- Post-inflammatory hyperpigmentation (PIH) results from picking or popping acne blemishes
- Unlike acne scars, dark spots caused by post-inflammatory hyperpigmentation eventually fade naturally, but the process can be sped up through treatment.
- This kind of hyperpigmentation is most prevalent among people of color and those with darker skin tones
- Post-inflammatory hyperpigmentation can be treated with OTC and RX topical skin lightening creams, professional procedures such as microdermabrasion, or through a variety of at-home remedies.
Can Hyperpigmentation be Caused by Acne?
Hyperpigmentation is the medical term used to explain patches of skin that are darker in color than the skin immediately surrounding it. There are several varieties of hyperpigmentation but the most common forms are:
Post-inflammatory hyperpigmentation (PIH): This typically results from a wound or inflammation to the skin (such as a pimple) after it has healed. It can affect any part of the body and appears as flat spots of discolouration, ranging in color from pinkish red to dark brown or black, depending on the individuals skin tone and the depth of the discoloration.
The condition tends to be more prevalent among people of color and those with darker skin tones, although anyone, male or female, with light or dark skin, is susceptible to PIH. Given it usually results from acne, it’s a very common condition whose root cause is an increase in the production of melanin. Melanin is what determines the depth of a person’s skin tone, and its production often increases after an inflammation or injury has healed, leaving a dark spot where the inflammation had been.
Melasma: Melasma are grayish-brown patches of skin common to women taking birth control pills or while pregnant. While it’s a chronic condition that can happen at any time, melasma is usually brought on by hormonal changes and greatly exacerbated by sun exposure. However, most of the time the dark patches eventually fade after the patient has given birth or upon the cessation of oral contraceptives. The discoloration caused by melasma most commonly occurs on the face and stomach area.
Photodamage: Also known as sun, age or liver spots, these small, darkened patches of skin are caused by unprotected exposure to the sun and consequently appear most frequently on areas of the body most frequently exposed to the elements, such as the face, neck, hands and arms.
Post-inflammatory hyperpigmentation vs acne scars
While both PIH and acne scars develop after an acne breakout and leave dark spots where the inflammation had been, there is a substantial difference between them.
Acne scars usually develop from picking acne blemishes, although they occasionally also cultivate on their own when a blemish is particularly severe. When cystic acne occurs, the increased inflammation and white blood cells flushing to the blemish often results in collagen loss, which is part of the body’s self-healing mechanism. When this happens an atrophic scar can develop, leaving a darkened indentation on the skin.
PIH also typically results from picking or popping acne blemishes, which makes the inflammation worse, not to the point where there is collagen loss, but where blood vessels are broken. For lighter-skinned people this often results in the formation of small red or purple spots on the skin, whereas with darker-skinned individuals the resulting macules are usually brown or black in color.
Also, unlike acne scars, post-inflammatory hyperpigmentation macules eventually fade with time naturally and are more responsive to topical remedies to remove them. Acne scars leave raised scars or actual depressions on the skin, but post-inflammatory hyperpigmentation spots are not actual scars, and as such, while they also leave a dark spot on the skin, there is never any damage to the actual follicle itself.
For these reasons, where treating acne scars usually requires fairly rigorous procedures such as microneedling or chemical peels to remove them or at least improve their appearance, post-inflammatory hyperpigmentation marks are much easier to treat, can usually be addressed topically, and tend to eventually fade naturally anyway.
Acne Related Hyperpigmentation in Darker Skin Tones
While post-inflammatory hyperpigmentation affects people of all skin tones, the problem tends to be more prevalent among people of color. This is because darker-skinned individuals have higher levels of melanin in their skin. The melanosomes (cells that hold melanin) are also fuller and more prone to leaking than they are for people with paler skin, another reason why hyperpigmentation is more prevalent among people of color.
It probably goes without saying that the best way to address post-inflammatory hyperpigmentation is to avoid acne outbreaks in the first place. While there is a myriad of ways to discourage acne from developing, some methods tend to work better for some people than for others. The following tips, however, are essentially universal when it comes to preventing acne.
Most importantly, in order to avoid post-inflammatory hyperpigmentation you need to make every effort not to scratch or pick at your acne blemishes, as that’s what’s responsible for the condition. PIH is fully treatable, whereas treatment for it’s first cousin, acne scarring, which also results from picking at blemishes, is a much more involved process. Here are a few tried and true methods to avoid acne breakouts from developing.
