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Postinflammatory hyperpigmentation in Adult
Other Resources UpToDate PubMed

Postinflammatory hyperpigmentation in Adult

Contributors: Precious Cebisile Sibisi MBChB, FCDerm, MMed, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Oyetewa Oyerinde MD, Callyn Iwuala MD, Susan Burgin MD
Other Resources UpToDate PubMed

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
  • Acne vulgaris
  • Atopic dermatitis and other eczematous eruptions
  • Psoriasis
  • Lichen planus
  • Lichen planus pigmentosus
  • Ashy dermatosis
  • Pityriasis rosea
  • Lichen simplex chronicus
Immunologic skin conditions
  • Systemic lupus erythematosus
  • Sarcoidosis
  • Dermatomyositis
  • Immunobullous disorders (eg, Pemphigus vulgaris, Bullous pemphigoid)
  • Scleroderma and Morphea
Drug reactions
  • Drug-induced phototoxic reaction (from Minocycline drug-induced pigmentation, Amiodarone drug-induced pigmentation, or chemotherapy)
  • Fixed drug eruption
  • Drug-induced flagellate pigmentation (from bleomycin)
  • Erythema multiforme and Stevens-Johnson syndrome (from antibiotics, antiepileptic drugs, antituberculosis drugs, and NSAIDs)
Physical injury
  • Minor abrasions and cuts
  • Burns
  • Friction
  • Radiation (see Radiation dermatitis)
Dermatological procedures
  • Dermabrasion
  • Cryotherapy
  • Lasers
  • Intense pulsed light
  • Chemical peels
  • Microneedling
Neoplastic
  • Cutaneous T-cell lymphoma
Allergy / hypersensitivity
  • Arthropod bite or sting
  • Papular urticaria
  • Allergic contact dermatitis
  • Polymorphous light eruption
  • Pigmented contact dermatitis (Riehl melanosis)
Infections
  • Viral (eg, Herpes simplex virus, Herpes zoster, Viral exanthem, Molluscum contagiosum)
  • Bacteria (eg, Bullous impetigo)
  • Fungal (eg, Tinea corporis, Tinea versicolor)
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.
  • Melasma – commonly associated with hormonal changes in women (eg, pregnancy, oral contraceptive pills, perimenopause)
  • Drug-induced pigmentation – common drugs include antimalarials, Amiodarone drug-induced pigmentation, chemotherapy drugs, heavy metals
  • Addison disease due to adrenal insufficiency
  • Acanthosis nigricans – commonly localized to knuckles, neck, axillae, and inner thighs; velvety appearance; related to insulin resistance and obesity
  • Ultraviolet (UV)-induced tanning
  • Exogenous ochronosis
  • Periorbital hyperpigmentation
  • Idiopathic eruptive macular pigmentation

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Therapy

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References

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Last Reviewed:09/12/2019
Last Updated:11/05/2019
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Postinflammatory hyperpigmentation in Adult
A medical illustration showing key findings of Postinflammatory hyperpigmentation
Clinical image of Postinflammatory hyperpigmentation - imageId=815538. Click to open in gallery.  caption: 'Scattered, dark brown macules on the lateral chest.'
Scattered, dark brown macules on the lateral chest.
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