Name: Black dots under the eyes
Creator: Dr Karen Martin
Published: 2023-02-27T17:20:37.393Z

If you are unsure of your diagnosis, you should book a routine appointment with your doctor, who will consider your symptoms and examine you. If one of the spots has changed or looks different from the others, you should book an urgent appointment in case this needs a specialist opinion. 

You should seek a dermatologist consultation if you wish to discuss any other treatment or surgical options. 

When should I see my doctor?

There isn't any treatment per se, but a dermatologist may choose to treat them surgically. This condition is more common in those of Afro-Caribbean descent and women get them more often than men. They often run in families.   

These are thought to be similar to seborrheic keratoses, harmless brownish spots that appear anywhere on the body, but dermatosis papulosa nigra tend to appear much earlier in life. They are not contagious, and can't be passed to others. 

How is this condition treated?

There are some treatments that can be used to reduce the appearance of hyperpigmentation associated with dermatosis papulosa nigra. Aside from using make-up that contains sun protection, you can use creams such as Fade Out that are available from pharmacies and popular health and beauty retailers. 

Fade Out cream can be applied daily, and is formulated with SPF 15 for UVB protection plus UVA protection to prevent the aging and skin darkening effects of the sun. It contains extracts of mulberry and licorice that penetrate deep into the skin's outer layers, working together to help reduce the production of melanin, our natural pigment. It also contains niacinamide (Vitamin B3) to help to inhibit the transfer of melanin to the upper layers, where it would become visible on the skin’s surface. 

Other products such as Bio-Oil can also be used since it is formulated specially to help improve the appearance of scars, stretch marks and uneven skin tone through regular use. 

Healthwords pharmacists' top tips

This is a rash where the skin becomes inflamed, appearing on greasy areas with lots of sebaceous glands - on the cheeks, between eyebrows, the folds next to the nose and the chin, and also on the chest or scalp.

Red, greasy, scaly, or flaky patches are common, and little red bumps known as papules may appear. It can cause a mild itch, but the appearance prompts most sufferers to seek treatment.

It is considered a type of [eczema](https://www.healthwords.ai/us/article/eczema!8228468d-aa68-4c89-8c21-7b06585ceee1) but can also overlap with [psoriasis](https://www.healthwords.ai/us/article/psoriasis!50c9e495-e60b-4ac8-a510-db71c81980a9) and [rosacea](https://www.healthwords.ai/us/article/rosacea!46e2bec6-793e-4a7a-9d5d-011cb6b7fd73). [Stress](https://www.healthwords.ai/us/article/stress!b1b907f1-6bd9-4b83-a41c-7d28b583e498), tiredness, and cold weather can prompt flare-ups in those susceptible. An overgrowth of a usually harmless [yeast](https://www.healthwords.ai/us/article/yeast-infection!3d3ce04e-5fcd-4cc3-a85e-889487b66f30) (scientific name: Malassezia) is thought to be part of the cause, so treatment focuses on eradicating this and reducing inflammation using a combined [antifungal](https://www.healthwords.ai/us/treatment/antifungal-medicines!b9048126-5524-45e3-816e-7dce1988d6ba) and mild [steroid](https://www.healthwords.ai/us/treatment/steroids:-a-comprehensive-guide-to-anti-inflammatory-medication!9e9c514c-f1ad-4fdc-9e7d-98469d9a7e18) cream.

Actinic keratoses (or solar keratoses) are small red, flaky marks on your skin in response to long-term sun damage. They appear many years after sun exposure on sun-exposed areas such as the top of the forehead or crown of the head, tops of ears, forearms, hands, and lower legs.  

They feel like rough patches or sandpaper, and yellow or orange scales can appear that resemble tiny cornflakes. The surrounding skin may be pink or red, and there might be other evidence of sun damage, such as deep wrinkles, large freckles, or brown blotches. They don't usually cause any symptoms beyond a mild itch or soreness, but some people feel self-conscious that they look unsightly. 

