Reposted with permission from Next Steps in Derm
Our new series, “The Many Faces of”, showcases side-by-side images of some of the most commonly seen dermatology conditions in an array of skin tones and briefly highlight nuances in clinical presentation. All images featured in the series are part of The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas, a resource developed by co-editors Misty Eleryan, MD, MS, and Adam Friedman, MD, and published by SanovaWorks and Educational Testing & Assessment Systems.
We continue our series with a look at post-inflammatory hyperpigmentation (PIH). Post-inflammatory hyperpigmentation affects all skin tones, but occurs more frequently and severely in darker skin tones. The degree of discoloration depends on the intensity of the preceding inflammation or injury, with a wide range of presentation from light tan to dark blue-gray.
Primary lesions such as bullae may be admixed with post-inflammatory hyperpigmentation (PIH). In absence of primary lesions, PIH will present as pink to dark brown hyperpigmented macules and patches in the distribution of the prior trauma or inflammatory insult to the skin.
Nuances to Highlight
Pigment deposited in the dermis will appear with gray-brown to blue-gray discoloration. In contrast to dermal involvement, pigment in the epidermis tends to be tan to dark brown, more responsive to topical treatment, and is accentuated with a Wood’s lamp. Pigment can obscure erythema, especially in darker skin tone, therefore be mindful not to miss an acute or active flare in the setting of this dyschromia.
Acknowledgements
We thank co-editors Misty Eleryan, MD, MS, and Adam Friedman, MD for reviewing the content of this article.
Reference
Eleryan, Misty, and Adam Friedman. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas. SanovaWorks, 2021.
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