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If you’re one of the nearly 32 million Americans living with eczema, a group of inflammatory conditions that often cause itchy, scaly skin, you know it can be a roller coaster. “It will kind of wax and wane, so patients have periods of flares or clearance,” says Dara Spearman, MD, a board-certified dermatologist in Fort Wayne, Indiana. On top of that eczema can sometimes cause the affected areas to lighten or darken post-flare-up. For many patients these pigment changes can be more frustrating than the eczema itself.
That’s the case for Florida resident Rakhi Roy Chowdhury, RDN, LDN, who has had eczema since infancy. Her flare-ups have left behind patches of hyperpigmentation where her skin is noticeably darker and ashy. “It’s been a long journey,” she tells Allure of navigating her discoloration challenges. "My eczema is in remission, but the pigment hasn’t returned yet, and that part can make me self-conscious. I’m still in an experimental phase, trying to see what we can do to get my pigment back to how it looked before.”
The way eczema presents varies depending on a person’s skin tone. Lighter-skinned people may notice red or pink rashes and scaling, while those with more melanin might develop flaky patches that are dark brown, purple, or gray. The skin’s appearance after a flare can also differ, with those with dark skin often experiencing more hyperpigmentation (dark patches) and hypopigmentation (light splotches) than those with fair skin.
This happens for a few reasons. Research on atopic dermatitis, the most common type of eczema, suggests that people of color, including South Asian individuals like Roy, as well as Black and Latinx folks, may have more severe and persistent eczema. More severe, chronic cases can be challenging to treat and can make the skin feel exceptionally itchy. Not only is this uncomfortable, but scratching (which is hard to resist) can increase the risk of hyperpigmentation and hypopigmentation. “The more they scratch, the more inflammation and the more potential for pigmentary issues post-flare,” says Mara Weinstein Velez, MD, a board-certified dermatologist in Rochester, New York. She adds that post-flare pigment changes are more likely to develop when eczema goes untreated for a prolonged period, which, unfortunately, is often the case for people of color, whose skin conditions are misdiagnosed more frequently than those of white patients.
The good news is that pigment changes due to eczema are usually temporary and treatment may help improve the affected areas more quickly. Here, we break down the most common treatments so you can get up to speed before getting personalized recs from your derm. (Asking a healthcare professional for advice is always a good idea when you have a chronic skin condition, and you should ask your dermatologist what options are best for you before trying anything to even out your skin tone.) Plus, learn how to prevent future flares so you’ll hopefully have fewer pigment changes to address in the future.
- Mara Weinstein Velez, MD is a board-certified dermatologist in Rochester, New York
- Dara Spearman, MD, a board-certified dermatologist in Fort Wayne, Indiana
- Treatments for hyperpigmentation
- Treatments for hypopigmentation
- Preventing future flares and pigment changes
Treatments for hyperpigmentation
Hyperpigmented areas will often improve on their own, Dr. Weinstein Velez says, though it will not happen overnight. There are a number of interventions you can try to expedite the process, but as Dr. Spearman stresses addressing discoloration should only be attempted after an eczema flare-up is fully healed, and should be handled with great care. It’s a bit of a balancing act; the goal is to find a solution that is effective but doesn’t upset the skin.
One quick reminder: Before trying any products that are new to you, it’s wise to perform a patch test. To do this apply the product to a small area of skin for a few days to ensure it won’t cause a reaction before using it more broadly. It’s also wise to avoid using active ingredients (like retinoid and vitamin C) simultaneously. This can be particularly irritating to eczema-prone skin.
Both dermatologists encourage moisturizing to help restore the skin’s lipid barrier and applying sunscreen daily to prevent the dark marks from intensifying. Sun exposure stimulates the cells that produce melanin, causing them to create more of the substance as a protective mechanism. Unfortunately, that same process can worsen hyperpigmentation by increasing melanin in the affected areas, which causes the skin to look even darker, Dr. Weinstein Velez explains.
When selecting skin-care products, the National Eczema Association’s Seal of Acceptance is a good place to start. The products that feature the seal are fragrance-free and have been vetted as suitable for eczema-prone skin. Dr. Spearman often recommends products with the seal and particularly likes Cetaphil’s Eczema Restoraderm Daily Soothing Moisturizer and CeraVe’s Moisturizing Cream as daily moisturizers, along with CeraVe’s Hydrating Mineral Sunscreen SPF 50 for sun protection.
