On skin of color, eczema rashes are less visible, which may make diagnosis more difficult. Inflammation may also leave lighter marks and must, therefore, be treated as soon as possible.
Eczema affects all skin colors
Eczema is a common disease affecting mostly children, and it does not discriminate against skin color. Light skin and dark skin tones are equally affected.
Similar symptoms appear in dark skin as in light skin:
- Changes in skin color on the eczema patch
- Swelling (edema)
- Itching
- Oozing
- Thickening of the skin (lichenification)
- Marks from scratching (excoriation)
In atopic eczema, which presents in flare-ups, skin also feels dry and tight, even in periods of remission. Intense itching can impede sleep and cause children to become irritable.
On dark skin: redness is less visible and lichenification is dark
On light skin, eczema patches are more visible due to the stark contrast. They may be more difficult to see on dark skin. If skin is lightly pigmented, and in adequate lighting, patches are visible but less noticeable on black skin.
Impact on pigmentation
Scratching often leads to hyperpigmentation
Inflammation and scratching stimulate pigmentation. Simply scratching the skin, even without eczema, can cause brown patches, for example on the back. Eczema lichenification—the thickening of the skin due to scratching—often appears hyperpigmented on dark skin.
This hyperpigmentation is temporary and is gradually reduced with treatment.
We also observe on dark skin a particular form of lichenification comprised of, for example, isolated spots (papules).
Eczema sometimes leads to depigmentation
In some cases, inflammation causes not hyperpigmentation but rather depigmentation, which can be light or totally white. This depigmentation most often appears in children, on the face, and is more visible against dark skin. It is temporary and goes away with treatment.
In some cases, this depigmentation is more intense and long-lasting. Prolonged itching can sometimes produce full depigmentation (vitiligo), particularly on the legs. This is rare, however, and appears only in cases of severe atopic dermatitis in adults.
Should you be worried about the effects of topical corticosteroids on pigmentation?
Cortisone creams (topical corticosteroids) used for the anti-inflammatory action against eczema offer another benefit in this case: they limit hyperpigmentation.
However, you should not be concerned about using a topical corticosteroid because of its potential depigmentation effect. Depriving a child of an effective treatment exposes them to the consequences of eczema and chronic scratching, and thus to pigmentation disorders, which are even more visible in children with dark skin. If treatment is properly administered (one daily application, stopped once patches have disappeared), the risk of depigmentation or hyperpigmentation is limited.
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7 Doctor-Approved Ways to Get Rid of Hyperpigmentation
Sunspots, acne scars, and big brown patches are all signs of hyperpigmentation on the skin. Try these hacks for a more even skin tone.
Reviewed: September 15, 2022
If you’re bothered by dark spots
due to hyperpigmentation on your skin, one thing is clear: Today there are more options for erasing that harmless but irksome discoloration than ever before. What exactly is hyperpigmentation? It’s any patch of skin that looks darker than your natural skin tone because the brown pigment melanin is being overproduced. Hyperpigmentation can be seen in
liver spots (or age spots) and sunspots, as the Cleveland Clinic notes. According to the Cleveland Clinic, these are the most common causes of
hyperpigmentation — and they can affect people of all skin tones to varying degrees. Skin trauma — such as acne, eczema, bug bites, cuts, scrapes, even scratching or friction from, say, vigorous rubbing — can set
off inflammation. Inflammation, in turn, can send pigment-producing cells into high gear, leaving behind a dark spot after the injury has healed. When inflammation is the cause of discoloration it is often referred to as post-inflammatory hyperpigmentation. According to the Mayo Clinic, the sun’s UV rays
trigger extra melanin production as a way to defend your skin from damage. That extra melanin is what gives you a tan. But when sun exposure is frequent or excessive it can make dark sunspots appear. Although sunspots are not cancerous, according to the American Society for Dermatologic Surgery, sun-exposed skin may develop precancerous blemishes that look similar to sunspots.
For this reason, it’s important to have your skin checked yearly by a dermatologist. Often referred to as the “mask of pregnancy,” melasma is characterized by brown patches that commonly form in women with fluctuating hormone levels, such as during pregnancy. This type of hyperpigmentation most often occurs in women, but can also occur in men. It is thought to be triggered by a combination of sun exposure, genetics, and hormonal
changes, since it has also been linked to the use of oral contraceptives, per experts at the American Osteopathic College of Dermatology (AOCD). Additionally, according to the Cleveland Clinic, other hormonal medications used for
birth control and menopause symptoms may cause melasma, as well as other types of medications discussed below. Hyperpigmentation can be caused by Addison’s disease, an adrenal gland disorder that can increase melanin production.
Certain drugs, including antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimalarials may all increase the risk of hyperpigmentation, according to a book published by StatPearls in July 2022. Some chemotherapy drugs can also cause temporary hyperpigmentation, per the advocacy group Cancer Connect. In the case of chemotherapy drugs, associated dark spots usually resolve 10 to 12 weeks after treatment ends as new skin cells replace dead ones. Today, there are plenty of dark-spot correctors to choose from — but it’s just as essential to
tackle them preventively. The following scientifically proven steps can help.Overproduction of melanin, a brown pigment, leads to hyperpigmentation.
