What to know about skin discoloration from eczema

Eczema is a chronic skin condition where you experience redness, itching, and inflammation on the surface of your skin. Often, it can cause skin discoloration in patches where eczema develops.

If it continues for a long time in the same spot, the inflammation can disrupt typical pigmentation, which dilates blood vessels and causes discoloration. It can also alter melanin production.

As eczema is itchy, this can cause the urge to scratch continuously, increasing the risk of pigment changes.

It can be helpful to speak with a healthcare professional, such as a dermatologist, about your symptoms, as they can put together a treatment plan tailored to your individual needs.

Eczema symptoms

Eczema-associated skin discoloration can look slightly different depending on your skin tone and the specific cause. According to the National Eczema Association, eczema can be more difficult to detect in people with dark skin tones.

There are two types of discoloration that eczema can cause.

The first is hypopigmentation. This is where the skin loses its pigment and becomes lighter in color. Hypopigmentation can be more prominent in those with a dark skin tone and often develops after sun exposure.  

The second is hyperpigmentation. This is where patches of skin will become darker as the level of pigment in it increases. On lighter skin tones, this can look like pink or red patches and may include a rough scaley texture. On darker skin tones, it can appear brown or black in color, depending on the severity.

In severe cases, eczema also causes these rough patches to form small blisters and ooze.

Some examples of eczema-induced discoloration include:

• Dennie- Morgan lines: These are specific features of severe eczema. These can occur on all skin tones and are characterized by wrinkling under the eyes and dark circles.
• Follicular prominence: This is where the eczema patches appear as small, itchy bumps under the skin. They are more commonly found in darker skin tones.

Discoloration is more prominent during eczema flare-ups and may persist after your symptoms ease.

Causes of skin discoloration from eczema

Hypopigmentation

Hypopigmentation often occurs when an eczema flare-up settles back down to dry skin and should go away on its own.

A less severe form of eczema called Pityriasis alba can cause a fine scale to develop on your skin, which is pale in color. It is more common in people with darker skin tones and often appears following sun exposure. This type of eczema mainly presents as oval, hypopigmented patches on the face and upper body. Unlike atopic eczema, it does not tend to itch.

Hyperpigmentation

Hyperpigmentation can be the result of inflammation or itching. Mostly, it is a combination of both.

Eczema causes inflammation in skin cells called melanocytes. These skin cells produce the pigment melanin that gives skin its color. When inflamed, these melanocytes overstimulate, which results in an overproduction of melanin.

This excess melanin then transfers to the top layer of skin, where patches of darker skin develop. This is known as post-inflammatory pigmentation.

After an eczema flare settles and the patches heal, sunlight can stimulate pigmentation in these areas. This can be frustrating, as this type of hyperpigmentation can linger for months even if the eczema does not return. Although more noticeable in dark skin tones, it can occur on any skin tone and gradually fade.

Lichenification

Lichenification is where the constant scratching or rubbing caused by eczema can thicken areas of the skin. This causes the appearance of hyperpigmentation.

In light skin tones, this may appear dark pink, while in dark skin tones, it can be gray. However, regardless of skin tone, it will appear leathery and dry. The scratching that causes lichenification can be unconscious and habitual, even when eczema is not severe.

Treatments for eczema discoloration

Receiving prompt treatment for symptoms of eczema will help ensure the best possible outcome for discoloration and minimize any long-term effects.

Topical steroids are the most common treatment for eczema. However, these can trigger skin discoloration. This is particularly the case for hypopigmentation, which can develop after long-term use.

Generally, over time, eczema-related discoloration will resolve itself. However, despite best efforts, it is still possible to have issues with hyperpigmentation.

Treatments for eczema discoloration can include:

• Topical skin-lightening creams: These medications can work to gradually improve skin discoloration. An example is hydroquinone (Blanche), which is available over-the-counter (OTC) and by prescription.
• Superficial chemical peels: There are numerous superficial peels available in drug stores. However, it is a good idea to visit a dermatologist for a clinical peel.
• Laser therapy: These medical treatments work by focusing light on areas of hyperpigmentation.
• Vitamin C serum: Medical-grade vitamin serums may help reduce hyperpigmentation. Vitamin C is a powerful antioxidant that does not irritate the skin.

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How to prevent skin discoloration from eczema

The first line of treatment to prevent discoloration from eczema is to treat the eczema flare-up promptly and effectively. If you can effectively manage eczema flare-ups, you will reduce the chances of developing hyper or hypopigmentation.

There are several ways you can prevent skin discoloration from eczema, such as:

Medication

The main treatments for eczema are topical steroids, but prolonged use of these can cause hypopigmentation.

Common medications for treating and managing eczema include:

• steroid creams, such as hydrocortisone (Cortef)
• oral medication, like cyclosporine (Neoral), which reduces inflammation
• biologic medications administered through injection, like dupilumab (Dupixent)
• JAK inhibitors, such as upadacitinib (Rinvoq) and abrocitinib (Cibinqo)

Lifestyle measures

Certain lifestyle measures can reduce the chances of skin discoloration. The main goal of these changes is to reduce the severity of itching and inflammation.

• Diet: Following a diet of anti-inflammatory foods may help reduce inflammation.
• Reducing sun exposure: Make sure to wear sunscreen, and if you are unable to apply it to eczema patches, cover up with clothing when in the sun. This will help reduce the risk of hyperpigmentation.
• Gentle skin care routine: Use products that will not irritate the skin, such as fragrance-free products, and ensure you keep your skin hydrated with regular moisturizing.

If your symptoms of eczema and subsequent skin discoloration become severe, then it is important to speak with a healthcare professional, such as a dermatologist.

Summary

Eczema discoloration is something that many people with eczema worry about. It can appear differently depending on your skin tone, but it is often a result of inflammation and scratching.

Treatment options include topical steroids, laser therapy, and prescription medications. Preventing eczema discoloration involves skin care, avoiding triggers, and seeking professional guidance when necessary.

If the issues persist or worsen, it is important to speak with a healthcare professional, such as a dermatologist. They can develop a tailored plan for managing eczema and minimizing skin discoloration.

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