Hidradenitis suppurativa occurs in areas where there are sweat glands around hair follicles. It is a condition that often affects the armpits but can also affect the groin, under the breasts, and around the anus, as well as other areas of the body. It is a chronic condition that can cause both abscesses and scarring of the skin. The cause of hidradenitis suppurativa is unknown.  

The symptoms are painful lumps ranging from blackheads to boils, cysts, or channels (called sinus tracts) that contain and sometimes leak pus. As it is a long-term recurrent condition that requires ongoing management, it can cause quite an impact on an individual’s everyday life and lead to depression.

Rosacea is a common condition that causes redness on the cheeks and across the nose, and is sometimes accompanied by more persistent red bumps, known as papules or pustules if they have a yellow center. Its full name is actually acne rosacea. Episodes of flushing may precede a more persistent redness.

Certain triggers are thought to cause blood vessels just under the skin to widen, becoming more visible and causing the redness, but the underlying cause is not well understood. It is common in those aged 30 to 60, and in fair-skinned/blue-eyed people. The exact cause remains unknown, but triggers for its development include sun damage, leaky tiny blood vessels under the skin, a skin mite called Demodex folliculorum, and a family history of rosacea. It is not contagious, so you cannot catch it from someone else.

Acne vulgaris, also known as pimples, acne, spots, or zits, is very common, usually starting in the teenage years and continuing up to the age of 30.  

It coincides with the hormonal changes of puberty, and women may suffer into adulthood with hormonal changes in their menstrual cycle. Hormones affect the amount of oil (sebum) produced by glands next to hair follicles – these follicles then become blocked and inflamed.  

Acne can cause blackheads, whiteheads or pustules, or more inflamed lesions, including red and sore cysts and larger nodules, which are more likely to cause long-term scarring. Acne usually affects the face - the T-zone is typical in teenagers (forehead, nose, and chin), or the muzzle distribution in early adulthood, which includes the upper lip, chin, jawline, and neck.

Dermatitis (sometimes also called eczema) simply means inflammation of the skin, and so contact dermatitis is the name used when this inflammation is caused by direct or indirect contact of the skin with something in your environment that it reacts to.

## What causes contact dermatitis?

There are two main types of contact dermatitis:

- **Irritant contact dermatitis.** This type develops when the skin comes into contact with things that irritate the skin, such as detergents or very hot water that strip the skin of its natural oils and so dry it out. If you have regular contact with these you can then get an irritant dermatitis. This means it’s common in people who put their hands in water a lot, such as nurses, hairdressers, and cleaners. This type of contact dermatitis is more likely to happen in people who have suffered from childhood eczema.

- **Allergic contact dermatitis.** This type occurs when you develop an allergy to a specific substance that’s been in contact with your skin. Common examples of these include hair dye, cosmetics, and perfumes. It’s unclear why some people who are exposed to these develop dermatitis while others don’t but unlike irritant dermatitis, contact dermatitis doesn’t seem to be more likely in people who had eczema when young.

## What are the symptoms of contact dermatitis?

The commonest symptom is itching of the skin, and this can be very intense and to a level where you can’t stop scratching it. The skin can also become sore and red, with blisters developing that can weep. In contact dermatitis of the hands, there may be painful cracking of the skin that can make it difficult to use your hands normally. The hands are the commonest area where contact dermatitis occurs, followed by the arms, neck and face.

Dr Kandi - Contact dermatitis

A mole is usually a mid- or dark-brown flat mark (a junctional nevus), or a dome-shaped brown or flesh-colored bump (a dermal nevus). It should be neither itchy nor bothersome.

You may have numerous moles, and they may run in your family. They may have been present for as long as you can remember, or since birth, although new moles can appear throughout childhood and even into your 20s, especially after recent sun exposure.

People with certain skin types, such as those with pale skin, blue eyes, and red or blond hair, and who are likely to easily sunburn, are likely to be more at risk of concerning changes to moles.

Blepharitis is a common and treatable inflammation of the inner rim of the eyelid, usually affecting both eyes. Irritation, itching, burning, excessive tears, and crusty debris or skin flakes around the eyelashes may occur. 

