Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment

  • Bridget P. Kaufman
  • Taulun Aman
  • Andrew F. Alexis
Review Article


Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of PIH include intrinsic skin conditions (e.g., acne and eczema) as well as external insults to the skin, such as burn injuries and dermatologic procedures. PIH more commonly occurs in individuals with darker skin, for whom it is often a source of significant psychological distress. Several therapeutic modalities are available for the treatment of PIH, including topical agents, chemical peels, and energy-based devices. We review the epidemiology, clinical presentation, pathogenesis, and treatment of PIH.


Compliance with Ethical Standards

Conflicts of interest

Dr. Kaufman and Ms. Aman have no conflicts of interest or financial disclosures to report. Dr. Alexis reports the following conflicts of interest and financial disclosures: grant to institution for clinical trial (Allergan) and honoraria for advisory board/consulting (Galderma and Allergan).


No sources of funding were used to conduct this study or prepare this manuscript.


  1. 1.
    Halder RM, Nootheti PK. Ethnic skin disorders overview. J Am Acad Dermatol. 2003;48(6 Suppl):S143–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Taylor S, Grimes P, Lim J, Im S, Lui H. Postinflammatory hyperpigmentation. J Cutan Med Surg. 2009;13(4):183–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Lacz NL, Vafaie J, Kihiczak NI, Schwartz RA. Postinflammatory hyperpigmentation: a common but troubling condition. Int J Dermatol. 2004;43(5):362–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Darji K, Varade R, West D, Armbrecht ES, Guo MA. Psychosocial impact of postinflammatory hyperpigmentation in patients with acne vulgaris. J Clin Aesthet Dermatol. 2017;10(5):18–23.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Joshi SS, Boone SL, Alam M, Yoo S, White L, Rademaker A, et al. Effectiveness, safety, and effect on quality of life of topical salicylic acid peels for treatment of postinflammatory hyperpigmentation in dark skin. Dermatol Surg. 2009;35(4):638–44 (discussion 44).PubMedCrossRefGoogle Scholar
  6. 6.
    Callender VD, Alexis AF, Daniels SR, Kawata AK, Burk CT, Wilcox TK, et al. Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne. J Clin Aesthet Dermatol. 2014;7(7):19–31.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Park JH, Kim JI, Kim WS. Treatment of persistent facial postinflammatory hyperpigmentation with novel pulse-in-pulse mode intense pulsed light. Dermatol Surg. 2016;42(2):218–24.PubMedCrossRefGoogle Scholar
  8. 8.
    El-Essawi D, Musial JL, Hammad A, Lim HW. A survey of skin disease and skin-related issues in Arab Americans. J Am Acad Dermatol. 2007;56(6):933–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sanchez MR. Cutaneous diseases in Latinos. Dermatol Clin. 2003;21(4):689–97.PubMedCrossRefGoogle Scholar
  10. 10.
    Dunwell P, Rose A. Study of the skin disease spectrum occurring in an Afro-Caribbean population. Int J Dermatol. 2003;42(4):287–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80(5):387–94.PubMedGoogle Scholar
  12. 12.
    Davis SA, Narahari S, Feldman SR, Huang W, Pichardo-Geisinger RO, McMichael AJ. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11(4):466–73.PubMedGoogle Scholar
  13. 13.
    Balkrishnan R, Feldman SR, McMichael AJ, DeHart KE, Cayce K, Fleischer AB Jr. Racial differences in the treatment of pigmentation disorders in outpatient settings: analysis of US national practice data. J Dermatol Treat. 2004;15(4):227–30.CrossRefGoogle Scholar
  14. 14.
    Chua-Ty G, Goh CL, Koh SL. Pattern of skin diseases at the National Skin Centre (Singapore) from 1989–1990. Int J Dermatol. 1992;31(8):555–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Pandya AG, Guevara IL. Disorders of hyperpigmentation. Dermatol Clin. 2000;18(1):91–98 ix.PubMedCrossRefGoogle Scholar
  16. 16.
    Ruiz-Maldonado R, Orozco-Covarrubias ML. Postinflammatory hypopigmentation and hyperpigmentation. Semin Cutan Med Surg. 1997;16(1):36–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Imokawa G, Yada Y, Miyagishi M. Endothelins secreted from human keratinocytes are intrinsic mitogens for human melanocytes. J Biol Chem. 1992;267(34):24675–80.PubMedGoogle Scholar
  18. 18.
