Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 1/01/2021
After an acne breakout, you may have noticed that small, dark patches sometimes develop on your skin in the same places as pimples and other acne lesions.
This is called post-inflammatory hyperpigmentation. It’s a very common condition, especially in people with darker skin. Although it’s typically harmless, post-inflammatory hyperpigmentation can be a major annoyance, especially when it develops in highly visible parts of your face.
Not everyone gets post-inflammatory hyperpigmentation after acne breakouts. However, if you do, a variety of treatments are available to lighten darker-than-normal areas and give your skin a more consistent color.
We’ve listed these below, along with additional information on how and why post-inflammatory hyperpigmentation develops in the first place.
Post-inflammatory hyperpigmentation is a skin condition in which certain areas of skin become darker than others following inflammation or injury.
Like other forms of hyperpigmentation, post-inflammatory hyperpigmentation occurs when your skin produces excessive amounts of melanin.
Melanin is the natural pigment that gives your skin its color. In addition to determining the color of your skin, melanin also influences your eye color, as well as the unique color and texture of your hair.
When certain areas of your skin produce more melanin than others, they take on a darker color that stands out next to the nearby skin.
If you’re prone to post-inflammatory hyperpigmentation, your body might overproduce melanin in response to a skin injury. Simple things like an acne lesion, a burn or other types of damage to your skin are often all it takes for hyperpigmentation to develop.
Post-inflammatory hyperpigmentation can affect anyone. However, it’s most common in people with darker skin tones. You may be more at risk of post-inflammatory hyperpigmentation if you have:
Darker white skin
Light brown skin
Dark brown or black skin
Post-inflammatory hyperpigmentation can vary in severity. You may notice a mild discoloration to your skin after a pimple heals. Some people may develop obvious dark spots that stand out significantly next to the surrounding, unaffected skin.
Post-inflammatory hyperpigmentation has numerous causes. Of these, the most common are acne, atopic dermatitis (eczema) and a type of skin infection called impetigo.
Anything that injures your skin or causes significant skin inflammation could potentially lead to post-inflammatory hyperpigmentation. Other potential causes include:
Skin injuries, such as cuts and burns, or medical treatments that cause skin injury, such as chemical peels, cryotherapy and laser/light therapy
Infections, including viral infections that affect your skin, fungal infections and bacterial infections
Skin disorders that cause inflammation, such as lichen planus, pityriasis rosea, lichen simplex chronicus and psoriasis
Other diseases and medical conditions that affect your skin
Although hyperpigmentation is usually associated with inflammatory acne, even mild acne can lead to hyperpigmentation. This is especially true if you’re prone to squeezing or popping acne — something that often worsens inflammation and leads to skin damage and scarring.
If you have post-inflammatory hyperpigmentation, there’s no need to panic. Several treatments are available, ranging from over-the-counter skincare products to prescription medications that can improve healing and lighten darker patches of your skin.
The first step in treating post-inflammatory hyperpigmentation is treating the medical condition that’s causing it to develop in the first place.
For many people, the condition that causes post-inflammatory hyperpigmentation to develop is acne. Your healthcare provider may prescribe medication to treat your acne, or recommend an over the counter acne treatment.
Common treatments for acne include benzoyl peroxide, salicylic acid, tretinoin and antibiotics such as clindamycin. Our full guide to prescription acne medications goes into more detail on how these medications work and how you can use them to treat acne breakouts.
As we’ve discussed below, some of these medications may also help to treat post-inflammatory hyperpigmentation.
After treating the underlying cause of your post-inflammatory hyperpigmentation, you may need to use medication to treat hyperpigmented areas of skin.
Not all hyperpigmentation needs active treatment. If you have mild hyperpigmentation, there’s a good chance that it will improve on its own. However, the process is often slow and can take months.
If you only have mild post-inflammatory hyperpigmentation, you may be able to treat it using an over-the-counter treatment. These products do not require a prescription and can be purchased online or from your local drugstore. Common over-the-counter treatments include:
Hydroquinone. Hydroquinone is a skin lightening medication that stops your skin from producing melanin. You can apply it topically to areas of your skin with dark spots left behind due to post-inflammatory hyperpigmentation.
While stronger concentrations of hydroquinone require a prescription, you can purchase mild hydroquinone-based “dark spot correctors” from most drugstores.
Salicylic acid. Salicylic acid is a beta-hydroxy acid that peels away the outermost layers of your skin. It’s available in many over-the-counter skincare treatments, including facial cleansers, gels, wipes and others.
Glycolic acid. Glycolic acid helps to disperse melanin and promote collagen production in your skin. Like salicylic acid, it’s available in over-the-counter cleansers, creams and other skincare products.
Azelaic acid. Azelaic acid helps to depigment skin and reduce the severity of dark spots left behind by acne. Like the two acids listed above, it’s widely used as an ingredient in over-the-counter cleansers and other skincare products.
Sunscreen. It’s important to apply a high quality, SPF 30+ sunscreen to keep your skin protected from the sun. UV radiation can stimulate melanin production and worsen dark patches caused by post-inflammatory hyperpigmentation.
Several prescription medications are used to treat post-inflammatory hyperpigmentation. Some of these are also effective against other skin conditions, such as acne.
Your healthcare provider may prescribe one or several of these medications if you have severe, obvious post-inflammatory hyperpigmentation that’s unlikely to respond well to over-the-counter treatments, or to produce a faster and more significant improvement in your skin.
Common prescription medications for post-inflammatory hyperpigmentation include:
Prescription hydroquinone. If you have obvious post-inflammatory hyperpigmentation, your healthcare provider may prescribe a more concentrated version of hydroquinone for you to use on affected skin.
Tretinoin. Tretinoin is a topical retinoid that lightens your skin. It’s also highly effective at treating acne. Your healthcare provider may prescribe tretinoin for you to apply to skin that’s affected by post-inflammatory hyperpigmentation.
If you have severe or stubborn post-inflammatory hyperpigmentation, you may need to treat it through a cosmetic procedure. Several surgical therapies are used to lighten hyperpigmented skin, either on their own or in combination with medication.
Common cosmetic procedures for post-inflammatory hyperpigmentation include:
Chemical peeling. Chemical peeling involves using exfoliating chemicals to strip away the outermost layers of your skin. This removes the extra melanin that can form in the epidermis and cause hyperpigmentation to develop.
Several different exfoliating chemicals are used for chemical peeling, including salicylic acid, glycolic acid and trichloroacetic acid.
Laser and light-based treatments. Several forms of light and laser therapy can lighten skin and treat post-inflammatory hyperpigmentation. These may be used on their own or in combination with medication.
If you have severe post-inflammatory hyperpigmentation and think a cosmetic procedure might be the right treatment option, it’s important to talk to a dermatologist.
They’ll be able to let you know which treatment is most effective for you based on the extent of your hyperpigmentation, your skin type and other factors that may affect your results.
Post-inflammatory hyperpigmentation is an annoying consequence of acne, eczema and other conditions that irritate and injure your skin.
While some post-inflammatory hyperpigmentation will disappear over time, most dark spots left behind by acne require treatment with over-the-counter products, prescription medication or, for severe hyperpigmentation, cosmetic procedures.
If you’re prone to acne, it’s important to treat it first before getting rid of hyperpigmentation. Our guide to acne medications lists your options for getting rid of acne and stopping breakouts from coming back in the future.
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