Eczema is a skin condition known to cause a range of uncomfortable symptoms, from dry, scaly patches to itchy rashes. A lesser-known symptom is dark spots, sometimes called post-inflammatory hyperpigmentation.
“Any inflammatory process in the skin can lead to discoloration,” says 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 range from light brown to dark purple.
If you have darker skin, you may also notice spots that are lighter than your natural skin tone, according to Westlake Dermatology-certified dermatologist Malini Fowler, MD. This is called hypopigmentation.
Below, dermatologists explain 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, Fishman says, but especially on areas exposed to the sun. These plaques, which often appear after a flare-up of eczema has resolved, may not go away for several months.
Common characteristics of eczema patches include:
- color that ranges from ash gray to dark brown or deep purplish, depending on your natural skin tone
- dryness, flaking, and itching on discolored patches
- lichenification, or skin that becomes leathery from frequent scratching and rubbing
- other general signs of eczema, including skin swelling, blistering, oozing, and crusting
Keep in mind, however, that not everyone with eczema has all of these symptoms, including hyperpigmentation.
Learn more about eczema and how to recognize it.
Eczema causes an inflammatory reaction in the body. This triggers the release of protein cells called cytokines that stimulate the cells responsible for producing melanin, says Michele Green, MD, a board-certified cosmetic dermatologist.
Melanin is a type of pigment that affects the color of your skin. When melanin production increases, the pigment can be transferred to the top layer of the skin, resulting in patches of discoloration.
Not everyone with eczema will notice these spots. Because darker-skinned people naturally have more melanin, they’re more prone to hyperpigmentation, Green says.
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 the skin can lead to darker spots.
The longer eczema-related discoloration goes untreated, the darker the discoloration can become, says Fowler.
Usually, brown spots from eczema will eventually go away on their own. Still, you might not want to wait months for them to fade.
Your treatment options include:
The most common professional treatment for this type of hyperpigmentation involves prescription topical hydroquinone and tretinoin, says Fowler.
Hydroquinone, a lightening agent, whitens your skin by decreasing the cells that produce skin pigment. You will typically apply it once or twice a day for 3-6 months. If you don’t notice results after about 3 months, your dermatologist will likely recommend a different approach.
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However, hydroquinone can make hyperpigmentation worse if you have darker skin. Your dermatologist can offer you more advice on the best treatment approach for your skin care needs.
Tretinoin is a natural form of vitamin A, or retinoic acid. This topical medication increases the rate at which skin cells renew themselves. In other words, old cells die faster, so new, healthier cells replace them.
According to a 2022 review, tretinoin appears to help reduce eczema-related discoloration in about 12 weeks, including in Hispanic and Black participants with medium to dark skin.
Studies suggest that hydroquinone and tretinoin may
Keep in mind that hydroquinone and tretinoin can sometimes cause irritation or trigger eczema flare-ups, which could make hyperpigmentation worse. A dermatologist may prescribe a topical steroid in addition to these medications to lessen any potential irritation.
Laser therapy and chemical peels
Laser therapy and chemical peels can also be beneficial, but 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 the skin and promote collagen growth.
Your dermatologist can help you determine the best type of laser therapy for your skin type.
Chemical peels, such as glycolic acid peels, remove the top layer of skin, which can help remove patches of hyperpigmentation. You can get this procedure done at a dermatologist’s office or by a licensed esthetician at a spa.
Research on the use of chemical peels for hyperpigmentation has yielded mixed results.
Chemical peels seem most effective when used with topical prescription medications like tretinoin and hydroquinone. According to Fowler, milder peels with lactic and mandelic acid 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 when using them.
If you’re hoping to treat eczema discoloration at home or are looking for gentler alternatives to prescription treatment, you have a few options.
Fishman suggests considering skincare products containing botanical ingredients known to promote brightening by slowing melanin production. These include ingredients such as:
She notes that you will likely need to use these products for at least 3 months to see results.
Another brightening skincare ingredient that can help lighten hyperpigmentation? Vitamin C.
According to Green, vitamin C may have benefits because it:
- has anti-inflammatory properties
- helps reduce melanin production
- has antioxidant properties that help neutralize free radicals from sun exposure
Vitamin B-3, which you may know as niacinamide, can also help prevent darker areas of pigmentation from rising to the top layer of your skin, where they are visible.
Green also stresses 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 retain moisture and repair skin, including:
Experts agree that sun protection is key to 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, Fowler says. The trauma this causes stimulates the melanocytes to produce more melanin, which leads to more dark spots.
Additionally, chronic scratching can lead to lichenification or scarring, says Green. To help relieve itching, she suggests instead:
- soak in a lukewarm oatmeal bath for 15 minutes and pat your skin dry
- using a rich moisturizer, especially after bathing
- apply a cool, damp washcloth to the affected area
Find more home remedies for eczema.
Post-inflammatory hyperpigmentation can affect anyone, regardless of other eczema symptoms or skin tone. Although these spots usually go away on their own after an eczema flare-up ends, it can take several months.
If you notice these patches growing, a good next step is to contact a dermatologist for more advice on your treatment options. Know that relief is possible, even if you live with severe eczema.
To help prevent eczema-related hyperpigmentation, or at least keep 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. His work has also appeared in Insider, Bustle, StyleCaster, Eat This Not That, AskMen and Elite Daily.