Skin Color Changes and Atopic Dermatitis

Atopic dermatitis, the most common type of eczema, can cause many different skin symptoms. Some of these skin symptoms can change the color of the skin. Color changes may look different based on how dark or light a person’s skin is normally.^1,2

Many different types of skin changes are possible. No two people will experience the same changes.^1,2

Understanding skin color changes

Your skin can change color for a variety of reasons. You cannot control some of these reasons, like skin lightening due to vitiligo or rashes due to allergies. But you can control some reasons, like seeking a tan, getting a tattoo, or wearing make-up.^1-3

Many of the skin color changes in people with eczema result from inflammation and irritation. Some are caused by long-term scratching or treatment side effects.^1-3

When the skin becomes darker than normal, it is called hyperpigmentation. When the skin becomes lighter than normal, it is called hypopigmentation. People with eczema can experience either or both all over their body. It also is possible to have other areas of discoloration, like purple patches of thickened skin around heavily scratched areas.^1,3

Types of skin color changes with eczema

Skin color can change in a few ways as a result of eczema. These include:^1-8

• Red or pink bumps and rashes on lighter skin, brown or purple bumps and rashes on darker skin
• Dry skin that appears gray or pale
• Areas of leathery, thickened skin (lichenification) that can be pink, red, brown, or purple
• Lightening of the skin around the center of the face but normal coloration on the outside of the face (centrofacial pallor)
• Red or purple pinpoint bumps around hair follicles, especially on the backs of the arms (keratosis pilaris)
• Small areas of skin lightening or loss of pigment (pityriasis alba or steroid side effect)
• Purple-gray darkening around the eyes (allergic shiners)
• Lightening of the skin in areas that were recently scratched (white dermatographism)
• General darkening or lightening of the skin after inflammation
• Widespread reddening and scaling of the skin which can cover up to 90 percent of the body (erythroderma, also called exfoliative dermatitis)
• Yellow crusting around healing blisters or skin infections

This is not a full list of all potential skin changes that can occur with eczema. Color changes may vary based on symptom severity, whether the issue is acute (short-term) or chronic (long-term), and skin tone.^1-4

Eczema on different skin tones

Experts believe that eczema is caused by a combination of a weakened skin barrier, an overactive immune system, and exposure to allergens or germs. Each person’s symptoms can differ in severity. They can also be different based on the person's underlying skin tone.^1,2

For example, in people with light skin tones, areas of active inflammation may be pink or red. On those with darker skin tones, these same types of patches may appear gray, brown, or purple. It may be hard to fully see a rash on darker skin tones at all. Instead, the first sign of eczema may be raised pinpoint bumps called papules.^2-4

Treating skin color changes

In order to treat a skin color change, its underlying cause needs to be treated. For example, crusting as a result of a skin infection can be treated with antibiotics. Hyperpigmentation from skin thickening may improve with direct steroid injections or steroid creams.⁹

The best way to prevent color changes that stem from eczema symptoms is to prevent flare-ups and treat the symptoms. You can:^1-4,9

• Moisturize regularly using thick cream moisturizers
• Take all drugs and creams as prescribed
• Reduce your stress level as much as possible
• Avoid potential triggers

Using medicated creams as prescribed is especially important. This is because some creams (like those that contain steroids) may worsen skin color changes if used too often.^1-4,9

Not all skin color changes are the result of eczema. There are other health issues or drug side effects that can affect the skin. If you notice new skin color changes or a worsening of existing symptoms, talk with your doctor. They can pinpoint the underlying issue and create a plan to treat it.