Pigmentary disorders, other than vitiligo, were the third most common dermatoses among African-American patients (9%), but were the seventh most common among Caucasian patients (1.7%). 2, 3 In 1983, Halder et al 2 published a study comparing the most common dermatoses seen in African American and Caucasian patients. Multiple epidemiological studies have shown that PIH tends to occur more commonly among skin-of-color patients compared to Caucasian patients. These figures typically include postinflammatory hyper- or hypopigmentation although melasma and solar lentigines may also be included. Table 1 shows the worldwide prevalence of pigmentary disorders, excluding vitiligo, in various ethnic populations. It is also important to use caution with all of the above treatments to prevent irritation and worsening of postinflammatory hyperpigmentation. Topical therapy is typically effective for epidermal postinflammatory hyperpigmentation however, certain procedures, such as chemical peeling and laser therapy, may help treat recalcitrant hyperpigmentation. Other depigmenting agents include retinoids, mequinol, ascorbic acid, niacinamide, N-acetyl glucosamine, and soy with a number of emerging therapies on the horizon. Topical tyrosinase inhibitors, such as hydroquinone, azelaic acid, kojic acid, arbutin, and certain licorice extracts, can effectively lighten areas of hypermelanosis.

First-line therapy typically consists of topical depigmenting agents in addition to photoprotection including a sunscreen. The treatment of postinflammatory hyperpigmentation should be started early to help hasten its resolution and begins with management of the initial inflammatory condition. Epidemiological studies show that dyschromias, including postinflammatory hyperpigmentation, are among the most common reasons darker racial/ethnic groups seek the care of a dermatologist. Postinflammatory hyperpigmentation is a common sequelae of inflammatory dermatoses that tends to affect darker skinned patients with greater frequency and severity.

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