- Wash your face regularly, at least twice a day, using an OTC benzoyl peroxide face wash, or if you’d prefer a more natural option, try diluted tea tree oil instead. Also, never use a washcloth to clean your face as in some instances this will actually promote acne. Rather, use your hands and pat the area dry with a clean towel. And don’t use exfoliating brushes either, as overly aggressive exfoliation can result in broken capillaries and worsen the inflammation, leading to more acne breakouts.
- Eat well. It’s generally accepted that the skin, as with other organs of the body, benefits greatly from a healthy, nutritious diet. As such, it’s only going to help your acne if you avoid junk food and eat plenty of fruit and vegetables while staying away from foods that cause blood sugar levels to spike, like refined carbs and sugary drinks (soda, fruit juice). It certainly isn’t going to hurt, plus, of course, there are all the additional benefits of a healthy diet to consider.
- Always shower and wash your face properly after any rigorous exercise.
- Only use water-based, oil-free makeup. Look for non-comedogenic products that won’t clog the pores and potentially cause breakouts.
- Only use sunscreens and moisturizers designed specifically for the face, as lotions designed for the body are heavier and more likely to clog pores.
- Avoid touching your face over the course of the day as your hands are likely full of dirt, bacteria, and oils that result in acne. At the same time, wash your hands frequently throughout the day. You may find you get fewer head colds at the same time.
- Change your pillowcase — if not all your bedsheets — every few days as the dirt and oil that accumulate on it can rub off on your skin, leading to breakouts.
- Never pick at or pop your pimples. This is, after all, the primary culprit responsible for both acne scars and post-inflammatory hyperpigmentation. So, tempting as it may be sometimes, leave those blemishes alone and let them heal naturally or with a topical acne-fighting ointment.
Over-the-Counter Treatments for Hyperpigmentation Caused by Acne
Hydroquinone is a standard tool dermatologists use to treat PIH and is one of the most effective topical agents for the condition. It’s available as a prescription cream or serum but gentler over-the-counter hydroquinone options are also available.
Hydroquinone is essentially a bleaching agent that lightens or fully removes dark spots on the skin while simultaneously reducing the release of melanin. It inhibits the activity of tyrosinase and is often combined with other agents to treat PIH.
Hydroquinone is frequently included as an ingredient in prescription bleaching creams, either alone or with retinoids like tretinoin. Topical solutions such as these enable hyperpigmentation to become less visible because they treat the epidermis, the topmost layer of the skin, where the problem is located.
Prescription hydroquinone can only be used for a limited amount of time, however, due to the risk of developing exogenous ochronosis, eventually irritating the skin, and even becoming a cause of hyperpigmentation itself. While it’s a proven effective treatment for PIH, it’s not generally suitable for people who have sensitive skin, nor for those with darker skin tones, ironically the same people most vulnerable to PIH. Some people find they are allergic to the substance as well.
Retinoids are most commonly used in conjunction with other drugs to address PIH. There are both prescription versions and OTC options of these drugs available – although with the exception of Differin, most are by prescription only. Tretinoin was the first retinoid used as a topical acne remedy and functions by unclogging pores, enabling other medicated creams and gels to permeate the skin and function better. Retinoid drugs reduce acne outbreaks by preventing dead cells from clogging pores, which encourages bacteria to form and acne blemishes to flourish. Fewer acne outbreaks of course means fewer acne scars or incidence of hyperpigmentation to address afterwards.
Tretinoin 0.1% is one retinoid cream that has been shown to be effective for hyperpigmentation as a solo treatment and in combination with hydroquinone. Other topical retinoids, such as tazarotene and adapalene, are also understood to help hyperpigmentation through similar mechanisms.
While the risk of any serious side-effects occurring are slight, a stinging sensation typically accompanies the topical application of retinol creams, gels or serums, and mild burning, skin redness, dryness, scaling and itching, along with the worsening of acne can occur over the first 2-4 weeks of use. For most people, however, these side effects eventually decrease with continued use.
Although a severe allergic reaction is unlikely, some people are allergic to Tretinoin and similar retinoids so it’s important to inform your dermatologist of any allergies you have before beginning any treatment involving retinoids.
Retinoids can also make users more sensitive to the sun, so when taking them to treat post-inflammatory hyperpigmentation it’s important to apply sunscreen daily and always wear protective clothing when going outdoors.
Professional Treatments for Acne Related Hyperpigmentation
In addition to RX and OTC lightening skin creams designed to reduce pigmentation, there are a few professional treatments available that also reduce the intensity of dark spots caused by post-inflammatory hyperpigmentation. Two of the most common professional treatments are microdermabrasion and chemical peels.
