# Post-inflammatory Hyperpigmentation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Sun protection and treatment of the underlying cause - Hydroquinone — topical - Referral & safety-netting (no drug therapy) - Azelaic acid — topical ## Complete treatment card ```text POST-INFLAMMATORY HYPERPIGMENTATION 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 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) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Once the triggering inflammation clears, the pigmentation change itself is painless, though it can cause psychological distress. [pigmentation change] - It follows any inflammation or injury of the skin and is an acquired, long-running problem - It is commoner and more severe the darker the skin, particularly Fitzpatrick types III to VI - It usually fades on its own, but that takes months to years, so treatment has to be long SIGNS - what you find (3) - Epidermal pigmentation is tan to dark brown, can last months to years untreated, but tends to fade over time. - Dermal-type pigmentation is blue-gray in color and can be permanent, unlike the epidermal type. - Epidermal pigmentation may show fluorescence when examined under a Wood lamp. TESTS (2) - Wood lamp exam helps distinguish the epidermal pigment type from the dermal type. - Labs to exclude Addison disease or lupus are only warranted if other suggestive signs are present. IF NOT THIS - what else fits (1) - Conditions on the differential include tinea versicolor, acanthosis nigricans, solar lentigines, discoid lupus erythematosus, melasma, and lichen planus pigmentosus. Source StatPearls "Postinflammatory Hyperpigmentation" - disease-level clinical article Status traced to the source above 1. SUN PROTECTION AND TREATMENT OF THE UNDERLYING CAUSE [1st line] Adult 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. - Continuous, and for months after the marks fade Peds Same advice at any age, and it is the only part of this page that is safe in a child under 12. Source Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b) Why 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. Caution 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'. 2. HYDROQUINONE [1st line] Adult 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. - Review at 2 months; do not continue indefinitely Peds Safety is not established in children 12 and under, or in pregnancy. Use sun protection alone in those patients. Source Hydroquinone 4% cream US prescribing information, Indications, Dosage and Administration, Warnings (DailyMed setid 595dfc50-ee6f-41b5-ab5b-4c293aee342b) Why 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. Caution 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. Egypt CLEARALIQUE 2% CREAM 30 GM DELTA PHARMA 6.00 EGP CLEARALIQUE FORTE 4% CREAM 30 GM DELTA PHARMA 8.00 EGP MELOQUIN 4% CREAM 20 GM BIOPHARM EGYP... 60.00 EGP 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Postinflammatory Hyperpigmentation - disease-level clinical article (post-inflammatory- hyperpigmentation-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Rule out Addison disease and systemic lupus erythematosus when associated signs/symptoms are present, rather than assuming hyperpigmentation is post-inflammatory. 4. AZELAIC ACID [2nd line] Adult 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. - Improvement is apparent at about 4 weeks; continue several months Peds Not established for pigmentation in children. Treat the underlying acne or eczema and protect from the sun. Source Skinoren 20% Cream SmPC sections 4.1, 4.2, 4.4 and 4.6 (eMC product 285) Why 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. Caution 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. Egypt AZECLEAR 20% CREAM 30 GM BIOPHARM EGYP... 21.60 EGP EZALIC 20% CREAM 30 GM MULTI-APEX 26.40 EGP SKINOREN 20% CREAM 30 GM INTENDIS MANU... 35.50 EGP AZADERM 20% CREAM 30 GM MUP 87.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)