Pigment
Post-inflammatory hyperpigmentation
Post-inflammatory hyperpigmentation (PIH) is a flat dark mark left behind after the skin has been inflamed or hurt, such as after acne, eczema, a cut, or a burn. It is common, it is not harmful, and it usually fades on its own, though in brown and deep skin tones it can take months to years.
Reviewed by Raashid Haque, MD, board-certified dermatologist
For education only. This guide does not diagnose or treat any condition.
Showing common starting points. Want picks matched to you?
2-minute quizSkin care picks for Post-inflammatory hyperpigmentation
Tap a category to see what to look for and the products I recommend.
Visible light can keep dark marks from fading; iron oxides add protection against it.
Look for
- Iron oxides listed in the ingredients
- Broad spectrum and SPF 30 or higher
- A shade close to your skin tone, tested in daylight
Full details, cautions and sourcesAvoid
- Assuming any makeup with a tint works; protection comes from the sunscreen amount and the iron oxides, so check the label
These are products Dr. Haque has reviewed and recommends for different reasons. Unless a product is clearly marked 'Affiliate link,' it is not one. Most are not.
Food and lifestyle may play a part in Post-inflammatory hyperpigmentation too
Anti-inflammatory eating and lifestyleLearn about Post-inflammatory hyperpigmentation
PIH is extra pigment (melanin) in the skin that shows up after inflammation or injury. When the skin is irritated, the cells that make color can become overactive. The result is a flat spot or patch that is darker than the skin around it.
Who gets it: Anyone can. It is more common, more intense, and slower to fade in people with brown, Black, and deep skin tones. On lighter skin the marks often look pink or red-brown. On brown and Black skin they often look dark brown, gray-brown, or nearly black.
Common starting points:
- Acne and picked pimples
- Eczema, psoriasis, and other rashes
- Cuts, scrapes, burns, and insect bites
- Irritation from skin or hair products, or from some procedures
How it behaves: The mark follows the shape of the original problem. Spots that are only a few shades darker than your natural skin often fade within months. Deeper or darker marks may take a year or longer. Sun exposure can make the marks darker and slower to fade.
What it is not: PIH is not contagious and is not skin cancer. It is different from melasma, which tends to appear as symmetric patches on the face and is linked to hormones and sun, and which does not need a prior rash or injury. It is also different from a scar, which changes the texture of the skin (raised, sunken, or firm), while PIH is a color change only.
Self-care
What it is
Clinicians commonly look at what caused the inflammation, such as acne, eczema, or irritation, because new flares can keep adding new dark marks.
Often considered when
Often considered when the original skin problem is still active or keeps coming back.
Less suitable or needs caution when
Less suitable as the only step when the mark has remained long after the original problem is gone.
What to watch for
Marks that keep appearing in the same areas can point to an active trigger worth discussing.
How long to judge it
Calming the cause may take weeks to months; fading of old marks is judged separately.
Questions to ask
- What is causing the inflammation, and how can it be controlled?
- Could any of my products or habits be irritating my skin?
- Is this mark PIH or something else?
What it is
Sun protection is a central part of PIH care. UV rays and visible light can darken marks. Dermatology sources describe broad-spectrum sunscreen, and tinted sunscreen with iron oxide for visible light, along with hats and shade.
Often considered when
Often considered for almost everyone with PIH, including people with deep skin tones who rarely burn.
Less suitable or needs caution when
Less suitable when a person is allergic to a sunscreen ingredient; clinicians can discuss other options.
What to watch for
Some sunscreens leave a white cast on deep skin; tinted formulas may blend better. Sunscreen cannot work well if it is not reapplied or if the skin is not covered.
How long to judge it
Protection works day to day; fading may be slower without it, and it is judged over months.
Questions to ask
- Which type of sunscreen is a good fit for my skin tone?
- Do I need a tinted product for visible light?
- How do I protect my skin while treatments are active?
What it is
Picking, squeezing, scratching, and rubbing add new inflammation, which can leave a darker or longer-lasting mark. Clinicians often discuss ways to keep hands off the skin.
Often considered when
Often considered when marks follow picked pimples or scratched rashes.
Less suitable or needs caution when
Less suitable as a simple tip when picking feels hard to control; this may need extra support.
What to watch for
Frequent urges to pick can be linked to stress or anxiety, and it is fine to bring this up.
How long to judge it
Habits change gradually; benefit is seen as fewer new marks over weeks to months.
Questions to ask
- How can I treat itch or acne so I am less tempted to pick?
- Are there habit-support options if I pick without noticing?
- Is a bandage or patch helpful for my spots?
What it is
Makeup, concealer, and color-correcting products can cover marks while the skin heals. This does not change the pigment itself.
Often considered when
Often considered for special events, work, or whenever someone wants even-looking skin without waiting.
Less suitable or needs caution when
Less suitable on skin that is broken, very irritated, or actively breaking out.
What to watch for
Heavy or comedogenic products may worsen acne for some people. Shade matching matters on brown and deep skin.
How long to judge it
Works right away and lasts a day; has no effect on fading.
Questions to ask
- Which products are less likely to irritate or clog pores?
- Can I use camouflage while using treatments?
- Can you suggest shade-matching tips for my skin tone?
Over the counter
What it is
Many nonprescription products contain ingredients such as azelaic acid, vitamin C, niacinamide, kojic acid, or glycolic acid. These may help fade marks or slow new pigment, usually with modest effect.
Often considered when
Often considered for mild or recent marks, or alongside other care.
