Post-inflammatory hyperpigmentation (PIH) is the flat brown, gray, or purple marks left behind after acne, eczema, bug bites, or any injury to the skin. It is not scarring; the skin is intact but has made extra pigment in response to inflammation. PIH is more common and longer lasting in medium and darker skin tones, and it is often more distressing to patients than the breakouts themselves.

What causes dark spots after breakouts?

Inflammation stimulates pigment-producing cells, and the pigment settles in the skin as the lesion heals. Picking, sun exposure, and ongoing breakouts all deepen and prolong the marks. Darker skin produces more pigment in response, which is why PIH can last a year or more without treatment.

How is PIH different from acne scars or melasma?

PIH is flat and fades with time; acne scars have a change in texture. Melasma is symmetric brown patches, usually on the cheeks, forehead, or upper lip, driven by hormones and sun rather than a prior breakout. The treatments overlap but are not identical, so the distinction matters.

How are dark spots treated?

First, control the breakouts so new marks stop forming. Then daily sunscreen, and topical agents that slow pigment production: hydroquinone, azelaic acid, tretinoin, tranexamic acid, and newer non-hydroquinone options. Chemical peels and select lasers are used carefully in darker skin to avoid worsening. Improvement is gradual over three to six months.

How Tono treats post-inflammatory hyperpigmentation

Tono's board-certified dermatologists see patients with dark spots within days, not months, by video visit in 33 states and in person at Tono clinical centers. Our Skin of Color center specializes in acne and pigmentation in Black, Hispanic, Asian, and Middle Eastern skin, where the wrong treatment can make marks worse. Regimens are built for your skin tone and adjusted by photo follow-up. Your visit ends with a written plan, prescriptions sent to your pharmacy, and follow-up scheduled with the same dermatologist. Most insurance is accepted and no referral is required.

When should I see a dermatologist for dark spots?

See a dermatologist if dark marks are lasting more than a few months, if you are still breaking out, or if over-the-counter products have caused irritation. Treating the acne and the marks together shortens the whole course.