    Callender VD, St Surin-Lord S, Davis EC, Maclin M. Postinflammatory hyperpigmentation: etiologic and therapeutic considerations. Am J Clin Dermatol. 2011;12(2):87–99.PubMedCrossRefGoogle Scholar
  19. 19.
    Savory SA, Agim NG, Mao R, Peter S, Wang C, Maldonado G, et al. Reliability assessment and validation of the postacne hyperpigmentation index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris. J Am Acad Dermatol. 2014;70(1):108–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Grimes P, Callender V. Tazarotene cream for postinflammatory hyperpigmentation and acne vulgaris in darker skin: a double-blind, randomized, vehicle-controlled study. Cutis. 2006;77(1):45–50.PubMedGoogle Scholar
  21. 21.
    Grimes PE. A microsponge formulation of hydroquinone 4% and retinol 0.15% in the treatment of melasma and postinflammatory hyperpigmentation. Cutis. 2004;74(6):362–8.PubMedGoogle Scholar
  22. 22.
    Bulengo-Ransby SM, Griffiths CE, Kimbrough-Green CK, Finkel LJ, Hamilton TA, Ellis CN, et al. Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients. N Engl J Med. 1993;328(20):1438–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Lowe NJ, Rizk D, Grimes P, Billips M, Pincus S. Azelaic acid 20% cream in the treatment of facial hyperpigmentation in darker-skinned patients. Clin Ther. 1998;20(5):945–59.PubMedCrossRefGoogle Scholar
  24. 24.
    Isedeh P, Kohli I, Al-Jamal M, Agbai ON, Chaffins M, Devpura S, et al. An in vivo model for postinflammatory hyperpigmentation: an analysis of histological, spectroscopic, colorimetric and clinical traits. Br J Dermatol. 2016;174(4):862–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Cook-Bolden F. The efficacy and tolerability of combination cream containing 4% hydroquinone in the treatment of postinflammatory hyperpigmentation in skin types IV–VI. Cosmetic Dermatol. 2004;17:149–55.Google Scholar
  26. 26.
    Park JY, Park JH, Kim SJ, Kwon JE, Kang HY, Lee ES, et al. Two histopathological patterns of postinflammatory hyperpigmentation: epidermal and dermal. J Cutan Pathol. 2017;44(2):118–24.PubMedCrossRefGoogle Scholar
  27. 27.
    Grimes PE. Management of hyperpigmentation in darker racial ethnic groups. Semin Cutan Med Surg. 2009;28(2):77–85.PubMedCrossRefGoogle Scholar
  28. 28.
    Medrano EE, Farooqui JZ, Boissy RE, Boissy YL, Akadiri B, Nordlund JJ. Chronic growth stimulation of human adult melanocytes by inflammatory mediators in vitro: implications for nevus formation and initial steps in melanocyte oncogenesis. Proc Natl Acad Sci USA. 1993;90(5):1790–4.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Tomita Y, Maeda K, Tagami H. Melanocyte-stimulating properties of arachidonic acid metabolites: possible role in postinflammatory pigmentation. Pigment Cell Res. 1992;5(5 Pt 2):357–61.PubMedCrossRefGoogle Scholar
  30. 30.
    Epstein JH. Postinflammatory hyperpigmentation. Clin Dermatol. 1989;7(2):55–65.PubMedCrossRefGoogle Scholar
  31. 31.
    Ebihara T, Nakayama H. Pigmented contact dermatitis. Clin Dermatol. 1997;15(4):593–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Taylor SC, Cook-Bolden F, Rahman Z, Strachan D. Acne vulgaris in skin of color. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S98–106.PubMedCrossRefGoogle Scholar
  33. 33.
    Halder RM, Holmes YC, Bridgeman-Shah S, Kligman AM. A clinicohistopathological study of acne vulgaris in black females. J Invest Dermatol. 1996;106:888 [abstract 495].Google Scholar
  34. 34.
    Yin NC, McMichael AJ. Acne in patients with skin of color: practical management. Am J Clin Dermatol. 2014;15(1):7–16.PubMedCrossRefGoogle Scholar
  35. 35.
