Overview

Post-inflammatory hyperpigmentation (PIH) is flat, discoloured skin following any inflammation or injury. It is the skin's response to damage, overproducing melanin in the affected area. PIH is significantly more common and pronounced in darker skin tones, which describes a large portion of Kuwait's population.

Symptoms

• Flat darkened patches from pink to brown or black, depending on skin tone and depth
• Appear where skin was previously inflamed or injured
• No itching or pain; worsens with sun exposure

Causes & Risk Factors

• Inflammation triggers excess melanin production
• Most common cause in GCC: acne vulgaris
• Other causes: eczema, psoriasis, insect bites, burns, cosmetic procedures
• Risk factors: darker skin tone, sun exposure post-inflammation, delayed treatment

Complications

• Prolonged or permanent dark spots without sun protection
• Worsening from inappropriate laser or chemical peel procedures on darker skin
• Significant psychological impact in cultures where clear skin is highly valued

Diagnosis

Clinical diagnosis linking dark patches to prior inflammation. Wood's lamp distinguishes epidermal from dermal PIH. Biopsy rarely needed.

Treatment

• Step 1: treat the underlying cause (control acne or eczema first)
• Topical: azelaic acid (gentle, all skin tones), niacinamide, hydroquinone 4%, tranexamic acid, vitamin C, tretinoin
• Procedures: chemical peels, microneedling, Q-switched Nd:YAG laser (safest for darker skin)
• Daily SPF 50+ sunscreen is non-negotiable

Prevention

• Treat inflammatory skin conditions early; never pick at spots, scabs, or rashes
• Apply SPF 50+ every morning and reapply every 2 hours outdoors
• Use gentle skincare products; follow aftercare instructions post-procedures

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