unsuitable for people

who suffer from active acne. Laser treatment is generally

expensive and carries a risk of causing new acne, PIH

and scarring.

Conclusion

Post inflammatory Hyperpigmentation usually

occurs after severe acne has healed. It may take years to

disappear if acne is not properly treated immediately.

Squeezing the acne spread infection up to dermis. The

deeper the infection, the darker the pigmentation will be.

Vinegar is the safest and most effective natural treatment

for Hyperpigmentation. With all topical and laser

treatments for PIH there is a some risk of causing new

outbreaks, new pigmentation problems and possibly even

new scarring. Risk of these occurences will probably

grow with increasing strength or invasiveness of topical

or laser procedures. Some treatments are NOT suitable

for people with active acne, sensitive skin or darker skin

tones. There is no single treatment that works for

everyone. The effectiveness of each treatments varies

and treatments may have to be used in conjunction with

each other.

REFERENCES:

1. Nordlund JJ, Boissy RE, Hearing VJ, King RA, Oetting

WS, Ortonne JP: The pigmentary system: Physiology and

pathophysiology. 2 nd ed. Malden, MA, USA: Blackwell

Publishing; 2006.

2. Lacz NL, Vafaie J, Kihiczak NI, Schwartz

RA: Postinflammatory hyperpigmentation: a common but

troubling condition. Int J Dermatol. May 2004; 43: 362-

365.

3. Davis EC, Callender VD: Postinflammatory

Hyperpigmentation: A Review of the Epidemiology,

Clinical Features, and Treatment Options in Skin of Color. J

Clin Aesthet Dermatol. 2010; 3: 20–31.

4. Kubba R, Bajaj AK, Thappa DM, Sharma R,

Vedamurthy M, Dhar S, et al: Postinflammatory

hyperpigmentation in acne. Indian J Dermatol Venereol

Leprol 2009; 75: 54.

5. Goodman GJ: Acne & Acne scarring: Why should we

treat? Med J 1999; 171: 62-63

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The most comprehensive and integrated book on pigmentation. The Pigmentary System, Second Edition, gathers into one convenient, all-inclusive volume a wealth of information about the science of pigmentation and all the common and rare clinical disorders that affect skin color. The two parts, physiology (science) and pathophysiology (clinical disorders), are complementary and annotated so that those reading one part can easily refer to relevant sections in the other. For the clinician interested in common or rare pigment disorders or the principles of teaching about such disorders, this book provides an immediate and complete resource on the biologic bases for these disorders. For the scientist studying the biology of melanocyte function, the book provides a list of disorders that are related to basic biological functions of melanocytes. New features of this Second Edition include: Completely new section on the basic science of pigmentation - explaining the integration of melanocyte functions with other epidermal cells and with various organ systems like the immune system. New chapters on pigmentary disorders related to intestinal diseases, the malignant melanocyte, benign proliferations of melanocytes (nevi) and phototherapy with narrow band UV. All clinical chapters include the latest genetic findings and advances in therapy. More than 400 color images of virtually all clinical disorders. The book is ideal for all dermatologists and especially those interested in disorders of pigmentation. It is of particular use for pediatric dermatologists and medical geneticists caring for patients with congenital and genetic pigmentary disorders. This authoritative volume will fill the gap for dermatology training programs that do not have local experts on pigmentation. Basic and cosmetic scientists studying pigmentation and melanocytes will find the science and clinical correlations very useful in showing human significance and relevance to the results of their studies.

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