What is PIH and why does it happen?
When skin experiences any form of inflammation — a pimple, an insect bite, a burn, a cut — the inflammatory response activates nearby melanocytes as part of the healing process. These melanocytes overproduce melanin, which gets deposited unevenly in the epidermis (upper layers of skin) and sometimes in the dermis (deeper layers). As the inflammation resolves, the mark remains — flat, dark, and often frustratingly slow to fade.
PIH is not technically a scar — it is pigmentation only, with no textural change or loss of collagen. This is why the treatment approach is fundamentally different to acne scarring. It also means PIH is entirely reversible — with the right products, time, and sun protection, it will fade completely.
Why PIH is more pronounced in darker skin
Fitzpatrick Type IV–VI skin (olive through very dark) contains more active melanocytes that produce larger melanin granules in response to inflammation. This means the same acne breakout produces a significantly darker, more widespread mark in a patient with dark skin than in a patient with fair skin. The mark is also slower to fade because the density of melanin is higher.
The same increased melanocyte reactivity that causes pronounced PIH also means certain skincare treatments can trigger PIH themselves if they cause irritation — including over-exfoliation, aggressive chemical peels, or the introduction of retinol too quickly. For darker skin tones, a gentle-first approach to active ingredients is essential.
How to treat PIH
The most important rule: treat the cause first. If the inflammation is active acne, clear the acne before focussing on PIH marks — ongoing breakouts will continuously generate new marks. Once acne is controlled, the PIH treatment can begin.
First-line treatment: niacinamide (inhibits melanin transfer), azelaic acid (inhibits tyrosinase), and vitamin C serum (antioxidant brightening). These are well-tolerated and safe for all skin tones. Gentle exfoliation with glycolic acid (5–10%) accelerates the shedding of pigmented surface cells — but only at concentrations that do not cause irritation.
Mandatory: Heliocare 360° SPF 50+ every single morning. UV exposure directly reactivates melanocytes and will delay the fading of PIH by weeks for every unprotected day. In Durban's UV environment, this cannot be overstated.