Eczema, also known as atopic dermatitis, is a prevalent chronic skin condition characterized by inflammation, intense itching, and dryness. Millions of people experience its uncomfortable symptoms, which can significantly impact daily life. A common concern among individuals with eczema is the potential for the condition to leave lasting marks on the skin. This article clarifies how eczema influences the skin’s appearance and outlines the types of marks that may arise from its effects.
How Eczema Affects Skin
Eczema involves a compromised skin barrier and an overactive immune response. The skin’s outermost layer, the stratum corneum, protects against irritants and allergens while retaining moisture. In eczema, this barrier is often dysfunctional, allowing moisture to escape and irritants to penetrate. This impaired barrier contributes to the dryness and increased sensitivity of affected skin.
Immune system dysregulation leads to chronic inflammation. When the skin barrier is breached or exposed to triggers, immune cells release inflammatory mediators. These cause redness, swelling, and damage to skin cells, resulting in visible eczema symptoms like red, scaly, and thickened patches. The persistent inflammation also contributes to intense itching.
What Eczema Skin Marks Look Like
Eczema does not cause the deep, indented (atrophic) or raised (hypertrophic) scars seen with injuries or acne. Instead, eczema’s skin changes are superficial and often temporary. One common mark is post-inflammatory hyperpigmentation (PIH), appearing as darkened patches where inflammation has subsided. These areas range from light brown to black, depending on skin tone.
Post-inflammatory hypopigmentation (PIH) can also occur, presenting as lighter skin patches. This is less common than hyperpigmentation but signifies a temporary reduction in melanin production after inflammation. Lichenification is another distinct change, a thickening and toughening of the skin, often described as leathery. This occurs in areas subjected to chronic rubbing or scratching.
Superficial breaks in the skin, known as excoriations, are also common. These are linear marks or scabs resulting directly from scratching. These marks are distinct from true scars and often fade over time with proper eczema management.
Why Skin Marks Develop With Eczema
Eczema skin marks develop due to the body’s inflammatory response and healing processes. Chronic scratching and rubbing are main causes of these changes. Persistent mechanical trauma from scratching exacerbates inflammation, leading to the thickened, leathery texture of lichenification. This continuous irritation also stimulates melanin-producing cells, contributing to post-inflammatory hyperpigmentation.
The severity and duration of eczema flares influence the likelihood and intensity of skin changes. Prolonged or severe inflammation can lead to more pronounced post-inflammatory hyperpigmentation or hypopigmentation. Secondary skin infections, arising from barrier breaks due to scratching, can contribute to deeper tissue damage. Bacterial infections, such as Staphylococcus aureus, can lead to significant skin alterations that, if severe and untreated, may rarely result in true scarring.
Individual skin type and genetic predisposition influence mark development. People with darker skin tones are more prone to noticeable post-inflammatory hyperpigmentation. The skin’s healing response affects how quickly these marks resolve.
Preventing and Treating Eczema Skin Marks
Preventing eczema skin marks involves effective management of the underlying condition. A consistent treatment plan is important for controlling inflammation and preventing flares. This includes regular use of moisturizers to maintain skin barrier function and prescribed topical medications, such as corticosteroids or calcineurin inhibitors, to reduce inflammation. Minimizing scratching is also essential for prevention. Strategies like keeping nails short, wearing soft gloves, and applying wet wraps help reduce the urge and impact of scratching.
Prompt recognition and treatment of secondary skin infections are important to prevent deeper tissue damage. If signs of infection, such as increased redness, swelling, pus, or warmth, appear, seek medical attention immediately. For existing skin marks, treatment approaches vary by mark type. Post-inflammatory hyperpigmentation benefits from sun protection to prevent further darkening.
Topical agents like niacinamide, vitamin C, or retinoids can lighten darkened areas over time. A dermatologist may recommend hydroquinone under medical supervision. Lichenified skin responds to continued use of prescribed anti-inflammatory treatments, which reduce skin thickness. True scars from eczema are rare, but if they occur, dermatological procedures such as laser therapy or microneedling can be considered.