4 Factors That Can Cause Hyperpigmentation
1. Inflammation
2. Sun Exposure
3. Melasma
4. Medical Conditions or Medication
The Best Ways to Treat and Prevent Future Hyperpigmentation
233Keep Skin Moist to Boost Cell Turnover
While your primary goal with hyperpigmentation is to lighten the dark spots, an effective over-the-counter (OTC) moisturizer should contain ingredients that benefit the skin in other ways. "In addition to addressing the pigment issues, a good product will have moisturizing agents like glycerin or hyaluronic acid, and maybe even a retinol to boost cell turnover," says Doris J. Day, MD, a clinical assistant professor of dermatology at NYU Medical School in New York City and the author of Beyond Beautiful: Using the Power of Your Mind and Aesthetic Breakthroughs to Look Naturally Young and Radiant. "These inactive ingredients allow the active brighteners to work more effectively."
A good moisturizer can also restore the skin’s lipid, or fat, barrier, helping new skin cells stay healthy as they rise to the surface in place of old ones, notes the University of Tennessee Medical Center.
234Keep Hands Off Bug Bites, Blackheads, and Other Injuries
As tempting as it may be to scratch a mosquito bite or squeeze a stubborn blackhead, remember your mother's warning — "Don't pick!" — and follow that advice. "Scratching and picking at a spot will only increase the inflammation that's responsible for skin discoloration," says Jeanine Downie, MD, a dermatologist and the director of Image Dermatology in Montclair, New Jersey. "The more you mess with it now, the worse it'll look later."
235Explore OTC Whitening Options
The sooner you treat hyperpigmentation, the easier it will be to erase. “The pigment in brown spots can move deeper into the skin over time,” Dr. Downie explains.
Spot-eradicating ingredients to look for in OTC treatments include azelaic and glycolic acids, vitamin C, and retinoids, says the American Academy of Dermatology Association (AAD).
“Treatments containing ingredients like vitamin C, licorice root, and kojic acid help reduce hyperpigmentation by inhibiting tyrosinase, an enzyme responsible for the formation of skin-darkening melanin," says Ni'Kita Wilson, a cosmetic chemist in New York City. Research published in 2017 in the Journal of Enzyme Inhibition and Medicinal Chemistry supports Wilson’s advice, noting that the knowledge of the link between tyrosinase and excess melanin development has led to the rise of multiple OTC products with the aforementioned ingredients.
While many of these OTC ingredients have “bleaching” effects on dark spots, the AAD strongly cautions against applying liquid bleach to your skin. The group recommends sticking with products made in the United States, as some imported skin lightening products have been found to be contaminated with mercury, steroids, and other harmful ingredients.
236Consider an Rx for Stubborn Skin Discoloration
If OTC remedies aren't helping, it's time to call in the pros. Dermatologists consider products with hydroquinone, alone or combined with other lighteners, to be the gold standard for fading dark spots because it slows the production of pigment. These are available by prescription, per the U.S. Food and Drug Administration (FDA). “It's our go-to,” says Downie, “because unlike many of the ingredients in OTC products, it almost always works at eliminating hyperpigmentation.” Have your dermatologist closely monitor hydroquinone treatment, she adds, because in high concentrations hydroquinone can cause sun sensitivity and may bleach the skin.
In addition to hydroquinone, the AOCD notes that your dermatologist may prescribe other treatments, such as topical cortisone cream or tretinoin, a type of synthetic vitamin A.
237Protect Your Skin From the Sun
The most effective way to prevent sun-induced discoloration is to diligently apply a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or greater, every day, even on cloudy or cool days. "UV rays just send the pigment into overdrive, turning dark spots darker," says Dr. Day. "You must wear sunblock daily on exposed areas."
SPF refers to protection from UVB short-wave rays only. To also protect against UVA long-wave rays, the Centers for Disease Control and Prevention (CDC) advises choosing a product that contains Mexoryl, Parsol 1789, titanium dioxide, zinc oxide, or avobenzone.
Additionally, the AAD recommends avoiding the outdoors between 10 a.m. and 2 p.m., when the sun is strongest. You can also wear a wide-brimmed hat to protect your head, as well as your face, ears, and neck.
238Ask a Dermatologist About High-Tech Options
If topical solutions aren't fixing the problem, you may want to talk to your dermatologist about more aggressive ways to banish discoloration, such as chemical peels, microdermabrasion, or dermabrasion, or, per the International Association for Physicians in Aesthetic Medicine, a laser resurfacing procedure. (Important note: If you have melasma, lasers are considered third-line treatments, as they have not been found to get rid of excess melanin production, according to a review published in March 2017 in the International Journal of Women's Dermatology.
239Other Steps to Prevent or Minimize Future Damage
Besides treatment and sun protection, there are other preventive measures you can take to minimize the onset of future dark spots. Stick to gentle skin-care products that don’t sting or burn, as irritation can worsen or trigger hyperpigmentation. Also, protect yourself against other common skin-darkening triggers by using acne medication to fight off pimples, as well as bug spray to prevent bites.