POST-INFLAMMATORY HYPERPIGMENTATION

How can you help patients with darker skin tones treat their post-inflammatory hyperpigmentation at home?

LOLA DANSU

Lola Dansu is an advanced aesthetician with expertise in skincare tailored to diverse skin tones. She is a speaker, trainer, and advocate for the connection between skin health and mental wellbeing. She won Advanced Aesthetician of the Year at the 2022 BABTAC Awards and was a finalist in 2023.

Post-inflammatory hyperpigmentation (PIH) is a common skin concern characterised by darker patches that stand out against the surrounding skin tone. It arises because of inflammation, which can be triggered by factors like acne, burns or sun exposure. When these patches appear because of acne, they are often referred to as “dark spots”.

Individuals with darker skin tones possess higher levels of melanin, the pigment responsible for the colour of our skin, eyes and hair. The melanocytes that make the pigment are more active and serve as a defence mechanism, making skin more prone to developing hyperpigmentation in response to inflammation. Even after the initial inflammation subsides, the affected area may continue to produce excess melanin.

During consultations, understanding the root cause of these dark spots will help in devising the most effective treatment plan. PIH typically fades naturally over time, but for those actively seeking to diminish PIH, here’s a tailored regimen for your patients to follow at home:

THE CAMS CODE: CLEANSE, ACTIVATE, MOISTURISE, SUNSCREEN

1. Cleanse: Begin with a gentle cleanser to get the skin ready for the activation stage. For patients with active acne, opt for a mild cleanser containing exfoliating agents like salicylic acid or benzoyl peroxide. This can help soothe inflammation, reducing the risk of exacerbating PIH.

2. Activate: Ensure the skin is well-hydrated before proceeding with products aimed at brightening the complexion. Consider incorporating hydrating mists and serums enriched with ingredients like glycerin and hyaluronic acid to boost skin hydration.

Tyrosinase inhibitors work to regulate melanin production, aiding in the evening out of skin tone. Look for serums containing niacinamide, vitamin C and azelaic acid with peptides and ceramides. This combination of actives addresses hyperpigmentation, enhances skin texture, stimulates collagen production, and builds the skin barrier.

At night time, patients can use retinoids, which are proven to accelerate cellular turnover and renewal, thereby slowly fading PIH on the skin’s surface, unclogging pores and reducing acne. Begin with a lower concentration and gradually increase frequency to reduce irritation, which can cause further PIH.

3. Moisturise: Seal in moisture with an appropriate moisturiser to manage dryness and irritation. This step is optional but a great one for patients with dry or ageing skin, particularly during the winter months.

4. Sunscreen: Daily application of sunscreen is pivotal in reducing the likelihood of prolonged darkening of acne spots, especially when paired with the right products. Sunscreen also protects against various forms of pigmentation triggered by sun exposure, including the potential risk of skin cancer.

CLINIC TREATMENTS

In-clinic, targeted treatments are great for addressing PIH. Chemical peels, especially those containing glycolic, mandelic, lactic or salicylic acid, can expedite the reduction of dark spots. I recommend beginning with a superficial peel, typically spanning four to six sessions, which often yields promising results.