Post-Inflammatory Hyperpigmentation

If you are after a natural home remedy (after you get your sunscreen right) try two ingredients-

Vitamin C or ascorbic acid. Do not attempt lemon or citrus juice as this makes pigment worse. Look for vitamin C serum, 10-20%, apply under sunscreen in the morning & at night.

Azelaic acid. This is derived from wheat is a safe & somewhat effective treatment for pigment. Look for 10-20% gel formulations, apply up to twice a day. It combines well with vitamin C.

Other ‘natural’ ingredients include bearberries, green tea, & licorice root extract.

The best way to treat PIH is with a combination of lasers, injectables & prescriptive skin care. We do acknowledge that most would like to try a skin care product prior to seeing us, hence here are our recommendations (skin care can work in 20-25% of PIH cases).

Azclear: is a readily available brand in Australia. It contains azelaic acid, a powerful pigment corrector with anti-inflammatory effects. Use it twice daily, great for PIH due to acne as it can also treat acne. 

MelaB3: is a new product for 2025, developed in France by La Roche Posay. It has novel ingredients to help reduce pigmentation, moderate pricing at around 60-80 AUD. Readily available in pharmacies. 

Meladerm: is a combination of topical lighteners including arbutin, kojic acid, niacinamide, vitamin C & botanicals. Use twice daily for PIH & melasma. It has no long term issues & is gentle on the skin. Mid range pricing, it can be bought online.

Lytera 2.0; by SkinMedica contains tranexamic acid topically as well as niacinamide & vitamin E. Twice daily application, it is super expensive at over $240 AUD.

If you suffer post-inflammatory hyperpigmentation due to acne, choose products aimed at treating acne. They include salicylic acid, retinol (or retinoids), azelaic acid as well as benzoyl peroxide. More on how to treat acne. 

*Our clinicians do not sell you a cream, we prescribe a tailored skincare routine consisting of a mix of pigment correctors based upon your skin type, type & depth of pigmentation, always in conjunction with lasers or novel chemical peels.

Acne induced PIH can be stubborn to manage, especially if-

• It is long lasting (greater than 6 months)
• Occurs in darker ethnic skin types
• You still have acne acne

The first step is to control your acne breakouts with medical therapy*. The best & fastest way to treat PIH due to acne (also known as grade one acne scars) is to combine pico laser with Rejuran injectables in addition to pigment corrector creams. 

The combination of pico laser & Rejuran clears the pigment in the upper & lower layers of skin, remodels the deeper layers of skin, whilst pigment correctors stop further production of melanin. In cases of extreme inflammation, we also use anti-inflammatory topicals. 

A simple DIY home treatment is as follows; 

AM: Salicylic acid wash 1.5 to 2% (Cerave or Neutrogena wash)

PM: Salicylic acid wash (as tolerated), Azelaic acid 20% applied to spots. Option for Differin Gel (can be bought online without a prescription). 

Once a week: AHA glycolic acid high strength 16-18% as tolerated. 

*For best results you must treat the cause of pigmentation. This means treating the source of acne. BHA washes, retinoids & skincare products can effectively treat 80% of acne. For resistant acne our clinical team at The Melasma Clinic can prescribe highly effective treatments to place acne into quick remission. Our dermatologist is not involved in acne treatment as this is medical. You will be referred to our physician or to another dermatologist. 

Fraxel is an awesome laser for sun damage, sun spots, age spots & freckles.

Picosure is more effective than Fraxel, has less downtime & cost less. This is why we prefer pico lasers over fractional lasers for melasma pigmentation.

Here is the check list for pigment that does not go away with treatment. 

1. Sun protection; it forms the cornerstone of treatment. Ensure you are using the correct sunscreen formulation at least twice a day. Each application should be a teaspoon to cover the head & neck.
2. Ensure the primary source of inflammation is in complete remission, for example acne or eczema.
3. Consider different lasers & pigment correctors. Pico lasers are at the forefront of pigmentation treatment. We use the pico laser in special settings that we have developed over the past 8 years. The correct combination of pigment correctors are essential for obtaining fast results.

Rejuran is a polynucleotide injectable that is frequently used to treat post-inflammatory hyperpigmentation, especially secondary to acne. It contains salmon DNA & works by increasing the collagen production in the skin, reflecting light, & reducing pigment production. 

As a guide-

• Rejuran is a DNA extract
• Requires 2-4 sessions
• Best combined with pico lasers
• Cost $690-990 per session
• Has less side effects compared to dermal fillers

Pico lasers, in the correct settings, offer twice the speed of pigmentation clearance as compared to older nano or Q switch lasers. The downside is that pico lasers cost more, hence why older technology is frequently used in third world countries.

Post-inflammatory HYPO pigmentation is the opposite of hyper pigmentation, namely lighter areas compared to darker areas in HYPER pigmentation. This follows a totally different algorithm. Here are some facts-

Hypopigmentation means less pigmentation.

• Treatments are aimed at stimulation of pigment cells. 
• Stimulation of pigment cells means MORE melanin.
• Stimulation can be achieved via at-home treatments such as microneedling & topicals such as Bimatoprost or tacrolimus.
• CO2 fractional lasers can be effective, especially if combined with the above.

If HYPO does not respond to the above treatments, melanocyte transfer may be an option. This is a complex process that requires harvesting of pigment cells from a donor site (usually thigh, arm or back of the ear). We then have to process these cells via micrografting or ReCell.

The hypopigmented area requires preparation before the donor cells are repositioned. Pigment production may take 6 to 18 months to occur, often with accessory stimulation using excimer 308 lasers or narrowband phototherapy. Pigment transfer is a surgical process that requires co-ordination of a surgical team. 

Supplements in the scheme of things play a very small role in lightening pigmentation due to inflammation, however if you would like to give this a try, here is the ultimate guide-

• Glutathione 500 mg tablet twice a day
• Polypodium extract 480 mg twice to three times a day

Eat a diet high in antioxidants including green leafy vegetables, fish, nuts & legumes.

Exosomes can potentially improve pigmentation including melasma & post inflammatory hyperpigmentation. Compared to injectables like Rejuran & pico lasers, exosomes are very slow to give results. We employ them in resistant cases of pigmentation. 

Here are the facts

• Exosomes need to penetrate the upper layers of skin to be effective
• They are best delivered via microneedling, RF microneedling or injections
• Exosomes have no side effects
• They require 2-4 sessions, spaced 3-7 weeks apart
• Compared to lasers exosomes are inefficient 

Four primary reasons. 

Firstly, you are getting too much sun. Learn to use the right formulation of sunscreen in the correct dose & frequency. If you don’t get this right, you will be spending a lot of time, effort & money on trying to treat pigment with no success. 

Secondly, apply the correct treatment combination of lasers, creams & peels. 

Thirdly, treat the primary source of inflammation. The most common is acne as this leads to more post inflammatory hyperpigmentation. Acne is the most common cause. 

Finally & most importantly, ensure that the diagnosis is correct. There are over 150 causes of pigmentation, finding the cause provides an avenue for treatment.