Post-Inflammatory Hyperpigmentation (PIH): Causes, Prevention, and Effective Treatments

Post-inflammatory hyperpigmentation (PIH) is a common skin concern that can appear after certain aesthetic treatments, acne, or any form of skin trauma. If you’ve ever noticed dark spots lingering long after a breakout healed or discoloration after a skin treatment, this is totally normal! While PIH can cause anyone distress, it’s also very preventable and treatable with the right approach! In our blog post we’ll go over how PIH happens, who is at risk, how to prevent and minimize it.

What Is Post-Inflammatory Hyperpigmentation (PIH)?

Post-inflammatory hyperpigmentation is the darkening of skin caused by an overproduction of melanin following inflammation or injury. This can occur anywhere on the body, but it’s especially common on the face, chest, and back. Unlike other forms of hyperpigmentation, PIH is tied to a specific event—like a breakout, skin irritation, or cosmetic treatment.

How PIH Develops: The Science Behind It

When your skin experiences inflammation—whether from acne, a laser treatment, or a chemical peel—it triggers your melanocytes (the cells that produce melanin) to produce excess pigment as a response to the trauma. Depending on where this pigment is deposited, PIH can appear:

• Brown or tan (epidermal): When the pigment is in the upper layers of skin.

• Gray or bluish (dermal): When the pigment is deeper in the skin.

This pigmentation can last weeks, months, or even years if left untreated. If you don’t know what it is and see it happen, it’s totally understandable why you would freak out! Luckily, there are tons of ways to prevent it and treat it.

However, PIH doesn’t always need a specific event or treatment to appear—it can occur randomly if your skin is naturally prone to it. People with darker skin tones (Fitzpatrick types III–VI) are more susceptible because their melanocytes are more active and reactive. Even minor triggers like mild irritation, scratching, or small pimples can lead to visible discoloration in these skin types. Research shows that PIH is one of the most common pigmentation disorders in individuals with deeper skin tones, as their skin’s healing response often involves overproduction of pigment. Factors like hormonal changes, chronic skin conditions like eczema, or even overly harsh skincare products can also cause unexpected bouts of PIH.

Who Is Most Likely to Experience PIH?

Anyone can experience PIH, buuuut certain factors make some individuals more susceptible:

1. Darker Skin Tones (Fitzpatrick Skin Types III–VI):
   Individuals with medium to deep skin tones are at higher risk because their melanocytes are more active, making them more prone to pigment changes. Read our blog post on the Fitzpatrick Scale here.

2. Skin Prone to Inflammation or Acne:
   Acne-prone skin, especially when breakouts are picked or improperly treated, is a common source of PIH.

3. Post-Treatment Trauma:
   Cosmetic treatments like laser hair removal, microneedling, and chemical peels can sometimes lead to PIH, especially if performed without proper precautions or aftercare.

4. Sensitive or Reactive Skin:
   People with sensitive skin may experience PIH after using harsh products or undergoing treatments that irritate their skin.

What Types of Aesthetic Treatments Can Cause PIH?

Although treatments like laser hair removal or Morpheus8 are designed to improve your skin, certain procedures can temporarily cause PIH if not done correctly or without proper aftercare. Some treatments that may cause PIH:

Laser Hair Removal

Laser hair removal targets hair follicles using heat. While it’s safe for most skin types, deeper skin tones or those with sensitive skin can sometimes experience temporary PIH, especially if the skin isn’t properly cooled or protected before and after treatment. Cooler showers after are totally recommended!

• PIH after laser hair removal happens when the skin reacts to heat and inflammation from the laser.

• The laser targets hair follicles but can irritate nearby skin, especially in darker or more sensitive skin types.

• This irritation triggers melanocytes (pigment-producing cells) to create extra melanin, leading to dark spots.

• Sun exposure or improper aftercare can make the pigmentation worse.

Preventing PIH with Laser Hair Removal:

• Always work with an experienced provider.

• Avoid sun exposure before and after treatment.

• Follow post-treatment instructions carefully.

Microneedling

Microneedling creates micro-injuries in the skin to stimulate collagen and elastin production. While incredibly effective for acne scars and fine lines, it can occasionally cause PIH if the skin isn’t properly prepared or protected post-treatment.

• PIH from microneedling occurs when the skin’s healing response triggers excess melanin production.

• Microneedling creates tiny micro-injuries to stimulate collagen, but in some cases, this inflammation can lead to pigmentation in darker skin tones.

• If the skin is not properly prepped or protected from the sun afterward, the risk of PIH increases.