    Shah SK, Alexis AF. Acne in skin of color: practical approaches to treatment. J Dermatolog Treat. 2010;21(3):206–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Perry PK, Cook-Bolden FE, Rahman Z, Jones E, Taylor SC. Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S113–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Seghers AC, Lee JS, Tan CS, Koh YP, Ho MS, Lim YL, et al. Atopic dirty neck or acquired atopic hyperpigmentation? An epidemiological and clinical study from the National Skin Centre in Singapore. Dermatology. 2014;229(3):174–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16–24.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Alexis AF, Coley MK, Nijhawan RI, Luke JD, Shah SK, Argobi YA, et al. Nonablative fractional laser resurfacing for acne scarring in patients with fitzpatrick skin phototypes IV–VI. Dermatol Surg. 2016;42(3):392–402.PubMedCrossRefGoogle Scholar
  40. 40.
    Tanzi EL, Alster TS. Treatment of atrophic facial acne scars with a dual-mode Er: YAG laser. Dermatol Surg. 2002;28(7):551–5.PubMedGoogle Scholar
  41. 41.
    Tanzi EL, Alster TS. Side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet laser skin resurfacing: extended experience with 50 patients. Plast Reconstr Surg. 2003;111(4):1524–9 (discussion 30–2).PubMedCrossRefGoogle Scholar
  42. 42.
    Chan HH, Manstein D, Yu CS, Shek S, Kono T, Wei WI. The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med. 2007;39(5):381–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Kono T, Chan HH, Groff WF, Manstein D, Sakurai H, Takeuchi M, et al. Prospective direct comparison study of fractional resurfacing using different fluences and densities for skin rejuvenation in Asians. Lasers Surg Med. 2007;39(4):311–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Kato H, Araki J, Eto H, Doi K, Hirai R, Kuno S, et al. A prospective randomized controlled study of oral tranexamic acid for preventing postinflammatory hyperpigmentation after Q-switched ruby laser. Dermatol Surg. 2011;37(5):605–10.PubMedCrossRefGoogle Scholar
  45. 45.
    McDaniel DH. Use of oral therapy for the prevention of postinflammatory hyperpigmentation. Dermatol Surg. 2011;37(5):611.PubMedCrossRefGoogle Scholar
  46. 46.
    Cheyasak N, Manuskiatti W, Maneeprasopchoke P, Wanitphakdeedecha R. Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians. Acta Derm Venereol. 2015;95(2):201–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Park GH, Rhee do Y, Moon HR, Won CH, Lee MW, Choi JH, et al. Effect of an epidermal growth factor-containing cream on postinflammatory hyperpigmentation after Q-switched 532-nm neodymium-doped yttrium aluminum garnet laser treatment. Dermatol Surg. 2015;41(1):131–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Clark CM, Silverberg JI, Alexis AF. A retrospective chart review to assess the safety of nonablative fractional laser resurfacing in Fitzpatrick skin types IV to VI. J Drugs Dermatol. 2013;12(4):428–31.PubMedGoogle Scholar
  49. 49.
    Kaushik SB, Alexis AF. Nonablative fractional laser resurfacing in skin of color: evidence-based review. J Clin Aesthet Dermatol. 2017;10(6):51–67.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Alexis AF. Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI. Br J Dermatol. 2013;169(Suppl 3):91–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Draelos Z. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser for melasma with pre- or post-treatment triple combination cream. Dermatol Surg. 2011;37(1):126–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Kim S, Cho KH. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg. 2010;36(9):1374–80.PubMedCrossRefGoogle Scholar
  53. 53.
    Negishi K, Akita H, Tanaka S, Yokoyama Y, Wakamatsu S, Matsunaga K. Comparative study of treatment efficacy and the incidence of post-inflammatory hyperpigmentation with different degrees of irradiation using two different quality-switched lasers for removing solar lentigines on Asian skin. J Eur Acad Dermatol Venereol. 2013;27(3):307–12.PubMedCrossRefGoogle Scholar
  54. 54.
    Kang HJ, Na JI, Lee JH, Roh MR, Ko JY, Chang SE. Postinflammatory hyperpigmentation associated with treatment of solar lentigines using a Q-Switched 532-nm Nd: YAG laser: a multicenter survey. J Dermatol Treat. 2017;28(5):447–51.CrossRefGoogle Scholar
  55. 55.
    Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg. 1998;24(3):315–20.PubMedCrossRefGoogle Scholar
  56. 56.
    Al-Waiz MM, Al-Sharqi AI. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg. 2002;28(5):383–7.PubMedGoogle Scholar
  57. 57.
    Salam A, Dadzie OE, Galadari H. Chemical peeling in ethnic skin: an update. Br J Dermatol. 2013;169(Suppl 3):82–90.PubMedCrossRefGoogle Scholar
  58. 58.
    Kodali S, Guevara IL, Carrigan CR, Daulat S, Blanco G, Boker A, et al. A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women. J Am Acad Dermatol. 2010;63(6):1030–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Dainichi T, Ueda S, Imayama S, Furue M. Excellent clinical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehicle. Dermatol Surg. 2008;34(7):891–9 (discussion 9).PubMedGoogle Scholar
  60. 60.
    Abdel Meguid AM, Elaziz Ahmed Attallah DA, Omar H. Trichloroacetic acid versus salicylic acid in the treatment of acne vulgaris in dark-skinned patients. Dermatol Surg. 2015;41(12):1398–404.PubMedCrossRefGoogle Scholar
  61. 61.
    Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25(1):18–22.PubMedCrossRefGoogle Scholar
  62. 62.
    Wang CM, Huang CL, Hu CT, Chan HL. The effect of glycolic acid on the treatment of acne in Asian skin. Dermatol Surg. 1997;23(1):23–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Garg VK, Sarkar R, Agarwal R. Comparative evaluation of beneficiary effects of priming agents (2% hydroquinone and 0.025% retinoic acid) in the treatment of melasma with glycolic acid peels. Dermatol Surg. 2008;34(8):1032–9 (discussion 340).PubMedGoogle Scholar
  64. 64.
    Sharad J. Glycolic acid peel therapy—a current review. Clin Cosmet Investig Dermatol. 2013;11(6):281–8.CrossRefGoogle Scholar
  65. 65.
    Sarkar R, Garg V, Bansal S, Sethi S, Gupta C. Comparative evaluation of efficacy and tolerability of glycolic acid, salicylic mandelic acid, and phytic acid combination peels in melasma. Dermatol Surg. 2016;42(3):384–91.PubMedCrossRefGoogle Scholar
  66. 66.
    Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D. Acne scarring treatment using skin needling. Clin Exp Dermatol. 2009;34(8):874–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Leheta T, El Tawdy A, Abdel Hay R, Farid S. Percutaneous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg. 2011;37(2):207–16.PubMedCrossRefGoogle Scholar
  68. 68.
    Majid I. Microneedling therapy in atrophic facial scars: an objective assessment. J Cutan Aesthet Surg. 2009;2(1):26–30.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol. 2011;10(4):317–23.PubMedCrossRefGoogle Scholar
  70. 70.
    Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol. 2014;13(3):180–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Leheta TM, Abdel Hay RM, El Garem YF. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatol Treat. 2014;25(2):130–6.CrossRefGoogle Scholar
  72. 72.
    Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20–31.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Halder R, Munhutu M, Foltis P, Battie C, Verschoore M, Oresajo C. Evaluation and effectiveness of photoprotection composition (sunscreen) on subjects of skin of color (abstract). J Am Acad Dermatol. 2015;72(5 Suppl):AB215.Google Scholar
  74. 74.
    Maymone MBC, Neamah HH, Wirya SA, Patzelt NM, Zancanaro PQ, Vashi NA. Sun-protective behaviors in patients with cutaneous hyperpigmentation: a cross-sectional study. J Am Acad Dermatol. 2017;76(5):841–846.e2.PubMedCrossRefGoogle Scholar
  75. 75.
    Callender VD, Young CM, Kindred C, Taylor SC. Efficacy and safety of clindamycin phosphate 1.2% and tretinoin 0.025% gel for the treatment of acne and acne-induced post-inflammatory hyperpigmentation in patients with skin of color. J Clin Aesthet Dermatol. 2012;5(7):25–32.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Kircik LH. Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study. J Drugs Dermatol. 2011;10(6):586–90.PubMedGoogle Scholar
  77. 77.
    Halder RM. The role of retinoids in the management of cutaneous conditions in blacks. J Am Acad Dermatol. 1998;39(2 Pt 3):S98–103.PubMedCrossRefGoogle Scholar
  78. 78.
