Dark elbows, what is the cause?

Patient : Hey Doctor! my elbows are really dark and it is very embarrassing for me to wear half sleeves .Can u please help me? Thank you.May GOD bless u all :)
Doctor :   Dark elbows may be caused by increased levels on melanin, repeated irritation/trauma to the area, hormonal imbalance and genetics. You may try a skin exfoliant and apply a sunscreen with a high SPF when you go outdoors.

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