Condition · Fitzpatrick IV to VI · Battersea SW11
Post-inflammatory hyperpigmentation in Skin of Colour, in London.
Healthy skin for every tone. PIH is more common, more persistent, and more visible in Fitzpatrick IV to VI skin. Acne marks, folliculitis scarring, and pigmentation from minor trauma may take 12 to 24 months to resolve without active treatment. At Melatone in Battersea, the protocol is built around cause control, sun-protection foundation, and combination therapy, not one-size-fits-all peels.
A personalised consultation with Arman Zaki, GMC-registered Physician Associate (Ref A8131967). We even tone. We do not lighten complexion. We do not offer skin-whitening or skin-bleaching protocols.
PIH vs melasma
Different cause. Different ladder.
Post-inflammatory hyperpigmentation requires a prior skin injury or inflammatory event as its trigger. Melasma does not. Both present as darker patches but respond to different treatment paths. PIH requires the inflammatory source to be controlled first. Melasma centres on strict sun protection and hormonal trigger management. Misidentifying one as the other is a common cause of treatment failure. Evidence: Callender VD et al. (2011), American Journal of Clinical Dermatology, DOI 10.2165/11536930-000000000-00000.
If you are looking for melasma-specific information, see melasma treatment at Melatone.
Why PIH is worse on darker skin
Higher melanocyte density. Higher PIH risk.
People with Fitzpatrick IV to VI skin have a greater density of active melanocytes. Any inflammatory stimulus, including acne, a burn, folliculitis, a reaction to a product, or a poorly chosen treatment, may trigger those melanocytes to overproduce melanin in the affected zone. This produces a darker, more visible patch that may persist for 12 to 24 months without active management.
This is also why certain aesthetic treatments that carry low PIH risk on Fitzpatrick I to III may themselves induce PIH on Fitzpatrick V and VI. A 2024 systematic review of 1,356 PIH patients in skin of colour reported that repeated procedural interventions in Fitzpatrick IV to VI carry an 11 to 17 percent rate of inducing further PIH, mandating conservative-fluence and low-concentration selection. Iatrogenic PIH from a prior clinic is a common presentation at Melatone. Evidence: Mar et al. (2024), Journal of Cutaneous Medicine and Surgery, DOI 10.1177/12034754241265716.
The Melatone protocol
Combination, not single-treatment.
A 2024 systematic review of 41 studies and 877 PIH patients found no single modality produced reliable complete clearance. Combination therapy yielded approximately 85 percent partial response. This evidence is why Melatone builds multi-modal protocols rather than single-treatment plans. Source: Kashetsky et al. (2024), JEADV, DOI 10.1111/jdv.19566. Results may vary.
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Identify and control the inflammatory trigger.
Active acne must be managed before any pigmentation intervention. This may include referral to your GP for systemic acne management. We do not apply peels or microneedling over active acne lesions.
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Daily mineral SPF 50+ with visible-light coverage.
The non-negotiable foundation. A 2025 systematic review of PIH prevention in skin of colour found that only sunscreen consistently prevented PIH incidence. Tinted mineral formulations with iron oxides may attenuate UVA1 and visible-light driven melanogenesis. No in-clinic procedure is started without daily SPF in place. Evidence: Mar K. et al. (2025), Australasian Journal of Dermatology, DOI 10.1111/ajd.14432.
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Topical pigment regulators.
Azelaic acid, tranexamic acid, niacinamide. Applied morning and evening once the skin is stable. Hydroquinone is prescribed only where appropriate and is contraindicated in pregnancy.
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Conservative low-strength chemical peels.
Mandelic acid or lactic acid, applied cautiously. The 2024 systematic review of pigmentation treatments in skin of colour identified salicylic acid peels as carrying a notable hyperpigmentation risk in the studied population; salicylic acid is not used for this indication at Melatone. Evidence: Mar K. et al. (2024).
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Polynucleotide biostimulator injections.
A regenerative skin-quality adjunct that may support skin barrier repair and hydration. Mechanism is supported in the literature; condition-specific evidence in Fitzpatrick IV to VI is preliminary. We frame polynucleotides as adjunctive, not first-line for pigmentation alone. Evidence: Lampridou et al. (2025), Journal of Cosmetic Dermatology, DOI 10.1111/jocd.16721.
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Microneedling with serum infusion, melanin-safe parameters.
Conservative pass numbers and short needle depths, only after the cause is controlled. Microneedling evidence is stronger for atrophic acne scarring than for PIH per se; we use it adjunctively for textural concerns alongside the pigmentation protocol.
One of five professional infusion serums is selected at consultation based on your skin's primary concern. Each serum supports a different mechanism alongside the microchannel delivery.
- Brightening serum for pigmentation. Tranexamic acid, niacinamide, glutathione, and vitamin C. Selected for PIH, hyperpigmentation, and uneven tone in Fitzpatrick IV to VI. May support brighter, more even-toned skin over a course of sessions. Results may vary.
- Regenerative serum. Polynucleotides (PDRN, salmon-derived sodium DNA), multi-peptide complex, and niacinamide. May support skin density, elasticity, and post-treatment recovery, particularly for ageing or fragile skin.
- Skin quality serum. Niacinamide, vitamin C, polynucleotides, vitamin B12, and a 25-peptide complex. Selected when the priority is overall texture, tone, and post-treatment recovery.