    Czernielewski J, Poncet M, Mizzi F. Efficacy and cutaneous safety of adapalene in black patients versus white patients with acne vulgaris. Cutis. 2002;70(4):243–8.PubMedGoogle Scholar
  79. 79.
    Zhu XJ, Tu P, Zhen J, Duan YQ. Adapalene gel 0.1%: effective and well tolerated in the topical treatment of acne vulgaris in Chinese patients. Cutis. 2001;68(4 Suppl):55–9.PubMedGoogle Scholar
  80. 80.
    Taylor SC. Utilizing combination therapy for ethnic skin. Cutis. 2007;80(1 Suppl):15–20.PubMedGoogle Scholar
  81. 81.
    Eichenfield LF, Krakowski AC. Moderate to severe acne in adolescents with skin of color: benefits of a fixed combination clindamycin phosphate 1.2% and benzoyl peroxide 2.5% aqueous gel. J Drugs Dermatol. 2012;11(7):818–24.PubMedGoogle Scholar
  82. 82.
    Cook-Bolden FE. Treatment of moderate to severe acne vulgaris in a Hispanic population: a post-hoc analysis of efficacy and tolerability of clindamycin phosphate 1.2%/benzoyl peroxide 2.5% gel. J Drugs Dermatol. 2012;11(4):455–9.PubMedGoogle Scholar
  83. 83.
    Callender VD. Fitzpatrick skin types and clindamycin phosphate 1.2%/benzoyl peroxide gel: efficacy and tolerability of treatment in moderate to severe acne. J Drugs Dermatol. 2012;11(5):643–8.PubMedGoogle Scholar
  84. 84.
    Schlessinger J, Menter A, Gold M, Leonardi C, Eichenfield L, Plott RT, et al. Clinical safety and efficacy studies of a novel formulation combining 1.2% clindamycin phosphate and 0.025% tretinoin for the treatment of acne vulgaris. J Drugs Dermatol. 2007;6(6):607–15.PubMedGoogle Scholar
  85. 85.
    Alexis AF, Burgess C, Callender VD, Herzog JL, Roberts WE, Schweiger ES, et al. The efficacy and safety of topical dapsone gel, 5% for the treatment of acne vulgaris in adult females with skin of color. J Drugs Dermatol. 2016;15(2):197–204.PubMedGoogle Scholar
  86. 86.
    Jacyk WK. Adapalene in the treatment of African patients. J Eur Acad Dermatol Venereol. 2001;15(Suppl 3):37–42.PubMedCrossRefGoogle Scholar
  87. 87.
    Palumbo A, d’Ischia M, Misuraca G, Prota G. Mechanism of inhibition of melanogenesis by hydroquinone. Biochem Biophys Acta. 1991;1073(1):85–90.PubMedCrossRefGoogle Scholar
  88. 88.
    Halder RM, Richards GM. Topical agents used in the management of hyperpigmentation. Skin Therapy Lett. 2004;9(6):1–3.PubMedGoogle Scholar
  89. 89.
    Cook-Bolden FE, Hamilton SF. An open-label study of the efficacy and tolerability of microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants for the treatment of hyperpigmentation. Cutis. 2008;81(4):365–71.PubMedGoogle Scholar
  90. 90.
    Baumann L, Grimes P, Pandya A. Triple combination cream is an effective treatment for post-inflammatory hyperpigmentation. In: Presented at the 65th Annual American Academy of Dermatology conference. 2007 February 3–5; Washington, DC.Google Scholar
  91. 91.
    Simmons BJ, Griffith RD, Bray FN, Falto-Aizpurua LA, Nouri K. Exogenous ochronosis: a comprehensive review of the diagnosis, epidemiology, causes, and treatments. Am J Clin Dermatol. 2015;16(3):205–12.PubMedCrossRefGoogle Scholar
  92. 92.
    Kang HY, Valerio L, Bahadoran P, Ortonne JP. The role of topical retinoids in the treatment of pigmentary disorders: an evidence-based review. Am J Clin Dermatol. 2009;10(4):251–60.PubMedCrossRefGoogle Scholar
  93. 93.
