Post-inflammatory Hyperpigmentation in Skin of Color: Emerging Therapies and Treatment Algorithms

Post-inflammatory hyperpigmentation (PIH) is a common pigmentary disorder that is especially prevalent among individuals with skin of color. Lesions can persist for months to years and may contribute to psychosocial distress. Given its chronicity and significant impact, it is important to optimize treatment approaches tailored to diverse skin types. This review evaluated emerging therapies and treatment algorithms for PIH across adult and pediatric populations, with a focus on evidence specific to skin of color. A comprehensive literature search covering 2015 to 2025 identified clinical studies including randomized controlled trials (RCTs), cohort studies, case series, and case reports that reported on topical, systemic, or procedural interventions for PIH. Emphasis was placed on therapies that were evaluated in skin-of-color cohorts. Topical agents such as hydroquinone (HQ), retinoids, azelaic acid (AA), cysteamine, and tranexamic acid (TXA) remain first-line therapies alongside photoprotection. Recent clinical trials have demonstrated their efficacy: cysteamine 5% cream reduced hyperpigmentation indices within 16 weeks, while topical TXA combinations yielded a 30-40% improvement in pigmentation with favorable safety. Oral TXA and emerging nutraceuticals have also shown promise as systemic options. Procedural interventions, including chemical peels and laser therapies, must be used cautiously in individuals with darker skin. In pediatric PIH, first-line management includes gentle skincare, sun protection, and treatment of the underlying inflammatory condition before considering more aggressive interventions. Emerging therapies such as cysteamine and TXA expand the range of treatment options for PIH, providing effective and safe alternatives to HQ in skin of color. Stepwise, individualized regimens that integrate topical therapy, photoprotection, and adjunctive interventions can optimize outcomes while minimizing risks. Further research in pediatric and skin-of-color populations is needed to refine treatment algorithms.