- Smoothing peptide serum. A multi-peptide complex with sodium DNA, niacinamide, and vitamin B12. Selected when the priority is the appearance of fine expression lines and surface texture. May support a smoother surface appearance.
- Hydrating serum. Hyaluronic acid. Selected for hydration, plumpness, and barrier support.
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Low-fluence 1064 nm Q-switched Nd:YAG laser, selectively.
The most-studied laser for PIH in skin of colour. Capable of gradually lightening diffuse post-acne PIH over 6 to 10 weekly sessions, and the only intervention to achieve complete resolution in a subgroup (26 percent) of a 2024 systematic review of 1,356 patients. Where laser is appropriate at Melatone, it is the 1064 nm wavelength at conservative low fluence after Fitzpatrick assessment and patch test, never first-line. Evidence: Mar et al. (2024), Journal of Cutaneous Medicine and Surgery, DOI 10.1177/12034754241265716.
For home-care support alongside in-clinic treatment, see the at-home pigmentation routine for Skin of Colour.
What we usually do not lead with
For PIH in Fitzpatrick V to VI, we do not lead with these.
Aggressive depigmenting devices, high-strength peels, and unsupervised hydroquinone carry a documented risk of worsening PIH in darker skin. The following are not first-line at Melatone for this indication:
- Skin-whitening, bleaching, or depigmentation creams. We do not stock, prescribe, or signpost to these.
- Salicylic acid peels for PIH on Fitzpatrick V to VI.
- Medium-depth or deep chemical peels in darker skin.
- IPL pigment-removal protocols on Fitzpatrick V to VI.
- Aggressive Q-switched laser settings for general pigmentation without patch test and Fitzpatrick assessment.
- Peels or microneedling over active acne lesions.
- Hydroquinone for unsupervised at-home use.
Where low-fluence 1064 nm Nd:YAG is considered, it is only after topicals and conservative peels have been tried, after patch test, and only where the risk-benefit profile is clearly favourable. The default at Melatone is conservative, not aggressive.
The consultation
£30, deducted from your first treatment.
One
Assessment
Fitzpatrick typing, PIH cause identification, trigger history, current skincare and SPF habits, hormonal context, current acne or inflammatory dermatoses. Photographic baseline at consistent lighting with your consent.
Two
Personalised plan
Written sequenced plan: trigger control first, foundation second, in-clinic add-ons third. Honest reading of what the evidence supports and where it stops.
Three
Review at 6 to 8 weeks
Photographic comparison, plan adjustment, decision to escalate or hold. Quarterly maintenance reviews thereafter.
Questions, answered honestly
Before you book.
What is the difference between post-inflammatory hyperpigmentation and melasma?
PIH follows a prior skin injury or inflammatory episode such as acne, folliculitis, a cut, a burn, or a poorly chosen aesthetic procedure. Melasma is hormonally and UV-driven and does not require a prior local injury. Both present as darker patches but the treatment approaches differ. PIH requires the inflammatory trigger to be controlled first; melasma requires strict sun protection and hormonal trigger management.
Why is PIH worse on darker skin tones?
People with Fitzpatrick IV to VI skin have a greater density of active melanocytes. Any inflammatory stimulus may trigger those melanocytes to overproduce melanin in the affected zone. This produces a darker, more visible patch that may persist for 12 to 24 months. A 2024 systematic review reported procedural interventions in Fitzpatrick IV to VI carry an 11 to 17 percent rate of inducing further PIH, mandating conservative-fluence selection. Source: Mar et al. (2024).
Which PIH treatments are safe for Fitzpatrick V skin?
The Melatone ladder may include daily mineral SPF 50+ with visible-light coverage (foundation), topical azelaic acid, tranexamic acid, niacinamide, conservative low-strength peels (mandelic acid, lactic acid), polynucleotide biostimulator injections as an adjunct, and microneedling with melanin-safe parameters where indicated. Where laser is appropriate, low-fluence 1064 nm Q-switched Nd:YAG is the most-studied option. Salicylic acid peels and high-fluence lasers carry a documented hyperpigmentation risk in darker skin and are not the starting point. Results may vary.
How do I treat acne marks on brown or Black skin?
Active acne must be managed first. This may include referral to your GP. The Melatone protocol then layers daily mineral SPF, barrier repair, topical pigment regulators, conservative peels, polynucleotides as an adjunct, and microneedling for textural concerns. Peels or microneedling are not applied over active lesions.
How long does PIH take to fade?
PIH depth, cause, and Fitzpatrick type affect timelines. With a consistent protocol most patients begin to see gradual lightening between weeks 8 and 12, with more meaningful change measurable photographically by 24 weeks. A 2024 systematic review of 877 patients found no single modality produced reliable complete clearance; combination therapy yielded a partial response in 85 percent (141 of 166 patients). Results may vary. Source: Kashetsky et al. (2024), DOI 10.1111/jdv.19566.
Who treats PIH at Melatone?
Arman Zaki, Founder and Lead Clinician, GMC-registered Physician Associate (Ref A8131967), MSc-trained. He has a declared special interest in Skin of Colour aesthetics across Fitzpatrick I to VI and personally leads every pigmentation consultation. Melatone is at Unit 13A, Battersea Business Centre, 99-109 Lavender Hill, London SW11 5QL. A £30 consultation is bookable via Treatwell or WhatsApp on +44 7586 817215.
£30 personalised consultation