Microdermabrasion is a quick, in-office, non-invasive procedure that incorporates diamond exfoliating to remove the top layers of the epidermis in order to improve the tone and texture of the skin. Most patients require multiple microdermabrasion treatments in order to address their specific skin issues, post-inflammatory hyperpigmentation among them. While a relatively mild skin treatment, microdermabrasion has been shown to reduce the brown spots associated with PIH by exfoliating the top layers of skin, stimulating collagen production while encouraging skin cells to repair themselves, which helps smoothen macules caused by PIH.
The procedure also removes the debris clogging up follicles that can lead to PIH, simultaneously improving the effectiveness of topical creams used to control acne breakouts. Consequently, microdermabrasion is sometimes used as a supplementary procedure in conjunction with other post-inflammatory hyperpigmentation treatments such as hydroquinone and retinoids.
Microdermabrasion is considered safe so long as the procedure is performed by a qualified professional. Incidences of scarring and infection are rare, although if applied too aggressively bruising or pinpoint bleeding are possible. The most common side effects are mild redness and dry skin.
While microdermabrasion isn’t as effective on acne scars or deep wrinkles as chemical peels or laser resurfacing, since post-inflammatory hyperpigmentation occurs on the surface layers of the epidermis it is an appropriate procedure to treat the condition.
The advantages to microdermabrasion are primarily that it’s relatively painless, comes with minimal risks or potential side effects and requires no recovery time. Its effectiveness in treating post-inflammatory hyperpigmentation is roughly commensurate with topical creams, although patients will usually see some improvement immediately after their first session, whereas hydroquinone and retinoids, either alone or in combination, can take longer to achieve the desired effect.
Chemical peels are another procedure that can be applied to lighten and eventually remove dark spots caused by post-inflammatory hyperpigmentation. They can be performed both at home or in a dermatologists office, and while the latter option is more expensive, having the peel performed by a qualified professional is recommended for people with severe hyperpigmentation.
Chemical peels incorporate an acid solution to remove the outer layers of damaged skin while simultaneously smoothing and enhancing the texture of the epidermis. The acid used in a chemical peel exfoliates the outer layer of dull skin, revealing a new layer underneath with improved tone and texture. Once the old cells have been shed, new skin cells are able to grow, so with respect to hyperpigmentation, the old damaged, hyperpigmented skin is gradually removed and replaced by new, even-toned skin, helping post-inflammatory hyperpigmentation dark spots to fade faster.
While topical therapies are typically effective to treat PIH, procedures such as chemical peels and microdermabrasion, either alone or in conjunction with other treatments, are also valid therapies to reduce and remove dark spots caused by the condition.
Light chemical peels, the variety of peel most appropriate to address PIH, are considered very safe procedures with minimal risk of side effects. The most common side effects are infection and scarring, although the risk of either with a light chemical peel is very slight, particularly when the peel has been performed by a qualified professional.
In addition to professional treatments, OTC and prescription oral and topical solutions to address hyperpigmentation issues, there are any number of safe, effective home remedies people use to lighten their dark spots caused by PIH. You can take some of these easily found ingredients to create your own topical facial cleanser to reduce or even eliminate dark patches of hyperpigmentation on the skin. Most of these remedies operate on the principle of reducing the production of melanin or dispersing clustered melanin through cleaning out the pores.
While the bulk of evidence supporting these remedies is anecdotal, there is some academic research to suggest the active ingredients found in these solutions may indeed be beneficial in the treatment of the condition.
Most at-home treatments take approximately 6-8 weeks before the desired result is realized and the dark spots caused by PIH noticeably lightened.
Some of the more popular home PIH remedies include:
- Aloe vera: Pure aloe vera gel contains a natural compound called aloesin which has been shown to lighten the skin. It’s non-toxic and inhibits the enzyme responsible for melanin production. The gel only needs to be applied to pigmented areas prior to going to bed at night. Rinse it off in the morning and continue the process until the hyperpigmentation has faded.
- Green tea extract: Studies have determined green tea extract has a lightening effect when applied to the skin. The evidence indicates that certain properties found in green tea inhibit the production of tyrosinase, which in turn curbs the production of melanin. Applying green tea extract is a simple process. Just boil one tea bag for several minutes, allow it to cool, and place the bag over the areas of hyperpigmentation you want to lighten. Do this twice a day until you the dark spots in question lighten.
- Milk: Milk contains lactic acid, which is understood to lighten hyperpigmentation. Just soak a cotton ball or similar material in milk or buttermilk and rub it over the areas you want to lighten. Repeat twice a day until the areas in question have lightened.
