INTRODUCTION
Post-inflammatory hyperpigmentation (PIH) is a pigmentary disorder in which the skin develops reactive hyper melanosis due to different exogenous and endogenous factors.1 PIH is induced by an excess of melanin in the epidermis and aberrant distribution of melanin pigment.2,3 PIH affects people of all ages and affects both men and women equally.4 It is common among dark-skinned ethnic groupings like South American, African, and Asian ancestors.4 In those with darker skin, it is common to visit dermatologists.5,6 Connective tissue diseases, papulo-squamous disorders, folliculitis, eczema, and acne are all examples of inflammatory dermatoses that can lead to PIH. Skin infections (such as herpes zoster, chickenpox, and impetigo), friction, sunburn, trauma, and drug reactions can cause PIH. It also happens after various dermatological procedures like chemical peeling and laser treatment.4,7 The degree and depth of inflammation and the color of the skin are likely to influence the severity of PIH. The disease has a chronic course with irregularly shaped lesions ranging from light brown to bluish-grey.6,7
The prevention and treatment of the underlying inflammatory diseases are crucial in the management of PIH. Topical depigmenting creams, including arbutin, hydroquinone, kojic acid, and azelaic acid, have also been tried with limited success.5,7 Several non-ablative fractional laser treatment options have recently been employed to treat PIH successfully.8,9 They aid complete and quick reepithelization after causing microscopic thermal injury surrounded by normal skin by driving a robust wound healing.10,11 PIH treatment in dark-skinned patients is complex since the treatment may trigger an inflammatory response, aggravating the condition.12,13 The current review aimed to discuss the epidemiology, pathogenesis, clinical presentation, and available treatment options for the PIH.
Epidemiology
Males and females are equally affected by PIH at all ages. A higher incidence of pigmentary disorders has been observed in several global studies among South American, Asian, and African ancestry, with PIH being the most common diagnosis.14-16 In the United States, dyschromia was the second most common diagnosis among Black and Hispanic individuals, while it was not in the top ten diagnoses among Caucasians.17 Dyschromias was likewise a top ten diagnosis among Hispanics and African Americans, but not among Whites, according to the National Ambulatory Care Survey (NAMCS).18,19 People with darker skin tones (originating from Yemen) are more likely than those with lighter skin tones (from Lebanon and Syria) to express concern about PIH among Arab Americans.14 In Singapore, Malays and
The prevention and treatment of the underlying inflammatory diseases are crucial in the management of PIH. Topical depigmenting creams, including arbutin, hydroquinone, kojic acid, and azelaic acid, have also been tried with limited success.5,7 Several non-ablative fractional laser treatment options have recently been employed to treat PIH successfully.8,9 They aid complete and quick reepithelization after causing microscopic thermal injury surrounded by normal skin by driving a robust wound healing.10,11 PIH treatment in dark-skinned patients is complex since the treatment may trigger an inflammatory response, aggravating the condition.12,13 The current review aimed to discuss the epidemiology, pathogenesis, clinical presentation, and available treatment options for the PIH.
Epidemiology
Males and females are equally affected by PIH at all ages. A higher incidence of pigmentary disorders has been observed in several global studies among South American, Asian, and African ancestry, with PIH being the most common diagnosis.14-16 In the United States, dyschromia was the second most common diagnosis among Black and Hispanic individuals, while it was not in the top ten diagnoses among Caucasians.17 Dyschromias was likewise a top ten diagnosis among Hispanics and African Americans, but not among Whites, according to the National Ambulatory Care Survey (NAMCS).18,19 People with darker skin tones (originating from Yemen) are more likely than those with lighter skin tones (from Lebanon and Syria) to express concern about PIH among Arab Americans.14 In Singapore, Malays and
