Does Atopic Dermatitis Cause Scars?
Reviewed by: HU Medical Review Board | June 2017 | Last updated: March 2022
Atopic dermatitis, also known as eczema, is a chronic, relapsing skin condition that most often affects children, although some people may have it as adults.
Does atopic dermatitis cause scars?
Atopic dermatitis usually does not cause scarring, although chronic atopic dermatitis and repeated scratching can cause areas of lichenification, patches of thickened skin that may have knots or areas of lumpy tissue.
What does lichenified skin look like?
Lichenified skin 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. Lichenified skin is also always itchy.1,2
Skin color changes
Atopic dermatitis may cause hyperpigmentation (an excess of pigment that causes darker patches) or hypopigmentation (a decrease in pigment of the skin that causes lighter patches). While hyperpigmentation or hypopigmentation from atopic dermatitis may be mistaken as scarring, these changes in skin color usually get better over time with proper treatment of atopic dermatitis.1,2
Itchiness and scratching
Itchiness is the most prevalent and distressing symptom of atopic dermatitis. Itchiness is medically known as pruritus, and it is defined as an “unpleasant sensation that elicits the urge to scratch.” Both the symptom of itching and the scratching it provokes significantly contribute to the burden of atopic dermatitis. The itching and scratching can lead to psychological distress, difficulty concentrating, disruption of sleep, and physical damage to the skin barrier, which leads to increased water loss, increased risk of infection, increased inflammation, as well as lichenification.3
What is the itch-scratch cycle?
The exact disease processes that cause itch in atopic dermatitis are not completely understood, but doctors know that the “itch-scratch cycle” (the skin feels itchy, which leads to scratching, which then causes the skin to feel even itchier) perpetuates the disease.
What causes the itch?
The itch appears to start before the inflammation. Research has uncovered that itch in atopic dermatitis is related to the close relationship between the nervous system and the skin. The nerves in the skin send an “itch” message to the brain through chemical messengers called cytokines. Researchers are studying the different mechanisms related to itch, including how people with atopic dermatitis may have skin sensitivity that causes other sensations, such as heat or pain, to be perceived as itch.3,4
How to prevent lichenificiation
To prevent skin from becoming lichenified, it is important to treat atopic dermatitis. Treating atopic dermatitis includes avoiding triggers, practicing good skincare, and using medications or other therapies as prescribed by your doctor.
Practice routine skin care
Routine skin care is critically important in the treatment and management of atopic dermatitis. Routine skin care involves bathing and moisturizing the skin, as well as avoiding skin irritants and scratching. The regular use of moisturizers is one of the most important aspects of caring for skin with atopic dermatitis. Moisturizers are one of the basic necessities for people with atopic dermatitis, regardless of the severity of their disease. Moisturizers should be used after bathing. The use of moisturizers helps retain the necessary hydration in the skin and helps repair the damaged skin barrier.3,5
How to treat the itch
There are several medications that are designed to reduce inflammation that may help with itchiness, including:
Wet wrap therapy
Wet-wrap therapy, with or without a topical corticosteroid, is another technique that can help moderate to severe atopic dermatitis. Wet-wrap therapy involves applying the medication (if used) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.5
Other treatment options
Other therapies that may help reduce itch include phototherapy, acupressure, and massage. (While more study is needed on alternative therapies like acupressure and massage in atopic dermatitis, researchers believe these therapies may address the role of the nervous system in itch perception.)3