You may also have redness around the eyes and missing eyelashes. Common causes are bacterial eyelid infections, meibomian gland dysfunction, dry eyes, fungal eyelid infections, and parasites. Blepharitis can be a recurrent or chronic problem, and patients often have other associated skin conditions, such as rosacea and dandruff. Blepharitis is not contagious. 

Keratosis pilaris is a very common skin condition, where the skin gets bumpy and red, resembling [chicken skin](https://www.healthwords.ai/us/article/chicken-skin!c979f3f7-ec70-4d6a-b40f-11883a636f56) or goosebumps. It typically occurs on the upper outer arms and thighs, where hair follicles get blocked with pockets of keratin, a thick, tough substance that helps to protect the skin. Bumps can be red, gray, or flesh-colored, and skin feels rough, dry, and sometimes itchy.

This condition affects up to half of the population, running in families and appearing most commonly in adolescence, with improvement usually in adulthood. It is completely harmless, but people become concerned with the appearance.

Polycystic ovary syndrome (PCOS) and acne

Polycystic ovary syndrome (PCOS) is a hormonal condition that causes a range of symptoms in women of reproductive age. [Acne](https://www.healthwords.ai/us/article/acne!5558595c-ca39-44bb-a234-1114af631c08) is one related condition affecting up to 30% of PCOS sufferers, which on top of other PCOS-related symptoms, adds to a feeling of anguish and low self-confidence.

Xailin Night is an eye ointment for treating [dry eye](https://www.healthwords.ai/us/article/dry-eyes!79b1a9e8-27c0-46b5-b54f-c424938108a7) conditions, corneal erosion, and lubricating the eyes before or after eye surgery. It contains paraffin and wool alcohols (lanolin) which all serve to lubricate and protect water loss from the eyes. This, in turn, relieves symptoms of dry eyes and forms a protective barrier on the surface of the eye.

Symptoms of dry eyes may include:

1. **Dryness**: A sensation of dryness or grittiness in the eyes is a hallmark symptom of dry eyes. This can be accompanied by a feeling of irritation or discomfort.

2. **Redness**: The eyes may appear red or bloodshot, particularly when they become irritated due to dryness.

3. **Burning or stinging**: Some individuals with dry eyes may experience a burning or stinging sensation in the eyes, especially in environments with low humidity or when exposed to irritants such as smoke or wind.

4. **Blurry vision**: Dry eyes can cause temporary fluctuations in vision, leading to blurry or fluctuating vision, particularly during activities that require prolonged visual concentration, such as reading or using a computer.

5. **Sensitivity to light**: Dry eyes may increase sensitivity to light, making it uncomfortable to be in brightly lit environments.

6. **Watery eyes**: Paradoxically, some people with dry eyes may experience excessive tearing as the eyes attempt to compensate for the lack of adequate lubrication.

Several factors can contribute to the development of dry eyes, including:

- **Ageing**: Dry eyes are more common as people age, as tear production tends to decrease with age.
- **Environmental factors**: Exposure to dry or windy climates, air conditioning, heating, and smoke can exacerbate dry eye symptoms.
- **Medical conditions**: Certain medical conditions, such as autoimmune diseases (e.g., Sjögren's syndrome, rheumatoid arthritis), hormonal changes (e.g., menopause), and eyelid abnormalities, can increase the risk of dry eyes.
- **Medications**: Certain medications, including antihistamines, decongestants, antidepressants, and hormonal therapies, can reduce tear production or affect tear composition, leading to dry eyes.
- **Prolonged screen time**: Extended use of digital devices can contribute to dry eyes due to reduced blinking and increased tear evaporation.
- **Contact lens wear**: Contact lens use can exacerbate dry eye symptoms, particularly if lenses are worn for extended periods or if proper hygiene practices are not followed.

Cradle cap, a type of seborrheic dermatitis, is a skin condition common in babies. It usually occurs in their first six weeks of life. It causes yellow scaly patches on the scalp or face that can appear oily. A red rash can emerge under the scales or in folds of skin, such as the groin area.  

In most cases, this gets better on its own over two to eight weeks. It is not harmful to your baby and should not cause them discomfort or to be unwell.  

