Skin Color Changes in Atopic Dermatitis

Atopic dermatitis (AD) is a form of eczema that causes dry, scaly rashes that are itchy. Acute areas of AD can cause changes in skin color, creating redness or darkened areas. Chronic areas of AD can also create changes in skin color, as the skin becomes thickened, or lichenified.¹

Eczema in different skin tones

Atopic dermatitis occurs in all ethnicities, and people of every skin color are affected. The changes in skin color seen in AD vary among different skin tones. The redness, or erythema, caused by AD is easily seen on white skin but may be harder to recognize on dark skin. Lichenification, the thickening of the skin that is caused by chronic scratching, appears differently on people depending on their skin tone. On white skin, lichenification may appear pink or red, while on dark skin, the lichenified areas may appear darker than the unaffected skin around them.^2,3

Can skin discoloration from eczema be lessened?

While the changes in skin color caused by atopic dermatitis can cause emotional distress, with proper treatment most of the discoloration typically can be resolved or lessened, although the improvement of the discoloration can take a long time, sometimes many months.⁴

Hyperpigmentation from eczema

Hyperpigmentation is an excess of pigment, or color, in the skin. The inflammation caused by atopic dermatitis, as well as the repeated scratching due to the extreme itch, can trigger pigmentation. The lichenified areas, which are leathery, thickened patches, can be hyperpigmented. The hyperpigmentation can be improved with treatment, such as with topical corticosteroids.³

Hypopigmentation from eczema

Hypopigmentation is a decrease in the pigment in the skin, causing skin to appear lighter than normal. Inflammation can cause hypopigmentation, although it is usually mild and temporary. Some adults with chronic, severe atopic dermatitis may have longer lasting hypopigmentation.³

How are skin color changes from eczema treated?

Treating atopic dermatitis involves a combination of good skin care and medications. Treatment offers the best protection from long-term consequences of AD, such as lichenified areas that are visibly noticeable from other areas of skin.

Moisturizing

Proper skin care for atopic dermatitis includes frequent moisturization, particularly after bathing or showering. Moisturizers seal in moisture from bathing and help repair the skin barrier.

Medications

Medications used in the treatment of atopic dermatitis include:

• Topical corticosteroids, to reduce redness, inflammation, and itching.Topical corticosteroids may cause a lightening of the treated skin (hypopigmentation), but this effect is usually temporary.
• Topical calcineurin inhibitors, to stop the dysfunctional immune response and reduce redness and itching
• Immunomodulators, which also target the dysfunctional immune response to reduce symptoms
• Antibiotics, to fight infection⁵

Phototherapy

Phototherapy, which uses light waves directed at the skin, is a second-line treatment strategy. That is, it is only recommended for use after other treatments and lifestyle approaches have failed to improve symptoms of atopic dermatitis. Phototherapy is sometimes used as a maintenance therapy in people with chronic AD.⁶

Other symptoms of atopic dermatitis

In addition to the change in skin color, atopic dermatitis can causes itch, weepy sores, bumps or papules, and blisters. Some people also experience eye symptoms or cracks behind the ears.