Research has shown that perceived attractiveness stems from visible skin color distribution,1 so achieving an even skin tone is important to many consumers. Hyperpigmentation or uneven pigmentation is, in the mind of the consumer, usually connected with inadequate sun protection and often enhanced by smoking, although it can result from other causes. It presents as diffuse and focused, dark, uneven patches and is typically asymmetrical. Here, the author describes a pigment condition and the three steps of protecting against, treating and concealing it.
In the United States, skin conditions related to pigmentation are not the most common diagnoses for Caucasians, although in this author’s practice in the U.K., post-inflammatory hyperpigmentation (PIH) is seen when treating women with oily and combination skin types prone to premenstrual acne. PIH, a sequela of inflammatory chin or jawline acne, was identified by this author in adult women in their 30s. Epidermal PIH presents as tan or darker brown patches on skin due to an increased production of melanin in melanocytes and transfer to surrounding keratinocytes.
PIH can occur in all skin types but is more frequently observed in heavily pigmented skin. PIH is sometimes associated with macrocomedones, i.e., large whiteheads present on the chin area. These are often treated with gentle cautery prior to commencing isotretinoin treatment to prevent a severe and repetitive inflammatory response.
Some consumers have suffered with chin acne for years. Having tried conventional skin care and medication, they have found nothing eliminates their acne. These consumers are afflicted with large flare-ups of bright red, painful spots on a monthly basis with subsequent pigmentation. Further, in this author’s practice, consumers have communicated that PIH makes them feel very low, significantly impacting them psychosocially. It can become even more anxiety-provoking than their primary acne, which is often magnified by the lack of quick and effective treatment other than covering the pigmentation with makeup. Most PIH seems to be of epidermal origin, and this superficial melanin location provides a rationale for the topical application of anti-inflammatory active ingredients.