• Improper aftercare, like using harsh products, can also worsen discoloration.

Prevention Tips:

• Use pigment-suppressing skincare products (e.g., vitamin C, hydroquinone) before your treatment.

• Avoid direct sunlight for at least two weeks post-treatment.

Morpheus8 (Radiofrequency Microneedling)

Morpheus8 treatments combines microneedling with radiofrequency (RF) energy to tighten skin and reduce texture issues. However, deeper skin tones may be more prone to PIH if settings are too aggressive or if aftercare isn’t meticulously followed. Learn more about Morpheus8!

• PIH after Morpheus8 can happen when the radiofrequency (RF) energy combined with microneedling causes inflammation in the skin.

• This inflammation can overstimulate melanocytes, especially in deeper skin tones, leading to dark patches or spots.

• The risk is higher if aggressive settings are used or if the skin isn’t properly cared for post-treatment.

• Sun exposure, irritation, or skipping aftercare instructions can make pigmentation worse.

Prevention Tips:

• Ensure your provider customizes settings for your skin type.

• Use a broad-spectrum sunscreen religiously after treatment.

• Avoid harsh scrubbing or exfoliants after your treatment.

Chemical Peels

Chemical peels exfoliate the skin using acids like glycolic, salicylic, or TCA to improve texture and tone. Improper application or neglecting post-treatment care can lead to PIH, particularly in darker skin tones.

• PIH after a chemical peel occurs when the skin's deeper layers become inflamed from the exfoliation process.

• The peel removes damaged skin, but if healing isn’t supported with sunscreen and gentle care, excess melanin production can occur.

• Darker skin tones are more prone to PIH, particularly after medium or deep peels.

• Using harsh products or exposing the skin to the sun post-peel can worsen pigmentation.

Prevention Tips:

• Use pigment inhibitors like kojic acid or arbutin pre-treatment.

• Moisturize and protect your skin post-treatment to prevent irritation.

• Avoid picking at your skin while it is in it’s peel period!

Acne Extractions

Even treatments designed to remove acne can cause PIH if the inflammation is severe or improperly managed.

• PIH after acne extractions happens when the skin becomes inflamed during the removal of clogged pores or pimples.

• This inflammation triggers melanocytes to produce excess melanin, resulting in dark spots where the extraction occurred.

• The risk is higher if the extraction is aggressive or if the skin is not properly soothed afterward.

• Skipping sunscreen or using irritating products after treatment can make the pigmentation worse.

Prevention Tips:

• Keep the treated area moisturized to aid in healing.

• Incorporate calming ingredients like niacinamide post-treatment.

Even with the most experienced provider performing your treatment, PIH can still occur because it’s a natural response of the skin to inflammation or injury. Studies show that PIH affects up to 65% of individuals with darker skin tones after certain cosmetic procedures, while lighter skin types experience it less frequently, at rates closer to 10-20% depending on the treatment.

According to a report published in the Journal of Clinical and Aesthetic Dermatology, “PIH is a common sequela of skin trauma, particularly in patients with skin of color, where it can persist for months or even years without treatment.”

Even with proper technique and precautions, the skin’s genetic predisposition plays a significant role in whether or not PIH develops.

How to Prevent PIH: Key Strategies

While it’s impossible (blah) to completely eliminate the risk of PIH, these tips can significantly lower your chances:

1. Always Wear Sunscreen:
   UV rays worsen pigmentation, so use a broad-spectrum SPF 30 or higher daily. Reapply every two hours when outdoors.

2. Prep Your Skin Pre-Treatment:
   Use pigment-suppressing ingredients like hydroquinone, azelaic acid, or tranexamic acid as directed by your provider.

3. Choose Experienced Practitioners:
   At Core Aesthetic, all procedures are performed by highly trained professionals to minimize risks, especially for those with darker skin tones.

4. Follow Post-Treatment Aftercare:
   This includes avoiding sun exposure, using gentle skincare, and applying a healing ointment as needed.

5. Avoid Picking or Scratching:
   This goes for acne, scabs, and peeling skin. Picking can increase inflammation and worsen PIH. Stop picking!!

How to Treat Post-Inflammatory Hyperpigmentation

If you’re already dealing with PIH, the good news is that it’s highly treatable! Here are some of our fav (and most effective!) solutions:

Topical Skincare for PIH

1. Retinoids (Retinol or Tretinoin):
   Retinoids increase cell turnover, helping fade pigmentation faster.

2. Vitamin C:
   This antioxidant brightens skin and inhibits melanin production.

3. Niacinamide:
   A calming ingredient that reduces inflammation and pigment production.

4. Azelaic Acid:
   Safe for sensitive skin, this ingredient brightens and soothes.

5. Hydroquinone (Short-Term Use):
   Often paired with other lighteners, hydroquinone is highly effective for stubborn pigmentation.

