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Chapter 35: Postinflammatory Pigment Alteration

INTRODUCTION

KEY POINTS

  • Postinflammatory pigment alteration (PIPA) includes both postinflammatory hyperpigmentation and postinflammatory hypopigmentation.

  • While PIPA can occur in all skin colors, it is more common in skin of color.

  • Individuals affected with PIPA are thought to have a predisposed tendency for their melanocytes to respond to inflammation or trauma with hyperpigmentation or hypopigmentation.

  • PIPA can often last significantly longer than the underlying cause. It has been associated with profound effects on quality of life.

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FIGURE 35-1.

Violaceous flat-topped papules with surrounding erythema and brown macules coalescing into patches on the lower extremity of a person with active and resolving lichen planus. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 3-28.)

A photo of a patient's leg with a few brown bumps of active infection with patches of postinflammatory hyperpigmentation following lichen planus in between.
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FIGURE 35-2.

Hypopigmented patches with background areas of erythema in a light-skinned person treated for psoriasis. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 110-21. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows irregular hypopigmented patches of varying sizes in the arm.
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FIGURE 35-3.

Violaceous to dark-brown patches along the knees and medial thigh of a young Black person, signifying postinflammatory hyperpigmentation secondary to atopic dermatitis. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 207-1B. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows irregular hyperpigmented patches of varying sizes in the knees and thighs.
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FIGURE 35-4.

Pink-brown macules and papules on a lower extremity, with areas of overlying excoriations signifying postinflammatory erythema and hyperpigmentation in a person with light skin. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 155-4. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows extensive red blisters covering the lower leg. The lesions appear as pinkish round spots with dark red pitted centers.
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FIGURE 35-5.

Pink macules and papules on the left cheek of a young light-skinned patient with acne. (Reproduced with permission from Alam M, Bhatia AC, Kundu RV, et al. Cosmetic Dermatology for Skin of Color. New York, NY: McGraw Hill; 2009, Figure 17-2.)

A photo of the left cheek of a patient shows a series of linear white scales below the corner of the lips and several small pink spots and papules scattered and covering the entire cheek.
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FIGURE 35-6.

Light to brown macules on the cheeks, jawline, and perioral skin consistent with postinflammatory hyperpigmentation secondary to acne. Note the lack of active acne. (Reproduced with permission from Alam M, Bhatia AC, Kundu RV, et al. Cosmetic Dermatology for Skin of Color. New York, NY: McGraw Hill; 2009, Figure 18-4.)

A photo of the left cheek of a patient shows big circular dark brown spots covering the cheek, chin, and under the mandible.
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FIGURE 35-7.

Pink and brown patches secondary to nummular eczema, scattered on the back ...

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