    Elias PM. Epidermal effects of retinoids: supramolecular observations and clinical implications. J Am Acad Dermatol. 1986;15(4 Pt 2):797–809.PubMedCrossRefGoogle Scholar
  94. 94.
    Taylor S, Callender V. A multicenter, 12-week, phase 3b trial: a combination solution of mequinol 2%/tretinon 0.01% vs. hydroquinone 4% cream in the treatment of mild to moderate postinflammatory hyperpigmentation [Abstract]. J Am Acad Dermatol. 2006;54:AB194.CrossRefGoogle Scholar
  95. 95.
    Yoshimura K, Harii K, Aoyama T, Iga T. Experience with a strong bleaching treatment for skin hyperpigmentation in orientals. Plast Reconstr Surg. 2000;105(3):1097–108.PubMedCrossRefGoogle Scholar
  96. 96.
    Schulte BC, Wu W, Rosen T. Azelaic acid: evidence-based update on mechanism of action and clinical application. J Drugs Dermatol. 2015;14(9):964–8.PubMedGoogle Scholar
  97. 97.
    Schallreuter KU, Wood JW. A possible mechanism of action for azelaic acid in the human epidermis. Arch Dermatol Res. 1990;282(3):168–71.PubMedCrossRefGoogle Scholar
  98. 98.
    Breathnach AS, Nazzaro-Porro M, Passi S. Azelaic acid. Br J Dermatol. 1984;111(1):115–20.PubMedCrossRefGoogle Scholar
  99. 99.
    Nguyen QH, Bui TP. Azelaic acid: pharmacokinetic and pharmacodynamic properties and its therapeutic role in hyperpigmentary disorders and acne. Int J Dermatol. 1995;34(2):75–84.PubMedCrossRefGoogle Scholar
  100. 100.
    Kakita LS, Lowe NJ. Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone. Clin Ther. 1998;20(5):960–70.PubMedCrossRefGoogle Scholar
  101. 101.
    Alexis AF, Blackcloud P. Natural ingredients for darker skin types: growing options for hyperpigmentation. J Drugs Dermatol. 2013;12(9 Suppl):s123–7.PubMedGoogle Scholar
  102. 102.
    Nestor M, Bucay V, Callender V, Cohen JL, Sadick N, Waldorf H. Polypodium leucotomos as an adjunct treatment of pigmentary disorders. J Clin Aesthet Dermatol. 2014;7(3):13–7.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Lim JT. Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatol Surg. 1999;25(4):282–4.PubMedCrossRefGoogle Scholar
  104. 104.
    Garcia A, Fulton JE Jr. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg. 1996;22(5):443–7.PubMedCrossRefGoogle Scholar
  105. 105.
    Amer M, Metwalli M. Topical liquiritin improves melasma. Int J Dermatol. 2000;39(4):299–301.PubMedCrossRefGoogle Scholar
  106. 106.
    Boissy RE, Visscher M, DeLong MA. DeoxyArbutin: a novel reversible tyrosinase inhibitor with effective in vivo skin lightening potency. Exp Dermatol. 2005;14(8):601–8.PubMedCrossRefGoogle Scholar
  107. 107.
    Hakozaki T, Minwalla L, Zhuang J, Chhoa M, Matsubara A, Miyamoto K, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20–31.PubMedCrossRefGoogle Scholar
  108. 108.
    Jerajani HR, Mizoguchi H, Li J, Whittenbarger DJ, Marmor MJ. The effects of a daily facial lotion containing vitamins B3 and E and provitamin B5 on the facial skin of Indian women: a randomized, double-blind trial. Indian J Dermatol Venereol Leprol. 2010;76(1):20–6.PubMedCrossRefGoogle Scholar
  109. 109.
    Navarrete-Solis J, Castanedo-Cazares JP, Torres-Alvarez B, Oros-Ovalle C, Fuentes-Ahumada C, Gonzalez FJ, et al. A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatol Res Pract. 2011;2011:379173.PubMedPubMedCentralGoogle Scholar
  110. 110.
    Kimball AB, Kaczvinsky JR, Li J, Robinson LR, Matts PJ, Berge CA, et al. Reduction in the appearance of facial hyperpigmentation after use of moisturizers with a combination of topical niacinamide and N-acetyl glucosamine: results of a randomized, double-blind, vehicle-controlled trial. Br J Dermatol. 2010;162(2):435–41.PubMedCrossRefGoogle Scholar
  111. 111.
