- Nazanin Saedi, MD
Nazanin Saedi, MD
- Assistant Professor - Department of Dermatology and Cutaneous Biology
- Thomas Jefferson University
Postinflammatory hyperpigmentation (PIH), also known as postinflammatory melanosis, is a reactive hypermelanosis of the skin that occurs as a sequela of cutaneous inflammation (picture 1A-I) . Common causes of PIH include acne vulgaris, eczematous dermatoses, and burn injury. PIH is a frustrating problem that can have a strong psychological toll on affected patients.
The pathogenesis, diagnosis, and treatment of PIH will be reviewed here. Other causes of cutaneous hyperpigmentation are reviewed separately. (See "Approach to the patient with hyperpigmentation disorders".)
PIH is a common disorder that can occur at any age and has an equivalent incidence in males and females. Although PIH may occur regardless of skin color, risk for clinically significant PIH increases with darkening skin pigmentation.
Skin phototype, a measure defined by the self-reported tendency to sunburn or tan after sun exposure (table 1), correlates with skin pigmentation and is useful for stratifying risk for PIH. Compared with individuals with skin phototype I or II, individuals with skin phototypes III to VI are more likely to develop PIH .
ETIOLOGY AND PATHOGENESIS
The provoking inflammatory process that leads to PIH can be endogenous or exogenous . Common endogenous causes of PIH include acne vulgaris, atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, psoriasis, and lichen planus. Accidental burns, non-ionizing radiation therapy, phototoxicity, chemical peels, and laser procedures are examples of exogenous causes [1,3,4].
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Patient history
- Physical examination
- Wood's lamp examination
- DIFFERENTIAL DIAGNOSIS
- Essential measures
- - Photoprotection
- - Elimination of exacerbating factors
- Medical treatment
- - Patient selection
- - First-line therapy
- Topical hydroquinone
- - Second-line therapy
- Topical retinoids
- Triple-agent therapy
- Azelaic acid
- Chemical peels
- Other therapies
- SUMMARY AND RECOMMENDATIONS