6. Tranexamic Acid:
   A newer ingredient shown to be effective in treating PIH, especially in combination with other actives.

Professional Treatments for PIH

Treating PIH with aesthetic treatments may seem counterintuitive, especially when PIH itself can result from certain procedures. However, specific treatments are designed to address the pigmentation caused by inflammation, making them effective for improving skin tone and reducing discoloration.

• For instance, Lumecca IPL (Intense Pulsed Light) can target dark spots caused by PIH, breaking up the excess melanin in the skin to fade pigmentation over time.

• Similarly, chemical peels like the VI Peel can exfoliate the upper layers of the skin and promote cell turnover, which helps lighten superficial PIH.

These treatments, when carefully performed and followed by diligent aftercare, can safely and effectively reduce hyperpigmentation.

Morpheus8 or microneedling with PRF can stimulate collagen production and improve overall skin texture and tone, indirectly addressing PIH. These treatments help speed up the skin’s natural healing process and fade discoloration by promoting healthy, evenly pigmented skin growth. While PIH may have been triggered by an initial treatment, layering these targeted approaches can actually enhance the skin's recovery and reduce pigmentation. The key is choosing experienced providers who can customize treatment plans based on skin type and existing conditions, ensuring that subsequent treatments are beneficial rather than exacerbating the problem.

1. Lumecca IPL:
   Intense Pulsed Light can effectively target superficial PIH for lighter skin types.

2. Microneedling + PRF:
   Combining microneedling with platelet-rich fibrin (PRF) boosts skin healing and fades PIH faster.

3. VI Peel:
   This medium-depth peel is ideal for treating pigmentation in deeper skin tones.

4. Morpheus8:
   By stimulating collagen and improving skin texture, Morpheus8 can indirectly improve uneven skin tone caused by PIH.

5. Customized Skincare Regimens:
   At Core Aesthetic, we can build a tailored skincare routine that incorporates the best ingredients for your unique needs.

Skincare Routine for PIH Prevention and Treatment

Morning Routine

• Cleanser: Obagi Nu-Derm Gentle Cleanser or IS Clinical Cleansing Complex for a thorough yet gentle cleanse.

• Vitamin C Serum: Obagi Professional-C Serum 15% or IS Clinical Pro-Heal Serum Advance+ for antioxidant protection and brightening.

• Moisturizer: SkinBetter Trio Rebalancing Moisture Treatment, which is lightweight yet hydrating and non-comedogenic.

• Sunscreen: SkinBetter Sunbetter Tone Smart SPF 68 Sunscreen Compact or IS Clinical Eclipse SPF 50+ for broad-spectrum sun protection.

Evening Routine

• Cleanser: Obagi Nu-Derm Gentle Cleanser or IS Clinical Cleansing Complex to remove impurities and prep the skin.

• Treatment Serum: SkinBetter AlphaRet Overnight Cream (retinol + lactic acid) or IS Clinical Active Serum for gentle exfoliation and treatment of discoloration.

• Moisturizer: Obagi Hydrate Luxe or SkinBetter Trio Rebalancing Moisture Treatment for deep hydration and skin barrier repair.

Weekly Additions

• Exfoliation: Use Obagi Professional-C Microdermabrasion Polish + Mask once or twice a week for brightening and gentle exfoliation.

• Mask: IS Clinical Brightening Masque or Obagi Clinical Vitamin C Microdermabrasion Masque to target discoloration and promote radiance.

Treat PIH at Core Aesthetic

At Core Aesthetic Medspa in Falls Church, VA, we specialize in treating post-inflammatory hyperpigmentation with advanced, safe, and effective solutions. Whether you’re dealing with pigmentation from acne, laser treatments, or other procedures, our team can customize a treatment plan for you.

Popular services include:

• Lumecca IPL for pigmentation removal.

• PRF with microneedling to boost healing and fade dark spots.

• VI Peel to brighten and even out skin tone.

• Morpheus8 for skin rejuvenation and texture improvement.

Located next to the Mosaic District, we’re here to help you achieve healthy, even-toned skin. Contact us today to schedule your consultation and start your journey to radiant skin!

For more information or to book your appointment, visit Core Aesthetic Medspa.