Adults do not get cradle cap, but they may suffer other forms of seborrheic dermatitis, such as dandruff or a red, flaky rash over their nose and cheeks. 

Sunburn is when excessive exposure to the sun damages the skin causing it to become red, inflamed, and painful. The majority of cases can be self-treated. Sunburn is an example of a first-degree (superficial) [burn](https://www.healthwords.ai/us/article/burns!22591115-32c3-49fb-ba7c-ca365c2b4a40) - the skin is red, painful and very sensitive to touch, and the damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.

Sunburn, caused by the UVB rays in sunlight, is common, but it also increases your risk of developing [skin cancer](https://www.healthwords.ai/us/article/melanoma-\(skin-cancer\)!44a94f5e-e286-4b67-b316-480a09870c12) later in life, so it's important to avoid this by using sun-safe practices. These include using adequate sun cream (SPF 30 and above, UVA and UVB protection), covering up with hats and clothes, and avoiding the sun altogether on summer days between 11 am and 3 pm.

Melanoma (also known as malignant melanoma) is the most serious type of skin cancer caused by sun exposure. It's serious because the cancer can spread to other organs in the body, so it needs prompt identification and treatment. You can take steps to prevent it, but also keep a watch for any moles or other skin marks that are new, changing or don't look like your other moles.

Melanoma is the 5th most common cancer in the US, with almost 100,000 new cases each year. The number of cases has doubled in the last 30 years, and it can occur at any age.

A squamous cell carcinoma (SCC) is usually a firm pink or red lump and typically occurs in sun-exposed areas like the face, ears, forearms and hands, shoulder, upper chest, and back. It might feel tender to press, it may develop a solid horny lump sticking up, and it can sometimes ulcerate, giving a wet appearance. This grows slowly over weeks, months, or even years.

It usually occurs in people over 50, in response to years of [sun damage](https://www.healthwords.ai/us/article/sunburn!9902e7f5-5d08-4ce9-91a8-78e1e5a8afed). While skin cancers all develop in response to sun damage, and similar risk factors make some more susceptible than others, there are different types of skin cancer. [Melanoma](https://www.healthwords.ai/us/article/melanoma-\(skin-cancer\)!44a94f5e-e286-4b67-b316-480a09870c12) is the most well-known but the least common. This is where a new mole appears or an existing [mole changes](https://www.healthwords.ai/us/article/when-to-worry-about-a-mole!6cbd813f-d9de-49f8-b775-136db63d15a7). SCC is a different process and doesn't usually start as a mole.

Milia (milk spots): causes and treatments

Milia is a condition described by tiny pearly-white bumps on the skin under the eyes. These are little cysts (or sacks) containing a hard semi-solid protein called keratin.

There may be one, two, or a few, and they usually cause no symptoms except that people become self-conscious about their appearance. They are entirely harmless, they need no treatment, and most disappear within a few months (although new ones may form in time).

## What causes milia?

In adults, these may form in response to recent [sunburn](https://www.healthwords.ai/us/article/sunburn!9902e7f5-5d08-4ce9-91a8-78e1e5a8afed) or from skin damage, such as from [burns](https://www.healthwords.ai/us/article/burns!22591115-32c3-49fb-ba7c-ca365c2b4a40) or unusual skin conditions. They appear in up to half of newborn babies, appearing around the eyes, nose, and across the cheeks and clearing up a short while later.

Dr Kandi - Milia

Scabies is an infection from a mite that produces an itch like no other - you (and family members) will be furiously scratching, especially at night. The mite (fancy name: Sarcoptes scabiei var. hominis) burrows under your skin, causing very subtle, but characteristic gray "track marks" towards a more defined skin mark.

The skin mark may be a tiny red bump (a papule) or may appear as a fluid-filled blister or a pus-filled bump (a pustule). The mite's favorite hide-outs include the webs between fingers, palms, wrists, forearms, chest and breasts, and genitals.

Vitiligo occurs when pigment (melanin) is lost from areas of skin, leaving behind white patches. The patches can grow in size and merge. These patches may be a little itchy but are not otherwise bothersome.

