Eczema is a skin condition known for causing a range of uncomfortable symptoms, from dry and scaly patches to itchy rashes. One lesser-known symptom is dark spots, sometimes referred to as post-inflammatory hyperpigmentation.
“Any inflammatory process in the skin can lead to discoloration,” explains Cybele Fishman, MD, a board certified dermatologist with Advanced Dermatology PC. “In general, the darker your skin color, the higher your risk of post-inflammatory hyperpigmentation.”
According to Fishman, these spots will always be darker than your natural skin tone, but they can vary from light brown to deep purple.
If you have darker skin, you might also notice patches that are lighter than your natural skin tone, according to Malini Fowler, MD, a board certified dermatologist at Westlake Dermatology. This is called hypopigmentation.
Below, dermatologists share how to identify eczema dark spots, why they happen, and what to do about them.
This type of hyperpigmentation can occur on any area of skin affected by inflammation, says Fishman, but especially those areas that receive sun exposure. These patches, which often appear after an eczema flare-up has resolved, may not go away for several months.
Common characteristics of eczema spots include:
- color that ranges from ashy gray to dark brown or deep purplish, depending on your natural skin tone
- dryness, scaliness, and itchiness on the discolored patches
- lichenification, or skin that becomes leathery as a result of frequent scratching and rubbing
- other general signs of eczema, including swelling of the skin, blistering, oozing, and crusting
Keep in mind, though, that not everyone with eczema experiences all of these symptoms, including hyperpigmentation.
Eczema causes an inflammatory response in the body. This triggers the release of protein cells called cytokines that stimulate the cells responsible for producing melanin, explains Michele Green, MD, a board certified cosmetic dermatologist.
Melanin is a type of pigment that affects your skin color. When melanin production ramps up, the pigment can get transferred to the top layer of the skin, resulting in patches of discoloration.
Not everyone who has eczema will notice these spots. Because people with darker skin naturally have more melanin, they’re more prone to hyperpigmentation, says Green.
Green also points out that sun exposure can trigger or worsen hyperpigmentation since the sun’s UVA rays can cause cells to produce more melanin.
Even scratching your skin can lead to darker patches.
The longer eczema-related discoloration goes untreated, the darker the discoloration can become, Fowler explains.
Usually, dark spots from eczema eventually clear up on their own. Still, you may not want to wait months for them to fade.
Your options for treatment include:
The most common professional treatment for this kind of hyperpigmentation involves topical prescription hydroquinone and tretinoin, says Fowler.
Hydroquinone, a lightening agent, bleaches your skin by decreasing cells that produce skin pigment. You’ll generally apply it once or twice a day for 3 to 6 months. If you don’t notice results after about 3 months, your dermatologist will likely recommend a different approach.
In an older
However, hydroquinone may worsen hyperpigmentation if you have darker skin. Your dermatologist can offer more guidance on the best approach to treatment for your skin care needs.
Tretinoin is a naturally occurring form of vitamin A, or retinoic acid. This topical medication increases the rate at which skin cells turn over. In other words, it causes old cells to die away faster so newer, healthier ones replace them.
According to a 2022 review, tretinoin appears to help reduce eczema-related discoloration within about 12 weeks, including in Hispanic and Black participants with medium to dark skin.
Studies suggest hydroquinone and tretinoin may
Keep in mind that hydroquinone and tretinoin can sometimes cause irritation or trigger eczema flares, which could worsen hyperpigmentation. A dermatologist may prescribe a topical steroid alongside these medications to lessen any potential irritation.
Laser therapy and chemical peels
Laser therapy and chemical peels can also have benefit, but they do come with a higher risk of adverse effects, including irritation.
Ablative laser procedures remove layers of skin, while non-ablative laser procedures can help tighten skin and promote the growth of collagen.
Your dermatologist can help you determine the best type of laser therapy for your skin type.
Chemical peels, like glycolic acid peels, remove the top layer of the skin, which can help get rid of patches of hyperpigmentation. You can get this procedure done at a dermatologist’s office or by a licensed aesthetician at a spa.
Research on using chemical peels for hyperpigmentation has found mixed results.
Chemical peels seem most effective when used with topical prescription medications like tretinoin and hydroquinone. According to Fowler, gentler lactic and mandelic acid peels may be a better option if you have sensitive, irritation-prone skin.
All of these treatments can increase your sensitivity to the sun, so it’s crucial to wear sunscreen daily while using them.
If you’re hoping to address eczema discoloration at home or searching for gentler alternatives to prescription treatment, you have a few options.
Fishman suggests considering skin care products with botanical ingredients known to promote lightening by slowing down melanin production. These include ingredients like:
She notes that you’ll likely need to use these products for at least 3 months in order to get results.
Another brightening skin care ingredient that may help lighten hyperpigmentation? Vitamin C.
According to Green, vitamin C can have benefit because it:
- has anti-inflammatory properties
- helps reduce the production of melanin
- has antioxidant properties that help neutralize free radicals from sun exposure
Vitamin B-3, which you might know as niacinamide, may also help prevent darker areas of pigmentation from rising to the top layer of your skin, where they’re visible.
Green also emphasizes the importance of using a moisturizer that repairs the skin’s natural protective barrier, which can promote healing and minimize discoloration. She recommends trying one with ingredients known to help to lock in moisture and repair the skin, including:
Experts agree that sun protection is key in preventing post-inflammatory hyperpigmentation. Green recommends applying sunscreen with a minimum of SPF 50 daily and reapplying every 90 minutes.
You’ll also want to avoid scratching or picking at patches of hyperpigmentation, says Fowler. The trauma this causes stimulates the melanocytes to make more melanin, resulting in more dark spots.
Not only that, chronic scratching can lead to lichenification or scarring, Green explains. To help ease itching, she suggests instead:
- soaking in a lukewarm oatmeal bath for 15 minutes and patting your skin dry
- using a rich moisturizer, especially after bathing
- applying a cool, wet washcloth to the affected area
Post-inflammatory hyperpigmentation can happen to anyone, regardless of other eczema symptoms or skin tone. While these spots typically fade on their own after an eczema flare-up has ended, this can take several months.
If you notice these patches developing, a good next step involves connecting with a dermatologist to get more guidance on your options for treatment. Know that relief is possible, even if you live with severe eczema.
To help ward off eczema-related hyperpigmentation, or at least prevent it from getting worse, you’ll want to use sunscreen daily and avoid scratching as much as possible.
Rebecca Strong is a Boston-based freelance writer covering health and wellness, fitness, food, lifestyle, and beauty. Her work has also appeared in Insider, Bustle, StyleCaster, Eat This Not That, AskMen, and Elite Daily.