Eczema and the Risk of Scarring

Eczema is a common skin condition that causes dry, itchy, and inflamed skin. Many people with atopic dermatitis, a common form of eczema, wonder whether it can cause scars. The good news is that eczema itself does not usually cause scars. However, the way you manage your eczema can influence whether scarring occurs.¹

Does eczema cause scars?

Eczema does not directly cause scars. Scarring happens when the deeper layers of the skin are damaged. Eczema mainly affects the outer layer of the skin. But scratching and picking at eczema-affected skin can lead to scarring.¹

When you scratch, you can break the skin, which increases the risk of infection and scarring. For this reason, it is important to manage itching and avoid scratching as much as possible.¹

The itch-scratch cycle

The itch-scratch cycle is a key factor in whether eczema leads to permanent skin changes. When eczema flares up, the skin becomes itchy. Scratching provides temporary relief, but it also makes eczema worse. Scratching can damage the skin, leading to more inflammation and itching. This cycle can continue for a long time and lead to skin color changes, lichenification, and scarring if not controlled.^1-3

Breaking the itch-scratch cycle is essential for preventing long-term skin damage. Using moisturizers, taking antihistamines, and applying topical treatments can help reduce itching and protect the skin.^1-3

Skin color changes: Hyperpigmentation and hypopigmentation

People with eczema may notice changes in their skin color. These are known as hyperpigmentation and hypopigmentation.⁴

Hyperpigmentation is when the skin becomes darker in certain areas. This can happen after an eczema flare-up, especially on darker skin and if the skin has been scratched a lot. The body produces more melanin (the pigment that gives skin its color) in response to inflammation and injury. As a result, the skin becomes darker.^1,4,5

Hypopigmentation is when the skin becomes lighter. This can occur when eczema heals. The affected area may lose some of its pigment, leading to lighter patches on the skin. Over time, the skin color may return to normal, but it can take months.^1,4

These skin color changes are usually temporary. But they can last for a long time, especially if the skin is not cared for properly.¹

What is lichenification?

Lichenification refers to the thickening and hardening of the skin. This happens when the skin is repeatedly scratched or rubbed. Over time, the skin becomes leathery and rough. This is the body's way of protecting itself from further damage. Lichenification is common in people with long-term or severe eczema.^1,5

Lichenified skin looks different from healthy skin. It may appear darker or have deep lines. The affected areas are usually more sensitive and can be very itchy.⁵

While lichenification is not a scar, it can change the appearance and texture of your skin permanently. The good news is that you can prevent and manage lichenification.⁵

How to prevent lichenification and scarring

Preventing lichenification is key to keeping your skin healthy. Here are some tips to help you manage your eczema and prevent long-term skin changes:^2,3

• Moisturize regularly – Keeping your skin hydrated helps to protect it from damage. Use a thick, fragrance-free moisturizer several times a day, especially after bathing.
• Avoid scratching – Try to resist the urge to scratch. Keep your nails short, and consider wearing gloves at night. If you feel itchy, pat or press the area instead of scratching.
• Protect your skin – Avoid irritants like harsh soaps, fragrances, and certain fabrics. Choose clothing made from soft, breathable materials like cotton. Steer clear of any itchy fabrics like wool.
• Avoid triggers – Identify and avoid triggers that worsen eczema. Common triggers include certain foods, stress, temperature changes, and harsh soaps.
• See a dermatologist – If over-the-counter treatments are not enough, a dermatologist can prescribe stronger medicines to control your eczema and prevent skin damage. Topical treatments like corticosteroids can reduce inflammation and itching. Use them only as prescribed.