Post Inflammatory Hyperpigmentation Treatments

Here's How to Treat the Marks That Remain After Your Pimples Have Healed

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Even after pimples have healed, they may leave dark pink, red, brown, or purplish spots, called post-inflammatory hyperpigmentation (PIH), on your skin. These PIH spots are your skin's reaction to an inflammatory injury (like inflamed pimples). PIH will fade over time. But because it can make you feel self-conscious about your skin, you may choose to treat it.

Post Inflammatory Hyperpigmentation (PIH) Treatments

Before you begin treatment, your acne should be under control, or at least being treated.

Otherwise, each new pimple could cause another PIH macule, reducing the effectiveness of treatment. Try to use sunscreen daily. The sun may darken the discolorations and increase fading time.

Be sure to monitor your skin for irritation. Although they are helping you clear your skin, acne treatments also have the potential for causing irritation. Unfortunately, irritated skin could lead to PIH. If post inflammatory hyperpigmentation is a problem for you, let your dermatologist know if your skin becomes irritated from your acne treatments. Whatever treatment option you choose, understand that improvement will take time. Think in terms of months rather than weeks.

When you're ready to begin treatment, you have plenty of options. Remember, this isn't a comprehensive list. Other treatments may be available. Your dermatologist can help guide you to the right treatment for your skin. Here are some options you and your doctor may consider.

Alpha Hydroxy Acids (AHAs)

Alpha hydroxy acids, especially glycolic acid, are a good starting point for PIH treatment. Alpha hydroxy acids (AHAs) help speed up the skin's natural exfoliation process, which can help improve the appearance of PIH.

Many over-the-counter cleansers, lotions, creams, and gels contain AHAs.

These may be a good choice if hyperpigmentation is fairly mild. Stronger AHA treatments are available with a prescription. AHAs are often used as anti-aging treatments too, and will leave your skin super soft and smooth.

Topical Retinoids

Topical retinoids are often prescribed to acne patients. Retinoids help clear acne by speeding up cell turnover rates. This rapid exfoliation can also help fade PIH.

Retinoid creams include Retin-A (tretinoin), Tazorac (tazarotene), and Differin (adapalene). The fact that they lessen post inflammatory hyperpigmentation as they treat acne breakouts is an added benefit for many people. These medications are available with a prescription only.


Hydroquinone is a widely used treatment for hyperpigmentation. It is available over-the-counter at 1% to 2% strength, and in 3% to 4% prescription creams. Hydroquinone works by blocking the enzyme responsible for melanin production, which helps lighten the skin.

Hydroquinone creams often contain additional lightening ingredients, such as kojic acid, glycolic acid, tretinoin and other retinoids, or vitamin C.

These combination creams can give you better results than using hydroquinone alone.

Hydroquinone creams should be carefully applied to darkened areas only to prevent the unwanted lightening of your natural skin color. Hydroquinone may cause irritation in sensitive individuals. It's worth talking to your doctor before beginning hydroquinone treatment.

Azelaic Acid

Azelaic acid is another medication used to treat acne as well as PIH. It works by decreasing inflammation and speeding up cell turnover rates. Azelaic acid is sometimes used in conjunction with glycolic acid or tretinoin.

Some studies have shown azelaic acid to be as effective as hydroquinone at treating hyperpigmentation. It is a good alternative for those who may be unable to use hydroquinone. To get azelaic acid, you'll need a prescription from your doctor.

Procedural Treatments

PIH can also be treated professionally at skin spas, medispas, or your dermatologist's office. Procedural treatments include various chemical peels and microdermabrasion.

But just one treatment isn't enough to fade PIH. Most likely you'll need a series of treatments spaced a week or so apart (depending on the procedure you're having done). Your doctor can help determine which of these treatments, if any, would be most effective for you.


Cayce KA, Feldman SR, McMichael AJ. "Hyperpigmentation: a review of common treatment options." Journal of Drugs in Dermatology (2004); 3(6):668-73.

Halder RM, Richards GM. "Topical agents used in the management of hyperpigmentation." Skin Therapy Letter (2004); 9(6):1-3.

Palumbo A, d’Ischia M, Misuraca G, Prota G. "Mechanism of inhibition of melanogenesis by hydroquinone." Biochem Biophys Acta (1991); 1073(1):85-90.

Kimball AB, Bissett DL, Robinson LR. "Topical formulation containing N-acetyl glucosamine and niacinamide reduces the appearance of hyperpigmented spots on human facial skin." Presented at: the 64th Annual Meeting of the American Academy of Dermatology, San Francisco, CA; March 3-7, 2006.

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