eMedicine Specialties > Dermatology > Diseases of Pigmentation
Postinflammatory Hyperpigmentation: Differential Diagnoses & Workup
Updated: Jul 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Acanthosis Nigricans | Melasma |
| Addison Disease | Tinea Versicolor |
| Amyloidosis, Lichen | |
| Amyloidosis, Macular | |
| Lichen Planus |
Workup
Laboratory Studies
- A Wood lamp examination enables distinction of epidermal postinflammatory hyperpigmentation (PIH) from dermal postinflammatory hyperpigmentation.
- Epidermal lesions tend to have accentuated borders under a Wood lamp examination, whereas those of dermal lesions are not accentuated with a Wood lamp examination.
Procedures
- If a history of preceding inflammatory dermatosis is unclear or absent, skin biopsy is warranted to exclude other underlying causes of hyperpigmentation.
- Staining of the biopsy specimen with Fontana-Masson silver stain for melanin enables localization of the melanin in the epidermis and/or the dermis.
Histologic Findings
Epidermal postinflammatory hyperpigmentation involves increased melanin pigment in the basal cell layer of the epidermis. Occasionally, giant melanosomes are evident in the epidermis.
Dermal postinflammatory hyperpigmentation involves the upper dermis, with pigment incontinence due to increased numbers of melanophages in the papillary dermis.
More on Postinflammatory Hyperpigmentation |
| Overview: Postinflammatory Hyperpigmentation |
Differential Diagnoses & Workup: Postinflammatory Hyperpigmentation |
| Treatment & Medication: Postinflammatory Hyperpigmentation |
| Follow-up: Postinflammatory Hyperpigmentation |
| Multimedia: Postinflammatory Hyperpigmentation |
| References |
| « Previous Page | Next Page » |
References
Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg. Mar 2008;34(3):301-5; discussion 305-7. [Medline].
Harari Z, Sommer I, Knobel B. Multifocal contact dermatitis to nitroderm TTS 5 with extensive postinflammatory hypermelanosis. Dermatologica. 1987;174(5):249-52. [Medline].
Breathnach AS. Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid, and other therapies. Cutis. Jan 1996;57(1 Suppl):36-45. [Medline].
Pandya AG, Guevara IL. Disorders of hyperpigmentation. Dermatol Clin. Jan 2000;18(1):91-8, ix. [Medline].
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. Mar 1997;23(3):171-4; discussion 175. [Medline].
Yoshimura K, Harii K, Aoyama T, Shibuya F, Iga T. A new bleaching protocol for hyperpigmented skin lesions with a high concentration of all-trans retinoic acid aqueous gel. Aesthetic Plast Surg. Jul-Aug 1999;23(4):285-91. [Medline].
Yoshimura K, Harii K, Aoyama T, Iga T. Experience with a strong bleaching treatment for skin hyperpigmentation in Orientals. Plast Reconstr Surg. Mar 2000;105(3):1097-108; discussion 1109-10. [Medline].
Del Rosso JQ. The use of topical azelaic acid for common skin disorders other than inflammatory rosacea. Cutis. Feb 2006;77(2 Suppl):22-4. [Medline].
Grimes P, Callender V. Tazarotene cream for postinflammatory hyperpigmentation and acne vulgaris in darker skin: a double-blind, randomized, vehicle-controlled study. Cutis. Jan 2006;77(1):45-50. [Medline].
Katsambas AD. RALGA (Diacneal), a retinaldehyde and glycolic acid association and postinflammatory hyperpigmentation in acne--a review. Dermatology. 2005;210 Suppl 1:39-45. [Medline].
Kasraee B, Handjani F, Parhizgar A, et al. Topical methimazole as a new treatment for postinflammatory hyperpigmentation: report of the first case. Dermatology. 2005;211(4):360-2. [Medline].
Erbil H, Sezer E, Tastan B, Arca E, Kurumlu Z. Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma. J Dermatol. Jan 2007;34(1):25-30. [Medline].
Choi H, Ahn S, Lee BG, Chang I, Hwang JS. Inhibition of skin pigmentation by an extract of Lepidium apetalum and its possible implication in IL-6 mediated signaling. Pigment Cell Res. Dec 2005;18(6):439-46. [Medline].
Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg. Dec 2005;31(12):1645-50. [Medline].
Rokhsar CK, Ciocon DH. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation after carbon dioxide laser resurfacing. Dermatol Surg. Mar 2009;35(3):535-7. [Medline].
[Guideline] Morton CA, McKenna KE, Rhodes LE. Guidelines for topical photodynamic therapy: update. Br J Dermatol. Dec 2008;159(6):1245-66. [Medline].
Perez-Bernal A, Munoz-Perez MA, Camacho F. Management of facial hyperpigmentation. Am J Clin Dermatol. Sep-Oct 2000;1(5):261-8. [Medline].
Winhoven SM, Ahmed I, Owen CM, Lear JT. Postinflammatory hyperpigmentation in an Asian patient: a dramatic response to oral isotretinoin (13-cis-retinoic acid). Br J Dermatol. Feb 2005;152(2):368-9. [Medline].
Momosawa A, Kurita M, Ozaki M, et al. Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians. Plast Reconstr Surg. Jan 2008;121(1):282-8. [Medline].
Epstein JH. Postinflammatory hyperpigmentation. Clin Dermatol. Apr-Jun 1989;7(2):55-65. [Medline].
Lacz NL, Vafaie J, Kihiczak NI, Schwartz RA. Postinflammatory hyperpigmentation: a common but troubling condition. Int J Dermatol. May 2004;43(5):362-5. [Medline].
Nordlund JJ. Postinflammatory hyperpigmentation. Dermatol Clin. Apr 1988;6(2):185-92. [Medline].
Ruiz-Maldonado R, Orozco-Covarrubias ML. Postinflammatory hypopigmentation and hyperpigmentation. Semin Cutan Med Surg. Mar 1997;16(1):36-43. [Medline].
Tomita Y, Maeda K, Tagami H. Mechanisms for hyperpigmentation in postinflammatory pigmentation, urticaria pigmentosa and sunburn. Dermatologica. 1989;179 Suppl 1:49-53. [Medline].
Further Reading
Keywords
postinflammatory hyperpigmentation, postinflammatory hypermelanosis, melanotic hyperpigmentation, PIH, dermal melanosis, epidermal melanosis, skin inflammation, hyperpigmentation
Differential Diagnoses & Workup: Postinflammatory Hyperpigmentation