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Postinflammatory hyperpigmentation in Adult
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Postinflammatory hyperpigmentation in Adult

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Contributors: Precious Cebisile Sibisi MBChB, FCDerm, MMed, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Susan Burgin MD
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Synopsis

Postinflammatory hyperpigmentation (PIH) describes localized darker skin areas as a consequence of trauma and/or inflammation. It can arise in all skin types but affects patients with darker skin phototypes with greater frequency and severity. There is no age or sex predilection.

The inflammatory process may be incited by an infection, allergy, drug reaction, mechanical or thermal injury, phototoxic eruption, or an intrinsic skin disease.

Although clinically benign, patches of PIH can cause significant cosmetic and psychosocial distress.

Inflammation may induce overproduction of melanin in the epidermis through the effect of inflammatory mediators such as metabolites of arachidonic acid and reactive oxygen species. PIH in the dermis results from damage to basal keratinocytes with release of melanin subsequently phagocytosed by dermal macrophages. Most lesions are a combination of epidermal and dermal pigmentation, the latter being more difficult to treat.

The lesions of PIH may be accentuated by sunlight.

Codes

ICD10CM:
L81.0 – Postinflammatory hyperpigmentation

SNOMEDCT:
238699007 – Post-inflammatory hyperpigmentation

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Dermatologic conditions that can cause PIH:

Inflammatory skin conditions Immunologic skin conditions Drug reactions Physical injury Dermatological procedures
  • Dermabrasion
  • Cryotherapy
  • Lasers
  • Intense pulsed light
  • Chemical peels
  • Microneedling
Neoplastic Allergy / hypersensitivity Infections Hyperpigmentation disorders that mimic PIH:
PIH must be differentiated from other hyperpigmentation conditions, especially in cases where there is no history or a visible evidence of a preceding inflammatory process.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 09/13/2019
Last Updated: 09/17/2019
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Postinflammatory hyperpigmentation in Adult
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Postinflammatory hyperpigmentation
Clinical image of Postinflammatory hyperpigmentation
Scattered, dark brown macules on the lateral chest.
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