If you have atopic dermatitis, the most common form of eczema, you’re probably familiar with the litany of skin problems it can cause: itchiness, inflammation, dryness, rashes, scaly patches, blisters, skin infections.

On top of all that, a flare can leave behind dark or light patches and spots on skin that may linger for months. Particularly for Black patients with atopic dermatitis, this discoloration can be very noticeable — and upsetting.

“Often my patients are distraught,” says Edidiong Kaminska, MD, founder and medical director of Kaminska Dermatology in Chicago, a private practice specializing in treating people of color.

Dr. Kaminska stresses to her patients that discoloration is not the same as scarring. “A true scar is irreversible,” she says, and that’s not the case with eczema spots. “When patients understand that this condition is not true scarring — we can improve it — I think that makes them feel better.”

Why Does Atopic Dermatitis Affect Skin Color?

According to the National Eczema Society, dark patches and spots (hyperpigmentation) are a result of inflammation. Inflammation stimulates cells in the skin called melanocytes to produce more melanin, the substance that gives skin its color. This results in more melanin transferring to the top surface of the skin (the epidermis).

Plus, constant scratching at itchy areas can lead to a thickening of the skin called lichenification, resulting in dry, scaly, leathery areas that may be dark pink on pale skin or slate gray on darker color.

Sometimes when an eczema flare is subsiding, paler areas of skin (hypopigmentation) appear as the inflammation decreases, notes the National Eczema Society.

A type of low-grade eczema called pityriasis can also result in hypopigmentation. The condition typically affects children and teenagers. Usually, anywhere from one to 20 round or oval patches appear on the skin, mainly on the face but also on the neck, shoulders, and upper arms.

Darker skin is more likely to be affected by pityriasis, often after too much sun exposure. This type of eczema differs from typical eczema in that it causes little or no itch.

Atopic Dermatitis Treatment Can Help Even Out Skin Color

In most cases, the best way to fix discoloration is to treat the atopic dermatitis itself. “If you treat the medical problem, the discoloration usually goes away on its own, as long as the underlying issue is addressed. But the question is, how long will it take?” says Danilo Del Campo, MD, a dermatologist with the Chicago Skin Clinic. “So we sometimes give medical treatments that help the discoloration go away faster.”

While there is no cure for atopic dermatitis, treatment usually begins with over-the-counter or prescription skin moisturizers and anti-inflammatory creams and ointments.

Dermatologists are also knowledgeable about newer prescription treatments that might provide relief where previous approaches have failed. Dr. Del Campo cites the drug dupilumab (Dupixent) as an example. Approved by the U.S. Food and Drug Administration (FDA) as an atopic dermatitis treatment for adults in 2017 and for young children in 2022, dupilumab is an injectable medication administered every two to four weeks.

Another common treatment that helps both eczema and discoloration is phototherapy. Phototherapy uses a special wavelength of light that reduces inflammation and helps normalize skin pigmentation.

Plus, “We always recommend sunscreen as part of treatment for hyperpigmentation,” says Kaminska. “When sun hits the skin, it can cause the melanin or pigment to stay in the skin a lot longer and get darker and thereby make the condition worse.” Wearing a wide-brimmed hat outside can also help, according to the American Academy of Dermatology (AAD).

Some Products and Procedures Can Help Make Spots and Patches Go Away

The AAD lists several ingredients in nonprescription skin-care products that may help even out skin tone, including azelaic acid, glycolic acid, kojic acid, retinoid (retinol, tretinoin, adapalene gel, or tazarotene), and vitamin C.

The skin lightening cream hydroquinone is a standard treatment for hyperpigmentation, according to Kaminska. Currently, the prescription medication Tri-Luma is the only hydroquinone product approved by the FDA for the short-term treatment of dark spots.

A resurfacing technique called a chemical peel is another way to treat discolored skin. These peels use a chemical solution to remove layers of skin. There are risks to this approach though: In some cases, peels can cause skin to become darker or lighter than normal, according to the Mayo Clinic.

“The best advice is to talk to a board certified dermatologist who will help to pick a treatment that is best for your skin type and the type of eczema,” says Del Campo.

Some Skin Lightening Products Can Be Dangerous

In 2022, the FDA sent warning letters to 12 companies for selling over-the-counter (OTC) skin lightening products containing hydroquinone that do not meet the requirements to be legally sold as OTC drugs.

The FDA has received reports of serious side effects from the use of these skin lightening products, including rashes, facial swelling, and ochronosis (discoloration of skin). The agency advises people not to use these products, due to the potential harm they may cause.

Separately, the AAD notes that certain skin lightening products imported to the United States from other countries may contain steroids or mercury, ingredients that aren’t listed on the label. The extended use of steroids can result not only in pimples and rashes but also skin thinning and permanent discoloration.

Sun Protection and a Good Skin-Care Routine Can Help Prevent Spots and Patches

For people of all skin types, sun protection can play a role in preventing skin discoloration.

A smart skin-care routine is another essential, according to Del Campo. He advises showering regularly with lukewarm water, using cleansers meant for sensitive skin, and applying a thick cream or ointment-based moisturizer after washing to “lock in” moisture.

“Putting a moisturizer on the skin is actually applying a skin shield,” he says. “You’re not only shielding your skin from the outside from getting new flares, but you’re also protecting your skin from the inside to heal, creating a healthy environment underneath that will help discoloration before it begins.”

Because eczema cases differ, people should work with their dermatologist, who can determine what’s driving pigment changes and how best to even out skin tone.