Does Atopic Dermatitis Cause Scars?

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, relapsing skin condition that most often affects children, although some people may have it as adults. AD usually does not cause scarring, although chronic AD and repeated scratching can cause areas of lichenification, patches of thickened skin that may have knots or areas of lumpy tissue. 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

AD 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 AD may be mistaken as scarring, these changes in skin color usually get better over time with proper treatment of AD.1,2

Itching and scarring

Itchiness is the most prevalent and distressing symptom of AD. 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 AD. 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

Itch-scratch cycle

The exact disease processes that cause itch in AD 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 more itchy) perpetuates the disease. The itch appears to start before the plaques or inflammation. Research has uncovered that itch in AD 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 AD may have skin sensitivity that causes other sensations, such as heat or pain, to be perceived as itch.3,4

Treating itch and preventing scarring

To prevent skin from becoming lichenified, it is important to treat AD. Treating AD includes avoiding triggers, practicing good skin care, and using medications or other therapies as prescribed by your doctor. Triggers to avoid include contacts with allergens, sweat left on the skin, wool fibers, dry skin, emotional stress, and some soaps or detergents.3,4

Routine skin care is critically important in the treatment and management of AD. 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 AD. Moisturizers are one of the basic necessities for people with AD, 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

Medications

There are several medications that are designed to reduce inflammation that may help with itchiness, including:

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 AD, researchers believe these therapies may address the role of the nervous system in itch perception.)3

Wet-wrap therapy, with or without a topical corticosteroid, is another technique that can help moderate to severe AD. Wet- wrap therapy involves applying the medication (if using) 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

Emily Downward | June 2017
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