    Draelos ZD, Carter E, Maloney JM, Elewski B, Poulin Y, Lynde C, et al. Two randomized studies demonstrate the efficacy and safety of dapsone gel, 5% for the treatment of acne vulgaris. J Am Acad Dermatol. 2007;56(3):439.e1–510.e1.CrossRefGoogle Scholar
  112. 112.
    Espinal-Perez LE, Moncada B, Castanedo-Cazares JP. A double-blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma. Int J Dermatol. 2004;43(8):604–7.PubMedCrossRefGoogle Scholar
  113. 113.
    Taylor MB, Yanaki JS, Draper DO, Shurtz JC, Coglianese M. Successful short-term and long-term treatment of melasma and postinflammatory hyperpigmentation using vitamin C with a full-face iontophoresis mask and a mandelic/malic acid skin care regimen. J Drugs Dermatol. 2013;12(1):45–50.PubMedGoogle Scholar
  114. 114.
    Lee SJ, Hossaine MD, Park SC. A potential anti-inflammation activity and depigmentation effect of Lespedeza bicolor extract and its fractions. Saudi J Biol Sci. 2016;23(1):9–14.PubMedCrossRefGoogle Scholar
  115. 115.
    Tanzi EL, Alster TS. Cutaneous laser surgery in darker skin phototypes. Cutis. 2004;73(1):21–4 (7–30).PubMedGoogle Scholar
  116. 116.
    Park KY, Choi SY, Mun SK, Kim BJ, Kim MN. Combined treatment with 578-/511-nm copper bromide laser and light-emitting diodes for post-laser pigmentation: a report of two cases. Dermatol Ther. 2014;27(2):121–5.PubMedCrossRefGoogle Scholar
  117. 117.
    Ho WS, Chan HH, Ying SY, Chan PC, Burd A, King WW. Prospective study on the treatment of postburn hyperpigmentation by intense pulsed light. Lasers Surg Med. 2003;32(1):42–5.PubMedCrossRefGoogle Scholar
  118. 118.
    Cho SB, Park SJ, Kim JS, Kim MJ, Bu TS. Treatment of post-inflammatory hyperpigmentation using 1064-nm Q-switched Nd: YAG laser with low fluence: report of three cases. J Eur Acad Dermatol Venereol. 2009;23(10):1206–7. Scholar
  119. 119.
    Zawar VP, Agarwal M, Vasudevan B. Treatment of postinflammatory pigmentation due to acne with Q-Switched neodymium-doped yttrium aluminum garnet in 78 Indian cases. J Cutan Aesthet Surg. 2015;8(4):222–6.PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Stratigos AJ, Dover JS, Arndt KA. Laser treatment of pigmented lesions–2000: how far have we gone? Arch Dermatol. 2000;136(7):915–21.PubMedCrossRefGoogle Scholar
  121. 121.
    Katz TM, Goldberg LH, Firoz BF, Friedman PM. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation. Dermatol Surg. 2009;35(11):1844–8.PubMedCrossRefGoogle Scholar
  122. 122.
    Rokhsar CK, Ciocon DH. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation after carbon dioxide laser resurfacing. Dermatol Surg. 2009;35(3):535–7.PubMedCrossRefGoogle Scholar
  123. 123.
    Kim S, Cho KH. Treatment of procedure-related postinflammatory hyperpigmentation using 1064-nm Q-switched Nd: YAG laser with low fluence in Asian patients: report of five cases. J Cosmet Dermatol. 2010;9(4):302–6.PubMedCrossRefGoogle Scholar
  124. 124.
    Lee YB, Park SM, Kim JW, Yu DS. Combination treatment of low-fluence Q-switched Nd: YAG laser and oral tranexamic acid for post-inflammatory hyperpigmentation due to allergic contact dermatitis to henna hair dye. J Cosmet Laser Ther. 2016;18(2):95–7.PubMedCrossRefGoogle Scholar
  125. 125.
    Agbai O, Hamzavi I, Jagdeo J. Laser treatments for postinflammatory hyperpigmentation: a systematic review. JAMA Dermatol. 2017;153(2):199–206. CrossRefGoogle Scholar
  126. 126.
