What can be done to improve rough elbows?

Skin on the elbows is tougher and thicker of course, So any darkening or dryness is more noticeable.

Try first some exfoliation - following your shower or bath, dry your elbows well with a cotton towel (this will provide some exfoliation on it's own). Then apply a cream with glycolic acid (Glytone has several options). This will further help exfoliate rougher skin.

Throughout the day, applying a non-fragranced cream will boost moisture retention. Look for the thicker creams by Eucerin, CeraVe or Aveeno.

I have found a combination of Sculptra and radiofrequency treatments like venus legacy and thermage help increase the tightening in this area.  Fractional laser like Fraxel added, can help increase collagen as well. See the link provided that takes you to emeragecosmetics.com where we do free skincare consultations and offer medical grade products.Best, Dr. Emer