Hyperpigmentation in Skin of Color
Dark marks that linger after a pimple or any skin inflammation are the most common pigment concern I see in patients with skin of color – and, understandably, one of the most frustrating, since the mark often outlasts the original problem by weeks to months. The good news is that PIH is treatable, and understanding why it happens is the first step toward clearing it rather than chasing it indefinitely.
It is also worth saying plainly: PIH is not a flaw in your skin and not a sign you did something wrong by picking at a blemish or scratching a bite. It is simply how melanin-rich skin responds to inflammation of almost any kind. Treating it effectively starts with treating it as a predictable biological response, rather than a cosmetic failure.
The Short Answer
Post-inflammatory hyperpigmentation (PIH) is the dark mark left behind after acne, injury, or irritation, and is extremely common in skin of color. It is very treatable with a combination of pigment-suppressing topicals, sun protection, and gentle, well-chosen procedures. The key is treating the underlying cause first, so new marks stop forming while old ones fade.
Nearly anyone with PIH is a reasonable candidate for treatment, but the plan depends heavily on what is causing the inflammation. Treating pigment while an underlying condition like active acne or eczema is left unaddressed is a common mistake, since new marks simply replace the old ones. Patients with very reactive skin or a history of PIH after minor irritation may do best with topicals and sun protection alone, since procedures carry a small chance of provoking the very pigment response we are trying to fade.
Even well-managed PIH fades gradually rather than disappearing overnight, and very deep or years-old marks may lighten substantially without erasing completely.
- Acne treatment
- Chemical peels
- Fraxel Dual
- Picosecond laser
How long does PIH take to fade?
With treatment, typically weeks to a few months, depending on depth. Consistent topicals and strict sun protection speed it up; gentle procedures can accelerate clearance further, once the underlying cause is controlled.
How do I stop getting new dark marks?
By treating the underlying cause (most often acne or another inflammatory condition). Once the inflammation is controlled, new PIH stops forming and existing marks can be cleared with a targeted topical regimen.
Is PIH the same as a scar?
No. PIH is a pigment change with the skin surface intact, while a scar involves a change in skin texture. PIH generally fades with treatment and time, while true scarring needs a different approach, such as microneedling or laser resurfacing.
Can I use over-the-counter products for dark marks?
Mild over-the-counter brighteners can help superficial marks, but prescription-strength topicals and rigorous sun protection work faster and more reliably. Deeper or longstanding PIH usually needs a supervised regimen along with carefully performed procedures to see meaningful improvement.
Why does experience matter for treating PIH in darker skin?
Because the same reactive pigment cells that created the mark can create more of it if a peel or laser is escalated too quickly. Judging how deep the pigment sits, how much the skin can tolerate, and when to hold at topicals alone is a skill built from routinely treating skin of color, not a generic protocol.
At a Glance
Dr. Brian Hibler
- Board-Certified Dermatologist (Cornell)
- Cosmetic Fellowship–Training (Harvard)
- Castle Connolly Top Doctor
- NY Times Super Doctor
- 70+ Publications, 90+ International Lectures
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