The distribution of the hypermelanotic lesions depends on the location of the original inflammatory cause. The colour of the lesions ranges from light brown to black, with a lighter brown appearance if the pigment is within the epidermis (i.e. epidermal melanosis) and a darker gray to bluish appearance if lesions contain dermal melanin (i.e. dermal melanosis).
Post-inflammatory hyper pigmentation can occur with various disease processes that affect the skin. These processes include allergic reactions, infections and trauma.
Common inflammatory diseases that result in post-inflammatory hyper pigmentation include acne excoriée and lichen planus to name a few.
Freckles are clusters of concentrated melanin which are most often visible on people with a fair complexion. They are predominantly found on the face, although they may appear on any skin exposed to the sun, such as the shoulders.
Upon exposure to the sun, freckles will reappear if they have been altered with creams or lasers. It is suggested that people prone to freckling avoid sun exposure and use a sunscreen regularly.
Drug-related pigmentation may cause prominent discoloration in sun-distributed areas, mucous membranes, sclera, cartilage and/or nails.
Furthermore, lesions of post-inflammatory hyper pigmentation can darken with exposure to sunlight and various chemicals and medications, such as tetracycline, arsenicals, silver, gold, anti-malarial drugs and hormones to name a few.
The most important factor in the management of drug-induced pigmentation involves the identification and discontinuation of the offending drug.
Skin lightening creams can be used like hydroquinone, azelaic acid, glycolic acid, tretinoin creams, kojic acid, soy, arbutin and those containing licorice. But these should be used under strict guidance and as prescribed.
Use of a good sunscreen with an SPF of 30+ with both UVA and UVB protection filters is a must. Sunscreens containing physical blockers, such as zinc oxide and titanium dioxide, are recommended to block UV rays.
Note: Sunscreen usage with SPF of 50+ with both UVA and UVB filters is a must for all Pigmentary problems.
