Burden of post-inflammatory hyperpigmentation in acne patients:  assessing psychological distress and quality of life among students at Delta State University, Oghara (Nigeria)

Background: Acne vulgaris is a ubiquitous dermatosis with a high prevalence among young adults worldwide. Among darker skinned populations, acne frequently heals with post-inflammatory hyperpigmentation (PIH), which may outlive active lesions and exert significant psychosocial burden. However, evidence quantifying the impact of PIH on psychological wellbeing and quality of life (QoL) in African student populations remains limited.Objective: To determine the prevalence of PIH among students with acne at Delta State University and to evaluate its association with QoL impairment and psychological distress.Methods : A descriptive cross-sectional study was conducted among 422 undergraduate students with acne. Participants completed structured questionnaires, the Dermatology Life Quality Index (DLQI), and the Patient Health Questionnaire-9 (PHQ-9). Severity of PIH and acne were clinically graded. Statistical analysis included descriptive statistical inferential testing using ANOVA.Results : The prevalence of post-inflammatory hyperpigmentation (PIH) was 70.6%. The majority of participants had Fitzpatrick skin types V (66.4%) and VI (18.7%), with most cases classified as mild PIH (47.6%). The mean Dermatology Life Quality Index (DLQI) score was 5.17 ± 5.63, indicating overall mild impairment; however, 18.2% of participants experienced moderate quality-of-life impact. The mean PHQ-9 score was 5.63 ± 5.75, reflecting generally low depressive burden, although 22.3% of respondents had moderate depressive symptoms and 1.4% severe depression. Increasing PIH severity was significantly associated with worsening quality of life (F = 36.507, p < 0.001) and higher depressive symptom burden (F = 23.687, p < 0.001).Conclusion: Post-inflammatory hyperpigmentation is highly prevalent among students with acne and represents a clinically significant yet often under-recognized source of psychosocial burden. While the overall impact appears mild, a substantial subset of affected individuals experience meaningful impairment in quality of life and psychological well-being, particularly with increasing disease severity. These findings underscore the need for early, targeted, and pigment-conscious therapeutic strategies, alongside integrated psychosocial assessment in the management of acne in skin of colour.