How to treat Post-inflammatory hyperpigmentation Skincare    resources with reliable information?

How to treat Post-inflammatory hyperpigmentation Skincare resources with reliable information?

What is Post-Inflammatory Hyperpigmentation?

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Post-inflammatory Hyperpigmentation (PIH) happens when there is any sort of damage or irritation or cutaneous inflammation takes place in the skin. It can happen to all skin/color types of patients including African, American, Asian and Middle east too. The skin turns tan, brown or purple due to it. It is most common in African Americans almost 65%.


What causes PIH?

Irritation or damage to the skin, can lead to post-inflammatory hyperpigmentation. Skin problems that often result in PIH include acne, burns, eczema (atopic dermatitis), allergic reactions, infection, insect bites, lichen planus, pseudofolliculitis barbae, and psoriasis.

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How can PIH be treated?

Post inflammatory hyperpigmentation can take months to years to fully clear. For effective long-term treatment of PIH, it is essential to treat the underlying skin problem that is leading to the discoloration. In addition, certain treatments can speed up the process, such as topical hydroquinone, retinoid, corticosteroid, azelaic acid, glycolic acid, kojic acid, along with procedures such as microdermabrasion and light chemical peels.

Sunlight can cause PIH to darken, so it is important to utilize protection from the sun such as sunscreen lotions and protective clothing.

Topical creams work in various ways to interfere with the amount of pigment production in the skin. Use ingredients that target lightening and reducing the production of the skin pigment i.e. melanin. Below are the eight pigment inhibitors that fade PIH acne scars plus blemishes, melasma, atopic dermatitis, and shingles. They usually include one of the following ingredients:

1.  Vitamin A (Retinol or Retinoids) – An active ingredient that increases skin cell turnover, evens out pigmentation, treats acne, and is anti-aging. Retinoids exert multiple biological effects that result in skin lightening including the modulation of cell proliferation, differentiation, and cohesiveness; induction of apoptosis; and expression of anti-inflammatory properties. 

2.  Vitamin C – The most powerful antioxidant that fades hyperpigmentation, acne scars, and especially melasma. It also prevents the skin from UV damage and is anti-aging.

3.  Alpha hydroxy acids (AHAs) – Acids such as glycolic and lactic acids, exfoliate the outermost layer of skin and evens out pigmented skin tone.

4.   Arbutin – Prevents the production of melanin. Extracted from the dried leaves of the bearberry shrub or pear, cranberry, or blueberry plants, arbutin is another derivative of HQ, but without the melanotoxic effects.  Arbutin causes depigmentation by inhibiting not only tyrosinase activity but also melanosome maturation. Although its efficacy is dose-dependent, higher concentrations of arbutin can lead to a paradoxical hyperpigmentation.

5.   Galactomyces (or fermented yeast) – A gentle brightener and hydrator.  

6.   Snail mucin – Brightener, hydrator, and anti-aging. 

7.   Licorice – A gentle brightener, and anti-aging. Licorice root extract (Glycyrrhiza glabra, Glycyrrhiza uralensis) is a common ingredient found in many skin-lightening cosmeceuticals, and is also used in the treatment of a wide variety of diseases even outside the scope of dermatology due to its anti-inflammatory, antiviral, antimicrobial, and anticarcinogenic properties. Some of the active ingredients in licorice root extract include glabridin, which inhibits tyrosinase and possesses anti-inflammatory effects, and liquiritin, which does not inhibit tyrosinase but causes depigmentation by melanin dispersion and removal. There are very few clinical trials that study the utility of licorice root extracts in the treatment of dermatological conditions. One study conducted in 20 Egyptian women showed that topical liquiritin cream (1g/day) for four weeks was both safe and effective in the treatment of melasma. Side effects were minimal. Further clinical studies with racial/ethnic patients are needed to evaluate the efficacy of licorice root extract in the treatment of PIH.

8.   Kojic acid – A gentle brightener. Its depigmenting ability originates from a potent inhibition of tyrosinase by chelating copper at the active site of the enzyme.  KA is available in 1 to 4% concentrations and can be formulated with other lightening agents, including glycolic acid and hydroquinone, to increase efficacy.

9. Niacinamide- Niacinamide is the physiologically active derivative of vitamin B3 or niacin. In-vitro studies show that niacinamide significantly decreases melanosome transfer to keratinocytes without inhibiting tyrosinase activity or cell proliferation, and niacinamide may also interfere with the cell-signaling pathway between keratinocytes and melanocytes to decrease melanogenesis. One of the advantages of niacinamide is its stability being unaffected by light, moisture, acids, alkalis, or oxidizers.

10. Laser and light-based therapies- Although topical skin-lightening agents remain the treatment of choice for PIH, lasers and light sources may be an effective adjunct to therapy or alternative for treatment failures.


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