The main complaint is the appearance of these patches, and the loss of self-confidence that comes with it. This requires specialist attention to treat, with the aim of stopping new patches from forming. If it's caught early enough, there's the possibility of reversing white areas to allow pigment to gradually come back. For this reason, it's important to see your doctor.

Dr Kandi - Vitiligo

A keloid scar is an area of scar tissue that has formed from a previous trauma - this may have been a small injury, such as an insect bite or acne, or a larger and more memorable injury, such as the site of keyhole surgery or a burn.

Your body has gone into overdrive trying to repair the wound and has formed a lot of collagen. This raised shiny area will feel smooth and firm, usually in an oval or line shape, commonly seen on the chest, back, shoulders, neck and stomach. It often extends beyond the original wound.

You may have other such scars, or family members may also have a tendency to form keloid scars. They are more common in Black and Asian skin, where scars turn dark brown or black rather than the red or pink scars on Caucasian skin. They most commonly form between the ages of 10 and 30 but can form at any age. The protrusion may shrink with time and grow paler, but will likely be lifelong. Keloid scars carry no risk in themselves, although some people are bothered by how they appear, and they may be itchy, painful, or give a burning sensation.

Dr Kandi - Keloid scar

An ectropion happens when the lower eyelid sags away from your eye, leaving the inner surface of the eyelid exposed. It can happen in one eye or both eyes.

When the lower eyelid droops away from the eye, it can affect the ability of teardrops to drain properly. This can cause the eye to water excessively, as well as feel dry and gritty. The eyes can also become red, sore, and inflamed, and this makes the eye more vulnerable to infections such as conjunctivitis.

In severe untreated cases, it's possible to develop a corneal ulcer (a sore on the eye's surface) that could affect your vision. But this is rare. An ectropion is different from an entropion, which is where the eyelid turns inwards, towards the eye.

Chicken skin, also known as [keratosis pilaris](https://www.healthwords.ai/us/article/keratosis-pilaris!b5bab09f-6c99-46b7-9b96-467ad7b05cca), is a very common skin condition, where the skin gets bumpy and red, resembling chicken skin or goosebumps. 

It typically occurs on the upper outer arms and thighs, where hair follicles get blocked with pockets of keratin, a thick tough substance that helps to protect the skin. Bumps can be red, gray or flesh colored, and skin feels rough, dry and sometimes itchy.

This condition affects up to half of the population, running in families and appearing most commonly in adolescence, with improvement usually in adulthood. It is completely harmless, but people become concerned with the appearance.

[Psoriasis](https://www.healthwords.ai/us/article/psoriasis!50c9e495-e60b-4ac8-a510-db71c81980a9) is a long-term condition that causes thickened patches on the skin. It may only affect the scalp, or you might have other patches on your body. It can be intensely itchy and, in a mild form, may cause red patches, usually at the back of the head and extending to the neck or behind the ears. In a more severe form, thickened plaque may cause temporary hair loss, which requires stronger and more prolonged treatment.

Rogaine contains minoxidil as its active ingredient. Minoxidil is a medication originally used to treat high blood pressure. However, it was later discovered that a side effect of minoxidil tablets was an increase in hair growth and thickness, which pleased those patients who were experiencing balding. It’s now been formulated as a liquid or foam to apply to the scalp to target the most common type of hair loss, often associated with aging, called male or female pattern baldness or androgenic alopecia.

Minoxidil tablets can still be used to treat [hypertension](https://www.healthwords.ai/us/article/hypertension:-what-is-it!12c82d9e-9583-49b6-8714-57603d28b1b6), but it’s not one of the common treatments.

Minoxidil hair loss treatment can be obtained without a prescription from a pharmacy or online in two strengths, 2% (recommended for females) and 5% (recommended for males). Minoxidil should be applied twice daily, 12 hours apart, and allowed to work for at least 4 hours without washing or rinsing the area.

Uveitis is when part of the eye suddenly becomes inflamed, giving you a very painful, red eye. You might also experience discomfort in bright light (photophobia), blurring, or reduced vision. It's important to seek help and get this treated promptly, as severe cases can lead to a loss of sight.

