Postinflammatory hyperpigmentation

Inflammatory dermatoses and any skin injury may resolve with hyperpigmentation, especially in people with darker skin types. Hyperpigmentation is common after acne, insect bites, atopic dermatitis, acute contact dermatitis, lichen planus, psoriasis, chronic cutaneous (discoid) lupus erythematosus and burns. Pigmentation usually fades within months, but occasionally it is permanent.

If hyperpigmentation is mild, strict sun protection and depigmenting agents (eg hydroquinone, as for melasma) can be effective. Avoid using tretinoin because it is irritating and may worsen postinflammatory pigmentation.

If hyperpigmentation is severe, refer for dermatologist advice. Specialist treatments may include laser treatment and chemical peels—expert dermatologist guidance is needed with these treatments. The risk of complications is significant (eg rebound or worsening of postinflammatory hyperpigmentation, confetti-like hypopigmentation and scarring). Safe use of these therapies requires skilled practitioners (eg dermatologists, practitioners trained by and working under guidance of dermatologists).