Eczema can cause dark patches of thickened skin called hyperpigmentation, especially in areas like the elbows and behind the knees. During eczema flare ups, inflammatory chemicals are released that stimulate overproduction of the pigment melanin in the skin. Scratching can worsen the condition by thickening the skin and darkening it further. Treatment of post-eczema hyperpigmentation involves avoiding irritants and the sun, moisturizing, and using a specialized protocol at The Hyperpigmentation Clinic involving priming, lightening, and post-treatment creams to calm melanocytes and promote skin cell shedding and regrowth. Certain treatments like lasers and acid peels are not recommended for darker

1. Hyperpigmentation post Eczema
By Dr Vanita Rattan
From The Hyperpigmentation Clinic

2. What is Eczema?
• Eczema is a form of inflammation.
• Symptoms include dry, red, itchy skin
sometimes with swelling. Flare ups happen
intermittently. Therefore it has a chronic,
relapsing natural course. However burnt out
eczema often presents as dark patches of
thickened skin which has had the abuse of
topical steroids & chronic scratching.

3. • Most cases of eczema that develop
Hyperpigmentation (Melanosis) occur early in
childhood.

4. The current treatment advice is to:
1. Avoid irritants
2. Moisturise
3. Apply short sharp bursts of mild topical
steroids

5. Typical cases
• At The Hyperpigmentation Clinic®, I typically
see clients with Hyperpigmentation on the
arms and legs after the acute eczema has
burnt out. Predominantly in the flexural folds
e.g. elbows & behind the knee.

6. • The pigmentation is generally widespread
with no clear margins. In addition it has a
grey-blue colour. Both these findings indicate
that the location of this melanin is deep in the
dermis.
• Clients tend to worry more about lower arms
and lower legs as these are exposed and
therefore more visible.

7. The Pathology
• The pathology is called Post Inflammatory
Hyperpigmentation(PIH) or Melanosis.
• During a flare up, inflammatory mediators are
released e.g. prostanoids and cytokines. These
chemicals excite the Melanocytes (cells that
produce the pigment melanin). This therefore
increases the production of pigmentation.

8. The Pathology
• In addition the histamine released cause intense
itching making the patient enter the itch –scratch
vicious circle that leads to thickening
(lichenification) & further darkening the skin. This
is the reason for the bumpy dark blue grey skin
seen on the arms & legs of long term sufferers.
• Pigmentation after Eczema is much more
common in those with darker skins as the
Melanocytes are larger & easily triggered. In
white skins, erythema (redness) is more likely to
be seen.

9. Treatment of Hyperpigmentation
after Eczema
• Avoid the sun. In my experience those with
Hyperpigmentation post eczema tend to wear long
sleeve tops and trousers, so avoid the sun exacerbating
Hyperpigmentation.
• Do not use steroid creams if possible. Steroid creams
should be limited to one week use only as they thin the
skin & promote long term Hyperpigmentation. Intense
regular moisturising is the cornerstone of long term
eczema management.
• The Hyperpigmentation Clinic® specialises in treating
Hyperpigmentation in darker skin.

10. Our protocol for treating
Hyperpigmentation post eczema in
darker skin is as follows
A. Prime the skin .This strengthens the skin and gives it a
uniform thickness. This avoids areas of thick skin
interspersed with thin damaged skin caused by steroid
abuse. The priming serum is a rich combination of
Vitamins A, C, B3 (Niacinamide), E with plant based
anti-oxidants Ferrulic acid, Rutin & green tea extract
with a small amount of salicylic acid. This preparing of
the skin is crucial in allowing uniform penetration of
the Mask which is applied on treatment day.
B. Load the skin with vitamins to promote rapid post peel
healing.

11. C. Lightenex Max Peel® is applied. This allows
Tyrosinase inhibitors present to penetrate the
skin and calm down the overactive Melanocytes.
In addition the Mandelic acid & Salicylic acid
cause the removal of these dark pigment loaded
cells.
D. Post treatment creams are used to continue to
calm down the Melanocytes & promote shedding
of these dead cells.
E. Skin protection is provided to protect the new,
young, healthy skin cells to grow.

12. Treatments to avoid in darker skins
are:
1. Laser
2. Glycolic peels
3. TCA peels
• This is because the Melanocytes in dark skin
are large & these treatments often lead to
“hot spots” which later darken & manifest as
Post Inflammatory Hyperpigmentation(PIH).

13. • For more information on Hyperpigmentation
treatments in darker skin please visit
TheHyperpigmentationClinic.com

14. • For more information on Hyperpigmentation
treatments in darker skin please visit
TheHyperpigmentationClinic.com
• We look forward to seeing you in the
Clinic soon!