    Ho SG, Yeung CK, Chan NP, Shek SY, Kono T, Chan HH. A retrospective analysis of the management of acne post-inflammatory hyperpigmentation using topical treatment, laser treatment, or combination topical and laser treatments in oriental patients. Lasers Surg Med. 2011;43(1):1–7.PubMedCrossRefGoogle Scholar
  127. 127.
    Kopera D, Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation. Dermatol Surg. 1995;21(11):994.PubMedCrossRefGoogle Scholar
  128. 128.
    Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol. 1994;20(9):592–7.PubMedCrossRefGoogle Scholar
  129. 129.
    Mitra A, Yeung R, Sheehan-Dare R, Wilson CL. Lentiginous hyperpigmentation confined to resolved psoriatic plaques and treated with a Q-switched ruby laser. Clin Exp Dermatol. 2006;31(2):298–9.PubMedCrossRefGoogle Scholar
  130. 130.
    Lee SJ, Chung WS, Lee JD, Kim HS. A patient with cupping-related post-inflammatory hyperpigmentation successfully treated with a 1,927 nm thulium fiber fractional laser. J Cosmet Laser Ther. 2014;16(2):66–8.PubMedCrossRefGoogle Scholar
  131. 131.
    Cho SB, Lee SJ, Kang JM, Kim YK, Oh SH. Treatment of refractory arcuate hyperpigmentation using a fractional photothermolysis system. J Dermatolog Treat. 2010;21(2):107–8.PubMedCrossRefGoogle Scholar
  132. 132.
    Waibel J, Wasserman D, Houshmand E, Tierney E. Treatment of post-inflammatory hyperpigmentation with 1927 nm thulium fractional laser [abstract]. Lasers Surg Med. 2011;43:986.Google Scholar
  133. 133.
    Kroon MW, Wind BS, Meesters AA, Wolkerstorfer A, van der Veen JP, Bos JD, et al. Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study. J Dermatol Treat. 2012;23(5):339–44.CrossRefGoogle Scholar
  134. 134.
    Oram Y, Akkaya AD. Refractory postinflammatory hyperpigmentation treated fractional CO2 laser. J Clin Aesthet Dermatol. 2014;7(3):42–4.PubMedPubMedCentralGoogle Scholar
  135. 135.
    Augustyniak A, Erkiert-Polguj A, Rotsztejn H. Variable pulsed light treatment of melasma and post-inflammatory hyperpigmentation—a pilot study. J Cosmet Laser Ther. 2015;17(1):15–9.PubMedCrossRefGoogle Scholar
  136. 136.
    Sarkar R, Parmar NV, Kapoor S. Treatment of postinflammatory hyperpigmentation with a combination of glycolic acid peels and a topical regimen in dark-skinned patients: a comparative study. Dermatol Surg. 2017;43(4):566–73.PubMedCrossRefGoogle Scholar
  137. 137.
    Roberts WE. Chemical peeling in ethnic/dark skin. Dermatol Ther. 2004;17(2):196–205.PubMedCrossRefGoogle Scholar
  138. 138.
    Burns RL, Prevost-Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP. Glycolic acid peels for postinflammatory hyperpigmentation in black patients. A comparative study. Dermatol Surg. 1997;23(3):171–4 (discussion 5).PubMedCrossRefGoogle Scholar
  139. 139.
    Sehgal VN, Luthra A, Aggarwal AK. Evaluation of graded strength glycolic acid (GA) facial peel: an Indian experience. J Dermatol. 2003;30(10):758–61.PubMedCrossRefGoogle Scholar
  140. 140.
    Grimes PE, Hunt SG. Considerations for cosmetic surgery in the black population. Clin Plast Surg. 1993;20(1):27–34.PubMedGoogle Scholar
  141. 141.
    Mohamed Ali BM, Gheida SF, El Mahdy NA, Sadek SN. Evaluation of salicylic acid peeling in comparison with topical tretinoin in the treatment of postinflammatory hyperpigmentation. J Cosmet Dermatol. 2017;16(1):52–60.PubMedCrossRefGoogle Scholar
  142. 142.
    Ahn HH, Kim IH. Whitening effect of salicylic acid peels in Asian patients. Dermatol Surg. 2006;32(3):372–5 (discussion 5).PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Mount Sinai St. Luke’s and WestNew YorkUSA
  2. 2.New York Medical CollegeValhallaUSA

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