Hyperpigmentation can be caused due to several reasons (melasma or drug reactions) however post-inflammatory hyperpigmentation (PIH) is the appearance of dark spots after skin inflammation from another rash or most commonly, acne.
The depth of skin involvement corresponds to actual color of dark spots and dictates treatment. Light to dark brown color is suggestive of superficial skin (epidermal) involvement and can be treated using topicals. Blue gray/black color means deeper skin (dermal) involvement and laser treatment is more appropriate.
In general, combination therapy with several topicals may be more effective than single treatment therapy.
1) The best way to prevent and treat dark spots is to use “broad-spectrum” sunscreen with both UVA and UVB coverage with SPF 30 or higher. Tinted sunscreens also have iron oxide which protects from visible light which is known to cause hyperpigmentation in those with darker skin. Also seek shade and wear hats and sun protective clothing.
2) Prescription treatments include
• Hydroquinone 4% or higher
• Topical retinoids (tretinoin, adapalene, tazarotene)
• Combination of the above with mild topical steroid
• 15-20% azelaic acid
3) Over the counter treatments include lower percentage hydroquinone, azelaic acid, retinols, vitamin C, kojic acid, niacinamide, soy, plant extracts etc (Stay tuned for the next post!)
4) Also office procedures such as chemical peels and laser treatment can reduce hyperpigmentation
In general you have to be patient with these dark spots. Need to treat at least 8-12 weeks for results!