Topical Treatments for Melasma and Postinflammatory Hyperpigmentation

C.B. Lynde; J.N. Kraft, MD; C.W. Lynde, MD, FRCPC


Skin Therapy Letter. 2006;11(9):1-6. 

In This Article

Postinflammatory Hyperpigmentation (PIH)

PIH represents a pathophysiologic response to cutaneous inflammation, such as acne, atopic dermatitis, lichen planus, and psoriasis. Similar to melasma, it is more obvious in patients with brown or black skin.[8] It has no gender or age predominance.[10] The lesions are characteristically limited to the site of the preceding inflammation and have indistinct, feathered borders.[7] Melanocytes can either be stimulated by the inflammatory process to become hypertrophic, thus secreting more melanin, or the number of melanocytes can increase. Epidermal hyperpigmentation (e.g., associated with acne) occurs when increased melanin is transferred to keratinocytes while dermal pigmentation (e.g., associated with lichen planus and cutaneous lupus erythematosus) occurs when the basement membrane is disrupted and melanin falls into the dermis and resides within melanophages.[8]

Any inflammatory disorder can be associated with PIH, including:

  • Acne vulgaris

  • Atopic dermatitis

  • Discoid lupus erythematosus

  • Erythema dyschromicum perstans

  • Fixed drug eruption

  • Generalized drug eruption

  • Idiopathic eruptive macular pigmentation

  • Impetigo

  • Insect bites

  • Irritant and allergic contact and photocontact-dermatitis

  • Lichen planus

  • Lichen simplex chronicus

  • Morphea

  • Pityriasis rosea

  • Polymorphous light eruption

  • Psoriasis

  • Trauma (i.e., burns, abrasions, postsurgical)

  • Viral exanthem


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