If you are out in direct sunlight for a prolonged period of time, Dr. Spearman recommends applying sunscreen every hour and a half to maintain optimal defense against sun damage and skin darkening. Follow the two-finger rule to apply the right amount to your face and neck.
Depigmenting treatments can help expedite the resolution of post-inflammatory hyperpigmentation. Here are a few worth asking your dermatologist about.
This lightening agent is only available by prescription. Dermatologists may also suggest formulations that combine hydroquinone with other depigmenting agents to boost its effectiveness. However, its use must be carefully managed to prevent the “halo effect,” where the skin around the treated area lightens more than intended, creating a lighter ring in that spot.
Generally derived from certain types of fungi, kojic acid is an alternative to hydroquinone that Dr. Spearman says patients with eczema tend to tolerate better. It helps lighten dark areas by inhibiting melanin production in the skin. Studies show that kojic acid is safe and effective at a 1% concentration. (Although some emerging research suggests that up to 2% may be tolerable.) The ingredient is available in various over-the-counter products like SkinCeuticals’ Discoloration Defense.
That said, long-term use of kojic acid may make your skin more sensitive to the sun, so don’t skip the sunscreen. It’s also wise to check in with your dermatologist about how long to keep kojic acid products in your treatment plan.
This form of vitamin B3 can help lighten dark spots and calm the skin by blocking certain chemicals that trigger inflammation. Niacinamide is a popular ingredient in serums, creams, oils, and other skin-care products.
This is another topical option that brightens skin and fades dark spots by inhibiting melanin production. Dr. Spearman notes that as an antioxidant, vitamin C helps protect against UV damage. It also has anti-inflammatory properties. From serums to creams to other formulations, many over-the-counter products contain vitamin C, but research shows that high concentrations can irritate skin. (L-ascorbic acid is the most potent form of the antioxidant and should be avoided by those with eczema, according to Dr. Spearman.) It’s best to ask your dermatologist which concentration will work best for you.
Topical retinoids like tretinoin (often sold under brand names like Retin-A) are also a treatment option. Retinoid products are available in various prescription and over-the-counter forms, such as creams, lotions, and gels.
They work by increasing skin-cell turnover, which Dr. Spearman says helps fade dark spots. But there’s a bit of a catch: This cellular process can irritate eczema-prone skin. That’s why it’s important to apply moisturizer before and after slathering on a retinoid to buffer its effects and minimize irritation. This so-called sandwich method can help prevent unintended results. “If the irritation from the retinoid is significant, it can actually cause post-inflammatory hyperpigmentation,” warns Dr. Spearman. In other words it could cause the skin to darken further.
Sunscreen use is also highly encouraged, as retinoids increase sensitivity to UV rays. “Sometimes [patients of color] don’t regularly use sunscreen because they don’t feel like they need one. This is not true,” says Dr. Spearman. “Particularly when using a retinoid, daily sun protection is essential.”
Brightening pads and cleansers are other options that Dr. Spearman says have proven beneficial for her patients. SkinMedica’s Even & Correct Brightening Treatment Pads, for example, contain alpha hydroxy acid (AHA), which gently exfoliates the skin’s surface to help even out skin tone. Along with AHA, brightening treatments may also contain beta hydroxy acid (BHA), which some find less irritating than AHA. It’s another gentle chemical exfoliant that works to brighten the complexion. Dr. Spearman encourages people with eczema-prone skin to look for formulas that include under 10% concentration of AHA and less than 2% of BHA, and to avoid daily use. That will help keep skin irritation at bay, she says.
While using brightening products that contain AHA, one thing to keep in mind is that the chemical may increase your skin’s risk of sunburn, so it’s essential to wear sunscreen and limit sun exposure.
Laser treatments can be a good addition or alternative to topical options. These in-office procedures can resurface areas that may be hyperpigmented or scarred from years of flare-ups and scratching. Dr. Spearman says some patients have also seen success in speeding up the resolution of hyperpigmentation with Aerolase, a non-ablative laser treatment that resurfaces the skin to improve pigment and texture.
