Post-inflammatory hyperpigmentation and acne


Post-inflammatory hyperpigmentation (HPV) is dark marks or blemishes that remain after a pimple has healed. They can often be even more annoying and disturbing than acne itself.

PIH is a change in skin color that remains after the wound has healed. This is a natural reaction of the skin to inflammation.

This article explains why these dark spots appear and what you can do to remove them.

Get Medical Information / Emily Roberts

Symptoms of HPV

PIH usually looks like a flat patch of discoloration on the skin. It can appear white, pink, red, purple, brown, or black, depending on your skin tone and the depth of discoloration.

PIH can develop on all skin types . However, in people of medium to dark complexion, it can be more severe and long-lasting. PIH affects all genders.

DermNet / CC BY-NC-ND


HPV develops when a wound or irritation, such as a scratch, rash, or pimple, causes the skin to become inflamed. As skin heals, it makes too much melanin (the protein that gives skin its color).

Excess melanin darkens and discolors the skin. This discoloration persists even after the wound has fully healed.

Most people with acne have some degree of HPV. Large pimples aren't the only cause of these spots – hyperpigmentation can appear even after relatively small pimples and blemishes .

However, the stronger the inflamed rash, the larger and darker the PIH spot can be. Also, isolating or squeezing a pimple increases the likelihood of developing HPV by increasing inflammation.

Other causes of HPV include:

Acne Scars Against PIH

You may be relieved to learn that PIHs are not real scars. In fact, people often refer to it as a "pseudo-scar" because, although it leaves a mark on the skin for a time, it does not damage the follicle.

DermNet / CC BY-NC-ND

True acne scars occur when tissue loss occurs, causing ulceration or indentation, or overgrowth of tissue, leaving a raised scar. PIH is flat. It is not pitted or raised, just darker than the surrounding skin.

Fading with time

The good news is that HPV can go away over time, even without treatment. But the main thing here is time . It can take three to 24 months for HPV to go away completely, and in some cases even longer.

The time it takes for PIH to disappear depends on how dark the spot is compared to the surrounding skin. The greater the contrast between the dark area and your natural skin tone, the longer it will take to fade.

PIH does not always go away on its own. In some cases it is more or less permanent.

Certain treatments will help. Some may not completely erase dark spots, but they can at least lighten them significantly. Therapy can also help speed up fading time if you don't want to wait for spots to clear naturally.

Treatment options

Over-the-counter (OTC) products can help remove the more subtle marks. However, for deeper brands or those that have been around for a long time, a prescription cream may be the best option. Your dermatologist has many products that can help.

If you beat acne, you will also stop developing hyperpigmentation. Therefore, getting rid of acne is an important step in the fight against HPV.

Whichever treatment option you choose, understand that improvement will take time.

Alpha hydroxy acids (AHA)

Alpha hydroxy acids , especially glycolic acid , are a good starting point for treatment. Alpha hydroxy acids (AHAs) help speed up the skin's natural exfoliation process, which can improve the appearance of PIH.

You can find these ingredients in many over-the-counter "brightening" treatments. Also, leave-in products like lotions, creams, and gels will work better than rinses like cleansers.

Other over-the-counter ingredients that can help reduce hyperpigmentation include:

The strongest AHAs are available by prescription. AHAs are also often used as anti-aging products to keep skin soft and smooth.


Hydroquinone is a widely used treatment for HPV. It is available over the counter in 1-2% strength creams and prescription 3-4% creams. Hydroquinone blocks the enzyme responsible for the production of melanin, thus brightening the skin.

These creams often contain additional brightening ingredients that can give you better results than using hydroquinone alone. Ingredients when combined with hydroquinone include:

To avoid lightening your natural complexion, only apply hydroquinone creams to dark areas.

Hydroquinone can irritate the skin in some people, so it's worth talking to your healthcare provider before starting this type of treatment.

Topical retinoids

Dermatologists often prescribe topical retinoids to treat acne. This is because retinoids help clear acne by speeding up cell renewal. This quick exfoliation can also help eliminate HPV.

Retinoid creams include:

An added benefit of retinoids is that they reduce HPV when acne breakouts are treated.

With the exception of Differin, these drugs are only available with a prescription. As with other treatments, noticeable results can take anywhere from a few weeks to several months.

Beware of excessive dryness, redness, and irritation when using these products, as this can trigger HPV.

Azelaic acid

Azelaic acid is another medicine used to treat acne and HPV. It works by reducing inflammation and accelerating the rate of cell renewal. Sometimes people use azelaic acid in conjunction with glycolic acid or tretinoin.

Several studies have shown that azelaic acid is as effective as hydroquinone in treating hyperpigmentation. Therefore, it is a good alternative for those who cannot use hydroquinone.

Azelaic acid is only available with a prescription. As always, monitor your skin for redness and irritation and tell your doctor immediately if you experience these side effects.

Treatment in the office

The most persistent cases of PIH can be treated professionally in a dermatologist's office. Treatment includes:

Treatment alone is not enough to remove hyperpigmentation. You will most likely need a series of treatments two to four weeks apart (depending on the procedure you performed). Your healthcare provider can help you determine which of these treatments, if any, will work best for you.

How to get the best results

For the best possible results, be sure to prepare the soil. There are a few things to keep in mind to prepare your skin for any treatment option.

Control your acne

Your acne must be under control before treatment. Otherwise each new pimple can cause a new dark spot and you will never get ahead of the curve (and you will never see the crisp, even skin tone you want).

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

Use sunscreen

Wear sunscreen every day. The sun can darken the spots and slow them down. Also, many PIH treatments (as well as many acne treatments) can make your skin more sensitive to the sun.

If you're concerned that sunscreen might make your breakouts worse, don't worry. There are many sunscreens available for skin prone to breakouts .

Care your skin

Check your skin for irritation. While treatments can help clear up the skin, acne and HPV treatments can also be irritating.

Unfortunately, irritated skin can lead to even darker blemishes and uneven skin tone. If HPV is a problem for you, tell your healthcare provider if your skin becomes irritated as a result of acne treatments.


PIH are dark spots left on the skin after a pimple has healed. It does not harm the skin, so the skin does not form holes or scars.

HPV usually goes away after a while without treatment, but it can take up to a couple of years. Some stains may never go away. Treatment includes over-the-counter creams, prescription drugs, and office procedures.

For the best results from your treatment, make sure your acne is under control and use a sunscreen. Monitor your skin closely for irritation during treatment.

Get the word of drug information

When you are ready to begin treatment, you have a variety of options. Be prepared to be patient. Regardless of the treatment option you choose, PIH takes a long time to go away. Think in months, not weeks. The constant and constant treatment is your friend.

Remember, this is not a complete list. Other treatments may be available, and your healthcare professional can help you choose the right treatment for your skin.

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