Postinflammatory
hyperpigmentation is a common sequelae of inflammatory
dermatoses that tends to affect darker skinned patients with greater frequency and severity. Epidemiological studies show that dyschromias, including postinflammatory
hyperpigmentation, are among the most common reasons darker racial/ethnic groups seek the care of a dermatologist. The treatment of postinflammatory
hyperpigmentation should be started early to help hasten its resolution and begins with management of the initial inflammatory condition. First-line
therapy typically consists of topical
depigmenting agents in addition to photoprotection including a
sunscreen. Topical
tyrosinase inhibitors, such as
hydroquinone,
azelaic acid,
kojic acid,
arbutin, and certain licorice extracts, can effectively lighten areas of
hypermelanosis. Other
depigmenting agents include
retinoids,
mequinol,
ascorbic acid,
niacinamide,
N-acetyl glucosamine, and soy with a number of emerging
therapies on the horizon. Topical
therapy is typically effective for epidermal postinflammatory
hyperpigmentation; however, certain procedures, such as chemical peeling and
laser therapy, may help treat recalcitrant
hyperpigmentation. It is also important to use caution with all of the above treatments to prevent irritation and worsening of postinflammatory
hyperpigmentation.