Behandeling van Post-inflammatoire Hyperpigmentatie bij Huidaandoeningen

Summary

PIH is dark spots left on the skin after a pimple heals. It doesn't damage the skin, so it doesn't cause pits or raised scars on the skin.

PIH usually heals over time without treatment, but it can take up to a couple of years or sometimes longer. Some spots may never fade. Treatments include OTC creams, prescription medications, and in-office procedures.

To get the best results from treatment, be sure your acne is under control and use sunscreen. During treatment, carefully watch your skin for irritation.

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How to Get the Best Results

To get the best results possible, keep a few things in mind to help prepare your skin for whichever treatment you choose.

Control Your Acne

Before treatment, your acne should be under control. Otherwise, each new pimple could cause another dark spot, and you would never get ahead of the curve (and never see the clear, even skin tone you're looking for).

Over-the-counter acne products are effective for treating mild acne. However, you may need to treat more stubborn or severe breakouts with prescription acne medications if you want to see real improvement.

Use Sunscreen

Use sunscreen every day and a sunhat as well. The sun may darken the discolorations and make them fade more slowly. Plus, many PIH treatments (and many acne treatments) can make your skin more sensitive to the sun.

If you're worried that sunscreen could make your breakouts worse, don't be. There are many sunscreens for breakout-prone skin.

Monitor Your Skin

Monitor your skin for irritation. Although treatments are helping you clear your skin, acne and PIH treatments also have the potential for irritation.

Histopathology

If a biopsy is performed, epidermal PIH histopathology is significant for increased melanin in keratinocytes. The presence of melanin in dermal macrophages is noted in dermal melanosis. A biopsy may also be useful in determining the etiology of the underlying inflammation.[7][8]

Patients with PIH have a history of an inflammatory disorder of the skin or skin injury in the same distribution. Once the underlying inflammation has resolved, PIH is asymptomatic. However, psychological distress and impact on the quality of life may persist.

On physical examination, PIH appears as irregular, hyperpigmented macules or patches in the initial inflammation or injury distribution. Epidermal hyperpigmentation is tan, brown, or dark brown and may persist for months to years without treatment but does tend to improve over time as the underlying inflammatory disorder resolves. Wood’s lamp examination of epidermal PIH may reveal fluorescence. Dermal hyperpigmentation is blue-gray and may be permanent. Dermal and epidermal hyperpigmentation may both be present. If the inflammatory process is still active, erythematous papules, plaques, or nodules may also be visible.[1][7]

What Is Postinflammatory Hyperpigmentation?

Hyperpigmentation refers to dark spots or patches of skin that are darker than the surrounding area. This discoloration occurs when melanocytes, which are responsible for melanin’s production and distribution, overproduce melanin in response to inflammation.

PIH can be caused by a skin injury such as cuts and scrapes and burns, or skin conditions, infections and allergic reactions. In skin of color, the main instigators are acne, atopic dermatitis and impetigo.

The skin produces melanin as part of the healing process and is a normal response to inflammation, the greater the severity of the injury the more prominent the hyperpigmented area will be in terms of size and color.

While these hyperpigmented areas do fade with time, one study examining PIH among acne patients found it was nevertheless long lasting: at least 1 year for more than 50% of patients and 5 years or longer in 22%.

These discolored areas of skin can be exacerbated due to exposure to damaging UV rays.

In an effort to protect itself from the sun, skin activates melanogenesis, the production of melanin pigments. These pigments also have antioxidant and scavenging properties to both protect and repair the skin.

To diagnose PIH, your care provider will use a Wood’s light to examine the skin, note the color of the hyperpigmented areas and take a complete history. If necessary, a biopsy will be made.

As an immediate first step, the inflammatory condition will be treated to reduce or prevent the progression, and a specific treatment or set of treatments will be chosen.