Treatments for hypopigmentation
With limited effective options, treating hypopigmentation can be quite challenging, Dr. Spearman and Dr. Weinstein Velez say. However, they emphasize that in many cases, pigment returns naturally over time. If you don’t want to wait, there are a few possible treatments the dermatologists suggest. Just like with hyperpigmentation, though, you should wait until an eczema flare has fully resolved before trying any targeted treatment for hypopigmented areas.
Potential topical treatments for hypopigmentation include pimecrolimus and tacrolimus, both part of a class of medications called calcineurin inhibitors. A small pilot study in 2006 found that pimecrolimus cream showed promise in treating skin discoloration in Black patients who experienced hypopigmentation related to seborrheic dermatitis, a common form of eczema that usually affects oily areas of the body such as the scalp, chest, groin, and nose. Participants saw noticeable improvements in their skin tone, particularly during the first two weeks of treatment. While these medications might help stimulate repigmentation for some patients, Dr. Spearman notes that the results can vary. Ask your doctor if this treatment may be worth trying.
Non-ablative laser treatments are used to fade conditions like dark spots and minor scars without damaging the skin’s surface. Dr. Spearman says these treatments can also help bring back lost melanin by stimulating the skin’s pigment-producing cells, including those in the hair follicles. Research has suggested that combining non-ablative laser therapy with topical bimatoprost (a medication that treats thinning or sparse eyelashes) can further help restore pigmentation in patients of color experiencing hypopigmentation.
Finally, there is excimer laser therapy, a targeted phototherapy treatment for the skin that can aid in treating hypopigmentation, and may also help to improve eczema flares. “We also use this device for patients with vitiligo to help stimulate pigment production,” Dr. Weinstein Velez says.
While phototherapy to treat hypopigmentation is typically an in-office procedure, she says she’s seen the lasers available for purchase online. However, she stresses that treating skin of color and eczema-prone skin requires specialized knowledge. “Experts in the field should be the ones using lasers,” she notes. In other words, do not try this at home, folks!
Enlisting a doctor’s expertise ensures that treatments are not only safe but tailored to the unique needs of your skin.
Preventing future flares and pigment changes
When it comes to preventing hyperpigmentation and hypopigmentation after an eczema flare, both dermatologists emphasize patience; sometimes seeing noticeable improvement can take several months if not longer. Also, it cannot be overstated that early intervention to resolve flare-related inflammation will improve your chances of minimizing long-term discoloration, Dr. Weinstein Velez says.
Perhaps more important, though, is doing your best to prevent those flares in the first place. Dr. Weinstein Velez tells her patients to take a holistic approach to prevention: daily skin care, avoiding known triggers like allergens, and, her big one, managing stress.
This is one of the reasons why Roy, having lived with eczema for three decades, has shifted her mindset from frustration to curiosity as she works to manage her condition. She saw a significant improvement in her skin after working with a dietician to understand how her diet impacted her eczema flares, ultimately deciding to pursue a career in the field herself. In her practice, Gut Skin Nutritionist and Instagram page, she helps clients and followers determine if food reactions drive their eczema flares. In terms of her own health, she also experiments in other ways. For example, she now uses gloves when cooking to protect her hands from irritants and is constantly looking for ways to better understand her body’s triggers and signals. “I’m a brown girl myself, and I wish this could go away, but [something I always tell my clients is that] I know my priority needs to always be to address the eczema, and I know if I can address that, my hyperpigmentation will get better,” says Roy.
Having navigated similar terrain to her patients and her social media followers, she says, above all, she tries to give them hope that people with eczema can regain a sense of control and live more comfortably with the condition. “I started to gear a lot of my content towards people who not only have eczema, but people who have melanated skin,” she said of her Instagram page. “There is a big gap in serving this population.”
Though it may take time and some trial and error to see results on the road to regaining an even skin tone, the good news is that there are safe and effective options. With the proper care and guidance, finding what works for your skin can make all the difference in healing and regaining your confidence.
More ways to care for your eczema-prone skin:
- What Being a Beauty Influencer With Eczema Is Really Like
- The 12 Best Eczema Creams to Soothe Your Itchiest Flare-Ups
- Eczema on Your Face? Dermatologists Give Their Best Tips for Managing It
