How to Treat Post-Inflammatory Hyperpigmentation (PIH) After Scars and Injuries

Post-inflammatory hyperpigmentation, or PIH, is the darkening of skin that develops after an injury, a surgery, or any other trigger of inflammation. It's relatively common after both traumatic injuries and surgical scars — and the good news is that we have a lot of effective treatments for it.

Here's a quick rundown of how we actually treat it.

The first line of treatment is almost always a topical agent. There are several options, but the two most common active ingredients are:

TXA works by interrupting the signaling between skin cells that drives pigment production. It's well tolerated and effective, and it's increasingly the go-to for many dermatologic and plastic surgery patients.

Hydroquinone is the long-established gold standard for lightening hyperpigmented skin. It's a skin-lightening agent that works by inhibiting melanin production.

Your physician will help you choose between them and walk you through how to use the product safely. A few realistic expectations:

• These creams do not fade pigmentation in 24 hours
• They typically take several months to show meaningful improvement
• Consistent, daily use is essential

If topicals alone aren't enough — or you want to accelerate your results — pairing them with a procedural treatment can be very effective. Two of the most common additions:

• Laser treatments targeting pigment
• Microneedling

Combining a topical agent with one of these treatments often works better than either alone.

Tranexamic acid also comes in an oral prescription form. For patients with:

• Very stubborn pigmentation
• Widespread PIH
• Poor response to topical TXA

...we can consider oral TXA in addition to topical therapy. It's not a first-line option for everyone, but it can be genuinely helpful for the toughest cases.

This step is non-negotiable. Sun exposure makes PIH significantly worse — it's the single fastest way to undo whatever progress you've made with treatment.

If you already have PIH or you know you're prone to it:

• Wear sunscreen daily (SPF 30+ minimum, ideally mineral)
• Reapply every couple of hours when outdoors
• Cover the affected area with clothing when possible
• Avoid peak-UV hours when you can

Any investment you're making in topicals, lasers, or microneedling is wasted if you're not protecting your skin from UV.

PIH after surgery or injury is common, but very treatable. The roadmap is:

1. Start with a topical — TXA or hydroquinone
2. Add a treatment like laser or microneedling if needed
3. Consider oral TXA for the most stubborn pigmentation
4. Wear sunscreen religiously no matter which option you're using

Be patient — meaningful fading takes months, not days — and don't skip the sun protection. That's the step that lets the rest of the plan actually work.