Post-inflammatory hyperpigmentation
What is hyperpigmentation?
Post-inflammatory hyperpigmentation is the temporary darkening of skin after inflammation or injury. In the photo above, there’s little active acne—but several dark spots where pimples used to be. That’s hyperpigmentation. It doesn’t itch or hurt, but it can be frustrating and takes time to fade.
Why do I have dark spots (hyperpigmentation)?
Hyperpigmentation is more common in darker skin types, where it often appears dark brown or nearly black. In lighter skin, it tends to look pink or purple. Sun exposure can make it worse. While it’s usually caused by inflammation (like acne or eczema), certain medications can rarely contribute as well.
How do I fix hyperpigmentation?
Post-inflammatory hyperpigmentation is tough to treat—mostly because the sun is hard to avoid. Daily sun protection is essential (see my pages on sun-protective clothing and sunscreen for skin of color).
BEDTIME ROUTINE:
Cleanse: Use a gentle facial cleanser.
Treatment layers (very thin layers, in this order):
Glycolic acid or kojic acid serum or Mela B3 serum
Adapalene gel (Differin, Effaclar, AcneFree, Glenmark [cheapest] Neutrogena, ProActiv)
Hydrocortisone ointment (to reduce irritation from the actives above)
Optional: If tolerated, add a niacinamide serum right after the acid serum.
Seal: Cover everything with a thick layer of Vaseline or CeraVe cream.
⚠️ Note: Overuse of topical steroids like hydrocortisone can lead to skin thinning, stretch marks, and easy bruising. Use sparingly and not long-term.
MORNING ROUTINE:
Cleanse: Gentle hydrating or foaming cleanser.
Treat: Apply a thin layer of azelaic acid or Mela B3 serum.
Protect: Use a daily facial moisturizer with SPF 30+.
Moisturize: Reapply CeraVe cream or Vaseline throughout the day as needed.
How to Use Adapalene at Bedtime
Start with clean, dry skin.
Dab a pea-sized amount of adapalene gel on the forehead, sides of the face, and chin (outer areas of face).
Rub it in gently.
Use whatever is left on your fingers to lightly spread around the nose, cheeks, and lips (these spots are more sensitive).
💡 Note: This will make your skin dry and flaky at first. That’s normal—it happens to everyone. Your skin will adjust after a few weeks.
🚫 Warning: Don’t use adapalene if you’re pregnant or trying to become pregnant. It may harm a developing baby.
After Adapalene: Moisturize
Right after applying adapalene, use lots of moisturizing cream or ointment. My favorites are CeraVe Cream, Vanicream Cream, or Vaseline (#SlugLife)
Put on a thick layer and go to bed a little shiny—your skin will soak it in overnight.
🕒 Stick with adapalene for at least 30 days—it takes about a month to start seeing results.
What if my hyperpigmentation isn’t getting better?
Most post-inflammatory hyperpigmentation will slowly fade over time, and the steps above help in most cases. In 2020, the FDA removed hydroquinone (a common bleaching cream) from over-the-counter shelves due to risks of overuse, which can cause permanent dark spots (ochronosis).
If over-the-counter options aren’t helping, see a board-certified dermatologist. They can prescribe creams with hydroquinone or discuss cosmetic procedures. If you’re in or near Utah, visit one of my excellent colleagues at the University of Utah or book a virtual visit with me through Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.