Pigmentation & PIH: Advice & Management

Caitlein Hannigan



Pigmentation abnormalities affect many people. There are a handful of conditions that result in uneven skin tone or patches. Some of the most common include discolouration, where the skin changes from its natural tone; freckles (or ephelides), which are most common in light-skinned individuals with red or blonde hair; solar lentigines, where dark patches are caused by cumulative UV exposure and skin ageing; and melasma, symmetrical hyperpigmentation often associated with hormonal changes. All of the above are intensified by sun exposure.

Everything you need to know about pigmentation

Pigmentation refers to the colour of our skin. It is influenced by the presence of melanin, a substance within the body that affects colour. The different amounts of melanin we possess is what determines our colouring, and the vast and varied tones of our skin, hair and eyes. Individuals with dark skin tones are more likely to have high concentrations of pigment, while people with fair skin and hair have low levels of melanin. 

There are two main types of melanin: eumelanin, which is associated with dark colours and helps to protect the skin from sunburn, and pheomelanin, which is associated with pale, red and blonde tones. Melanin production and distribution is controlled by cells called melanocytes. These can be found all over the body, located in the epidermis, hair follicles and the middle layer of the eye. 

Skin pigmentation and melanin synthesis differ from person to person, mostly dictated by genetics and hormones. Other factors include autoimmune conditions, medication and inflammatory skin conditions. These influences can lead to abnormal pigmentation and uneven skin tone which, whilst generally harmless, can be extremely frustrating and affect a person’s quality of life and self-esteem1. In some cases, pigmentation abnormalities may be a sign of an underlying condition. As such, pigmentation should always be taken seriously, particularly amongst patients at a heightened risk, including those who are about to undertake treatments in-clinic.

As we’ve mentioned, sun exposure is inextricably linked to hyperpigmentation, both in the formation of new areas and the increasing severity of existing patches. The relationship between the sun and pigmentation is relatively straightforward: in order to protect itself from the sun’s rays, our skin produces higher levels of melanin, and this upsurge leads to dark patches or hyperpigmentation. 

Hyperpigmentation can also occur when the skin experiences inflammation or injury. This is called post-inflammatory hyperpigmentation, or PIH. 

The difference between pigmentation and PIH

PIH is a common pigmentation issue. The condition can affect all skin types but is most often experienced by darker-skinned patients, including Asian, Middle Eastern and African skin types.

One of the main triggers for PIH is clinical treatments that involve ablative or energy-based procedures, which cause a rapid inflammation surge. Other factors to consider are medications and topical products that heighten photosensitivity, hormonal fluctuations and UV exposure. When the skin becomes injured or inflamed, our melanin-producing cells are stimulated to generate higher quantities of pigment. The surplus pigment accumulates in the affected area. Individuals with darker skin tones (Fitzpatrick skin types III to VI) are more likely to experience PIH, owing to their innately high levels of melanin. 

PIH typically occurs as dark patches on the skin’s surface. The colour is determined by the location of the excess pigment within the skin. For instance, epidermal hypermelanosis is brown or dark brown, while hyperpigmentation within the dermis may be blue/grey in appearance.2 

So how can you best advise your patients who are at risk of developing PIH? And what is the best course of treatment, should the condition emerge?

How to prevent and manage pigmentation & PIH after in-clinic treatments

There are several options for pigmentation treatment. Anti-inflammatory medications can play an important role in pigmentation treatments, along with medications that inhibit the production of melanin. Depigmenting agents include retinoids, niacinamide and ascorbic acid, along with the tyrosinase inhibitors azelaic acid, kojic acid and hydroquinone3, can be applied topically. Other procedures include chemical peels and laser therapy, which target stubborn areas of pigmentation at a deeper level.

The most effective form of treatment, however, is prevention. High-level, broad-spectrum sun protection is the single best way to prevent the development and worsening of PIH. Clients must understand the importance of daily sun protection, including SPF50+, sun hats and protective clothing.  

Careful consideration of skin type and pre-existing skin conditions, along with a thorough preparation regime before in-clinic treatments, will help to reduce the risk of PIH and enhance treatment results. That’s where the ALLSKIN | MED Pigment Control Plan comes in – an expert-led, three-step skin care regime to manage pigmentation following in-clinic treatments. 

Prevention is always better than cure when it comes to PIH. Regardless of skin type or condition, careful preventative measures and the control of any underlying skin conditions will minimise the risk of PIH developing and therefore a robust understanding is key.

Download the Guide

Download the guide to Hyperpigmentation & PIH management to find out more about how you can manage this in-clinic and the clinical data & technologies behind our new Pigment Control Plan.

1 Jain, S., Morgaonkar, M., Gupta, S., Vijay, A., Sharma, M. and Agarwal, S. (2017). Melasma: Its impact on quality of life. Pigment International, 4(1), p.39. doi:https://doi.org/10.4103/2349-5847.208298.‌ 
2, 3 Davis, E.C. and Callender, V.D. (2010). Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of clinical and aesthetic dermatology, [online] 3(7), pp.20–31. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921758/

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