Uveitis affects the middle layer of the eyeball, including the iris, which gives your eye its unique color, a muscle behind the iris called the ciliary body, and a layer called the choroid.

Most cases of uveitis affect just one eye, but it can affect the other later on. Most cases are acute, meaning it comes on suddenly, and lasts for a few days, although it can be a few weeks. Some people get repeated episodes, and others have an ongoing inflammation, known as chronic uveitis, which is defined as lasting more than six months.

Uveitis can come out of the blue, and we don't know what has caused it. An autoimmune process may be behind it, where your body attacks certain parts of itself, and this may go along with certain other conditions. Other triggers include an eye infection or injury. If you wear contact lenses, you should switch to your glasses as soon as possible. Sunglasses may make you feel more comfortable when in daylight.

Uveitis puts you at a higher risk of developing [glaucoma](https://www.healthwords.ai/us/article/glaucoma!d27252bc-e853-417e-8978-981850a5f08a) or [cataracts](https://www.healthwords.ai/us/article/cataracts!dccd86ac-1b27-4b87-a3a1-e45e5c81e5fd) in the long term, so make sure you get regular eye checks.

Viscotears are used to relieve symptoms of dry eyes. They are formulated as liquid gel eye drops. They come in either a tube or as single-dose units to be disposed of after each use. This product is not available in the US. Your pharmacist can help you choose an appropriate alternative.

[Dry eyes](https://www.healthwords.ai/us/article/dry-eyes!79b1a9e8-27c0-46b5-b54f-c424938108a7) are very common, and most people will likely have suffered from the symptoms at some point in their life. Symptoms can include your eyes feeling dry, tired, gritty, and painful. Blurred vision and eye redness can also occur. Older age, tiredness, weather conditions, certain medications, and wearing contact lenses can make dry eye symptoms more common. Also, if you have certain medical conditions such as [allergies](https://www.healthwords.ai/us/article/allergic-rhinitis!b7310dec-ab06-43a5-83fc-67929bf2bf4c), [blepharitis](https://www.healthwords.ai/us/article/blepharitis!b48bf4e9-b61c-40f3-b021-c9a8fc08f872), [rosacea](https://www.healthwords.ai/us/article/rosacea!46e2bec6-793e-4a7a-9d5d-011cb6b7fd73), or Sjogren's syndrome, dry eyes can be linked to these.

We have all grown more aware of the dangers of sun exposure in recent years, with the threat of sun damage altering our appearance and the risk of [skin cancer](https://www.healthwords.ai/us/article/melanoma-\(skin-cancer\)!44a94f5e-e286-4b67-b316-480a09870c12). There are different types of skin cancer, but there are some rules of thumb to follow for any [mole](https://www.healthwords.ai/us/article/moles!b20bff18-e3a8-4da3-b2b0-813d4d9a3f13), whether it’s new or existing. Let's take you through when to be concerned.

Dr Karen Martin

Pharmacist and Head of US Content

If you have dark brown or black lumps, tiny in size and multiple in number, sitting on the cheekbones and under the eyes, it’s likely you have dermatosis papulosa nigra. Despite the grand title, these are completely harmless. 

These usually feel smooth and soft and are each only 1 to 5 mm wide, and you may have a few or many, of differing sizes. They appear from the teenage years onwards and don't usually cause any symptoms, but some find them unsightly, especially with their prominence on the face. 

Black dots under the eyes

Doctor’s advice

How is this condition treated?

Healthwords pharmacists' top tips

When should I see my doctor?

Related topics

Seborrheic Dermatitis

Actinic keratoses

Hidradenitis suppurativa

Rosacea

Acne

Contact Dermatitis

Moles

Blepharitis

Keratosis pilaris

Polycystic ovary syndrome (PCOS) and acne

Xailin Night eye ointment

Dry eyes

Cradle cap

Sunburn

Melanoma (skin cancer)

SCC (non-melanoma skin cancer)

Milia (milk spots): causes and treatments

Scabies

Vitiligo

Keloid scar

Ectropion (eyelid)

Chicken skin

Scalp psoriasis

Rogaine (minoxidil)

Uveitis

Viscotears

When to worry about a mole?