Less suitable or needs caution when
Less suitable for very sensitive or inflamed skin, or when a product has caused irritation or allergy before.
What to watch for
Stinging, dryness, or redness can lead to more dark marks in deep skin. Be wary of unlabeled or imported creams, which may hide steroids or mercury.
How long to judge it
Visible change is often judged after about 2 to 3 months, and full fading can take longer.
Questions to ask
- Which ingredients are the best fit for my skin and my marks?
- How do I avoid irritation that could darken my skin?
- How will we know whether a product is working?
Prescription creams and gels
What it is
Hydroquinone is a medicine that lowers pigment production. Dermatology sources describe prescription-strength hydroquinone as an option that may speed fading when other approaches fall short.
Often considered when
Often discussed when marks are stubborn or more noticeable and sun protection is already in place.
Less suitable or needs caution when
Less suitable during pregnancy or breastfeeding unless a clinician advises, or with known allergy to its ingredients.
What to watch for
Irritation can happen. With long or unsupervised use, rare skin darkening (ochronosis) has been reported, which is why medical supervision is commonly advised.
How long to judge it
Often judged over about 2 to 3 months; clinicians commonly review how long to continue.
Questions to ask
- Is hydroquinone right for my skin and marks?
- How long would treatment typically be reviewed?
- What signs mean I should call you?
What it is
Retinoids such as tretinoin speed skin cell turnover and are commonly used for acne and for fading marks. Some prescription creams combine several ingredients, such as a retinoid, azelaic acid, or a mild steroid.
Often considered when
Often considered when acne and PIH are present together, or when other products have not been enough.
Less suitable or needs caution when
Less suitable during pregnancy and breastfeeding; may not suit very sensitive skin or eczema flares.
What to watch for
Dryness, peeling, and redness are common and may leave new dark marks if skin becomes irritated. Sun sensitivity can increase.
How long to judge it
Often judged over 3 to 6 months; early irritation may be the main change at first.
Questions to ask
- Is a retinoid appropriate while I am pregnant or planning pregnancy?
- How can I lower the chance of irritation darkening my skin?
- Should treatment be combined with something else?
Procedures
What it is
Peels and some lasers are used by dermatologists to treat certain marks that sit in the upper layer of skin. Dermatology sources note they can help some marks, but they can also injure the skin and make pigment worse, especially in brown and deep skin, and they are not helpful for pigment that sits deeper.
Often considered when
Often discussed when topical care has not been enough and a clinician experienced with deep skin tones can assess the mark.
Less suitable or needs caution when
Less suitable when skin is inflamed, tanned, or prone to dark marks, and during active acne or eczema flares unless a clinician decides otherwise.
What to watch for
New or darker pigment, burns, blisters, or lighter patches can happen. Preparing the skin and strict sun protection are commonly part of the plan.
How long to judge it
Several visits may be needed, and results are judged over months.
Questions to ask
- Is my pigment shallow or deep, and could a procedure help?
- What is the risk of making my marks worse?
- Do you have experience treating my skin tone?
Things that can start PIH, or keep it from fading:
- Inflammation itself: acne, eczema, psoriasis, burns, bites, and rashes. The stronger or longer the inflammation, the darker the mark can be.
- Sun and visible light: ultraviolet (UV) rays and the visible light from the sun and, to a lesser degree, indoor screens and bulbs may darken existing marks.
- Picking, scratching, and rubbing: these create more inflammation and more pigment.
- Harsh products or procedures: strong scrubs, peels, or hair removal methods can irritate skin and leave marks.
- Some medicines: a few medicines can cause dark patches. Talk with the prescriber before changing any medicine.
| Topic | Evidence | What it means |
|---|---|---|
| Emotional impact | Established | Visible marks can affect confidence and mood, and this is well recognized. Talking with a clinician or a support person is reasonable, and it is not vanity. |
| Stress and skin picking | Early | Stress may increase picking or scratching, which can add new marks. Research on stress management for PIH specifically is limited, but calming habits may help reduce picking. |
| Diet | Anecdotal | There is no good proof that a specific food or diet fades PIH. Eating a balanced diet is reasonable, but restrictive diets are not recommended without medical guidance, since they can cause other problems. |
| Sleep | Anecdotal | Many people ask whether poor sleep slows fading. This has not been shown for PIH, though good sleep supports general health and can make it easier to manage stress. |
Read: Anti-inflammatory eating
Avoid very restrictive diets, especially for children, unless a clinician is guiding you.
Post-inflammatory hyperpigmentation ·
When to get care soon
- A dark spot that is new and changing in size, shape, or color, has uneven edges, bleeds, or looks different from your other spots. This needs a clinician's check to rule out skin cancer.
- You are not sure the mark is PIH, or it appeared without any earlier rash or injury.
- The original problem is still active, such as new acne, an eczema flare, or a rash that keeps coming back.
- Signs of infection in the area: spreading redness, warmth, swelling, pus, or fever.
- Marks that are getting worse despite sun protection, or that are very upsetting or affecting your mood and daily life.
- Darkening that appeared after starting a new medicine, or on a large area of the body.
- Skin that is burning, peeling, or getting darker after using skin-lightening creams, especially products with no ingredient list or imported products.
About the reviewer
Raashid Haque, MD
Board Certified Dermatologist · Charlotte, NC
- 25+ years of clinical experience
- Dermatology at University of Oklahoma - Chief Resident
- Internship at Baylor College of Medicine
- LSU School of Medicine Shreveport - Valedictorian, AOA