- Vitamin C: Citrus fruits like oranges, lemons, and limes that are rich in vitamin C are believed to reduce or curb the production of melanin, as are orchid extracts. To employ vitamin C to reduce pigmentation simply take the juice of one of these fruits and apply it to a well-washed dark spot on the skin. The cleaning process is quite important in order for this remedy to be effective, you don’t want any surface debris on your skin prior to application. Massage the juice into your dark spots and leave it on for 10-12 minutes before washing off with warm water. Repeat this process this daily, but if your skin experiences any irritation either switch to another home – or conventional – remedy, or only apply this mixture a few times a week, based on how your skin reacts to the juice.
- Licorice extract: Licorice extract contains ingredients that are understood to lighten hyperpigmentation, most notably a chemical compound called glabridin, which both reduces inflammation and stifles the production of tyrosinase.
Topical lotions containing licorice extract are commercially available OTC, with instructions explaining how to get the maximum benefit from the substance. That said, the procedure is similarly straightforward to other PIH home remedies. Wash your face thoroughly to remove any surface debris, apply the extract to the dark spots you want to lighten, and leave to dry for 3 – 4 hours before washing it away with warm water. Repeat the process daily, and as with other home remedies, the dark spots should become noticeably lighter in approximately 2 months.
- Soy extract: Soy has repeatedly been shown to effectively treat hyperpigmentation on the top layers of the epidermis, usually in combination with a conventional skin moisturizer. It’s most commonly purchased in powder form and blended with a moisturizing oil (almond or jojoba oil, for example) into a paste, which is then applied to the well-washed area of hyperpigmentation you wish to lighten. Leave it on the skin for approximately 10-15 minutes, and then rinse with warm water. Do this once or twice a day until you see your desired results, which again should become noticeable within 6 – 8 weeks.
Post-inflammatory hyperpigmentation is a relatively common form of hyperpigmentation typically caused by scratching or picking at acne blemishes, which upon healing, leave dark spots where the lesions had been. Fortunately, unlike acne scars, macules resulting from PIH are receptive to a wide variety of treatments and in most cases will eventually fade naturally on their own.
There are several ways to treat PIH, with some professional procedures such as microdermabrasion and in-office chemical peels likely to work a little faster than other methods.
In addition to certain prescription and over-the-counter skin creams and serums designed to lighten pigmentation caused by the condition, there are several home remedies with plenty of anecdotal evidence to back them up and, to a lesser degree, some academic research further confirming their merits.
While RX and over-the-counter lightening skin creams and certain professional procedures are all effective ways to reduce post-inflammatory hyperpigmentation, home remedies are a notably less expensive option, although they may take longer to produce results than professional treatments.
- Ali, Sharique A.; Galgut, Jyoti M.; Choudhary, Ram K. (2012) On The Novel Action of Melanolysis by a Leaf Extract of Aloe vera and Its Active Ingredient Aloin, Potent Skin Depigmenting Agents. Planta Med 2012; 78(08): 767-771. DOI:10.1055/s-0031-1298406
- No JK, Soung DY, Kim YJ, Shim KH, Jun YS, Rhee SH, Yokozawa T, Chung HY. Inhibition of tyrosinase by green tea components. Life Sci. 1999;65(21):PL241-6. ncbi.nlm.nih.gov/pubmed/10576599
- Management of melasma with 2% analogue of green tea extract in a hydrophilic cream: A placebo-controlled, double-blind study. Journal of the American Academy of Dermatology, Volume 60, Issue 3, Supplement 1, 2009, Page AB160, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2008.11.702
- Tadokoro T, Bonté F, Archambault JC, Cauchard JH, Neveu M, Ozawa K, Noguchi F, Ikeda A, Nagamatsu M, Shinn S. Whitening efficacy of plant extracts including orchid extracts on Japanese female skin with melasma and lentigo senilis. J Dermatol. 2010 Jun;37(6):522-30. doi:10.1111/j.1346-8138.2010.00897.x
- Leyden JJ, Shergill B, Micali G, Downie J, Wallo W. Natural options for the management of hyperpigmentation. J Eur Acad Dermatol Venereol. 2011 Oct;25(10):1140-5. doi:10.1111/j.1468 3083.2011.04130.x
- Wallo W, Nebus J, Leyden JJ. Efficacy of a soy moisturizer in photoaging: a double-blind, vehicle-controlled, 12-week study. J Drugs Dermatol. 2007 Sep;6(9):917-22. ncbi.nlm.nih.gov/pubmed/17941363
- Bulengo-Ransby SM, Griffiths CE, Kimbrough-Green CK, et al. Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients. The New England Journal of Medicine. 1993 May;328(20):1438-1443. DOI:10.1056/nejm199305203282002