{ "schema_version": 1, "kind": "condition", "id": "post-inflammatory-hyperpigmentation", "name": "Post-inflammatory Hyperpigmentation", "category": "chronic", "sources": "Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b) · Skinoren 20% Cream SmPC sections 4.1, 4.2, 4.4 and 4.6 (eMC product 285)", "review_status": "reviewed", "verified_against": "Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b) · Skinoren 20% Cream SmPC sections 4.1, 4.2, 4.4 and 4.6 (eMC product 285) · Postinflammatory Hyperpigmentation - disease-level clinical article (post-inflammatory-hyperpigmentation-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1493, "generic": "Sun protection and treatment of the underlying cause", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Broad-spectrum SPF 30 or higher every morning, reapplied through the day, plus shade and a hat. Treat whatever caused the inflammation - the acne, the eczema, the bite - or the marks keep being replaced.", "adult_duration": "Continuous, and for months after the marks fade", "dose_source": "Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b)", "rationale": "The label for the bleaching cream says it plainly: even minimal sunlight sustains melanocyte activity. Without sun protection every other treatment on this page is wasted money.", "cautions": [ "Cairo sun is the whole problem. A patient who uses the cream and skips the sunscreen will not improve, and may darken.", "Give a timescale honestly: epidermal pigment takes 6-12 months to fade and dermal pigment can take years. Patients stop treatment at 6 weeks because nobody told them.", "Picking, scrubbing and harsh bleaching products make it worse by adding fresh inflammation.", "SPF 30 is general public-health advice, not a figure from the hydroquinone label. That label is cited here for what it does carry: that sun exposure reverses the treatment's effect and that a sunscreen should be used with it. There is no licensed medicine behind 'wear a hat'." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Same advice at any age, and it is the only part of this page that is safe in a child under 12.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "post-inflammatory-hyperpigmentation" }, { "id": 1494, "generic": "Hydroquinone", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply a thin layer to the dark patches only and rub in well, twice daily, morning and bedtime. Stop if there is no improvement after 2 months.", "adult_duration": "Review at 2 months; do not continue indefinitely", "dose_source": "Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b)", "rationale": "The standard depigmenting agent and cheap here - 2% from 6 EGP, 4% from 8 EGP. Start at 2% and go to 4% only if 2% has not worked.", "cautions": [ "Exogenous ochronosis - a gradual blue-black darkening that is worse than what you were treating and hard to reverse. It is commonest in darker skin, which is most patients here. Stop at once if the area goes darker rather than lighter.", "Test on a small patch of unbroken skin first and check it at 24 hours.", "The cream contains no sunscreen. Prescribe both or neither.", "Onto the dark patches only, not the whole face - it will bleach the normal skin around them and leave a halo.", "Two months without improvement means stop, not escalate." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety is not established in children 12 and under, or in pregnancy. Use sun protection alone in those patients.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CLEARALIQUE 2% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLEARALIQUE FORTE 4% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELOQUIN 4% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "post-inflammatory-hyperpigmentation" }, { "id": 1496, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Postinflammatory Hyperpigmentation - disease-level clinical article (post-inflammatory-hyperpigmentation-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Rule out Addison disease and systemic lupus erythematosus when associated signs/symptoms are present, rather than assuming hyperpigmentation is post-inflammatory." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "post-inflammatory-hyperpigmentation" }, { "id": 1495, "generic": "Azelaic acid", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 20% cream to the affected skin twice daily, morning and evening, and rub in gently. About 0.5 g covers a whole face. On sensitive skin start once daily at night for the first week.", "adult_duration": "Improvement is apparent at about 4 weeks; continue several months", "dose_source": "Skinoren 20% Cream SmPC sections 4.1, 4.2, 4.4 and 4.6 (eMC product 285)", "rationale": "The choice in pregnancy and where hydroquinone has failed or caused irritation. It also treats the acne that is often causing the marks in the first place. From 21.60 EGP.", "cautions": [ "This is an off-label use. The licence is for acne vulgaris - the pigmentation benefit is real but the label does not claim it, and the patient should be told.", "Stinging and redness in the first weeks are expected. Drop to once daily until it settles rather than stopping.", "Keep it away from the eyes, mouth and nostrils; wash with plenty of water if it gets in.", "In pregnancy the SmPC says exercise caution rather than avoid. If breastfeeding, keep the infant from contact with treated skin." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not established for pigmentation in children. Treat the underlying acne or eczema and protect from the sun.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AZECLEAR 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA", "price_egp": 21.6, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZALIC 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 26.4, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SKINOREN 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTENDIS MANUFACTURING SPA-ITALY > BAYER HEALTHCARE", "price_egp": 35.5, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AZADERM 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 87.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "post-inflammatory-hyperpigmentation" } ] }