Q: I am a black woman suffering from post-inflammatory hyperpigmentation. Is there anything you can recommend to improve the appearance of my legs?
Post-inflammatory hyperpigmentation (PIH) is a relatively common condition where the cells that govern skin pigment, melanocytes, respond to inflammation by generating an excess of coloring, or melanin. The excess melanin shows up as dark spots or scars in affected areas.
PIH can affect all skin types, fair to dark. While common in all ethnicities, people of color naturally have the ability to make more color, so PIH may appear more pronounced in richer skin tones. It is triggered by a wide variety of common skin conditions, from irritants and dry skin, to acne, sun exposure, or injury. Occasionally, an underlying disease may cause PIH, which is why it is important to consult a dermatologist with expertise in treating skin of color to determine the best treatment options.
Successful treatment to clear PIH on the legs typically takes the better part of a year because, in general, the further the affected area is from the heart, the longer it takes for it to resolve. Furthermore, the longer PIH has been present, the harder it is to reverse. However, with patience and motivation, a patient can often get dramatic clearing of PIH on the legs with the appropriate treatment protocol, and there are several promising therapies that your dermatologist can discuss with you. A variety of topical treatments, including exfoliating fruit acids, natural lighteners like vitamin C and kojic acid, and hydroquinone, used with appropriate laser therapies, are usually required to achieve the optimal results.
It is reasonable to start with topical remedies prior to undergoing laser therapy, as the latter can be quite expensive. However, you would benefit from the guidance of a dermatologist who can provide the most effective and safe topical therapies. If you decide to proceed with laser treatment, be sure to consult an experienced laser surgeon who has expertise in treating skin of color, as some laser therapies may further irritate the skin, actually worsening the condition.