How To Treat Hyperpigmentation Caused by Atopic Dermatitis

Atopic dermatitis, a type of eczema, causes dry, itchy, and inflamed skin. After a flare-up, post-inflammatory hyperpigmentation can develop, resulting in persistent dark patches. 

Post-inflammatory hyperpigmentation is common in darker skin tones, which naturally produce more melanin, the pigment that gives skin its color.

Hyperpigmentation can take months or years to fade, and it can sometimes be more bothersome than the eczema itself.

After you manage your atopic dermatitis, there are several treatments to try for fading hyperpigmentation.

Topical retinoids, a form of vitamin A, are often used to treat acne, but they can also help fade hyperpigmentation from atopic dermatitis. These medications work by increasing the rate at which your skin produces new cells, helping to shed dead skin cells and reveal new, even-toned skin. 

Some research focusing on people with darker skin tones found that three commonly used retinoids—tretinoin, adapalene, and tazarotene—improved hyperpigmentation after about three months of regular use.

Study participants who used tretinoin saw their dark spots improve by up to 100%, resulting in complete clearing. With adapalene gel, about two-thirds experienced fewer and lighter dark spots. Tazarotene reduced hyperpigmentation by about 15%.

Topical retinoids can cause side effects, such as redness, dryness, irritation, and peeling, especially with stronger concentrations and frequent use. A dermatologist (a doctor specializing in skin conditions) can help you find the right medication dosage to minimize the risk of side effects.

Hydroquinone is a prescription skin-lightening agent that you apply to your skin. It has been used for decades to treat dark spots, including post-inflammatory hyperpigmentation. 

According to the same research on post-inflammatory hyperpigmentation in people with darker skin tones, 2% and 4% hydroquinone formulas showed good results. When combined with other treatments, such as chemical peels or tretinoin, hydroquinone reduced dark spots by 24-36% over 12 weeks.

Side effects may include dryness, irritation, itching, and a burning sensation.

Healthcare providers recommend using hydroquinone for a limited time, usually with pauses in between treatments. Long-term use of hydroquinone can lead to a condition called ochronosis, where skin turns a bluish-black color, particularly in individuals with darker skin tones.

During a chemical peel, a dermatologist applies a solution to your skin that causes the top layer to peel off. After the skin peels, it reveals evenly toned skin underneath.

For people with darker skin tones and hyperpigmentation from atopic dermatitis, several types of chemical peels have shown promising results. These include salicylic acid, glycolic acid, phytic acid, and lactic acid.

In some research, salicylic acid peels lightened dark spots by about 32%. Glycolic acid peels reduced dark spots by about 50% after about five months. Lactic and phytic acid peels also helped fade hyperpigmentation, but were less effective.

Chemical peels can sometimes cause inflammation and irritation, which may worsen hyperpigmentation in some individuals, especially those with darker skin types. For this reason, it’s best to see a dermatologist familiar with treating skin of color.

Laser treatments use light energy to repair and regenerate damaged skin.

A healthcare provider may suggest it after topical creams haven’t worked. Laser treatment can be pricey, and results aren’t always consistent. Side effects, like worsening hyperpigmentation, can occur if your healthcare provider uses the wrong type of laser or settings.

Q-switched neodymium-doped yttrium aluminum garnet (Q-switched Nd:YAG) laser therapy has shown promising results for people with dark skin. In studies, receiving about six treatments with this laser led to significant improvement in dark spots, with some people noticing complete clearing. 

If you’re considering laser treatments, be sure to see a healthcare provider who has experience treating darker skin tones. Ask them about their success rate with people who have your skin type, any treatment risks, and what results you can expect. Make sure your provider knows which lasers are safest for your skin type.

Other treatments may help fade hyperpigmentation caused by atopic dermatitis. Not all are widely used or studied for post-inflammatory hyperpigmentation in dark skin tones, specifically. They may be worth discussing with a dermatologist:

• Azelaic acid: This gentle skin-lightening ingredient also fights inflammation and acne. It works by slowing melanin production and calming irritated skin. Studies show that azelaic acid can work as well as hydroquinone for fading melasma, a type of facial hyperpigmentation. It may also help with post-inflammatory hyperpigmentation, though research is limited.
• Kojic acid: Made from fungi, kojic acid may help lighten dark spots by blocking an enzyme in your body that helps produce melanin. Kojic acid has mostly been studied in melasma. Some people develop skin irritation or an allergic reaction to kojic acid.
• Tranexamic acid (TXA): This medication can help stop bleeding but may also help fade hyperpigmentation. In studies, topical TXA showed similar results to hydroquinone on darker skin with melasma, and it tends to have fewer side effects.
• Cysteamine: This natural compound is a newer option that may help lighten dark patches. Studies suggest that cysteamine works as well as or better than hydroquinone for some people, with fewer safety concerns. The main drawbacks are mild dryness, an occasional burning sensation, and a noticeable smell.
• Cosmeceuticals: Ingredients such as arbutin, vitamin C, liquiritin (licorice extract), and niacinamide can help treat hyperpigmentation in darker skin tones. These natural options cause fewer side effects, though they typically take longer to show results than prescription treatments.

To help lower your risk of developing darkened areas of skin after an atopic dermatitis flare, try these strategies:

• Manage your atopic dermatitis: Keep your eczema under control by following your treatment plan and moisturizing regularly to help prevent flare-ups. Treat flares right away to reduce inflammation before it can cause hyperpigmentation.
• Use sunscreen: Daily sun protection is a must. Look for a broad-spectrum sunscreen with SPF 30 or higher and reapply it every two hours.
• Use protective clothing: Wear wide-brimmed hats and sun-protective clothing when outdoors. Try to avoid peak sun hours, which are mid-morning to mid-afternoon.
• Be gentle with your skin: Scratching, rubbing, or picking can trigger inflammation and make dark spots worse.
• See a dermatologist: Regular checkups with a dermatologist who understands your skin can help you manage atopic dermatitis and hyperpigmentation.

Hyperpigmentation from atopic dermatitis is common in darker skin tones.

After getting your atopic dermatitis under control, you can address hyperpigmentation with options like retinoids, hydroquinone, chemical peels, or laser therapy. 

Treatments differ in effectiveness and side effects. It’s important to work with a dermatologist who’s familiar with your skin type.