A Guide to Eczema Scars

Eczema is an inflammatory skin condition that causes itching and rashes. It can come and go in flare-ups, leaving discoloration and scarring behind. While some scars will disappear on their own, you may be able to treat others with topical treatments or in-office procedures like chemical peels. Awareness of any eczema triggers, using gentle skin products, and applying topical treatments to manage itching can help prevent scratching and keep scars from forming.

This article discusses what causes eczema scars, how to treat them, and how they can be prevented.

Eczema scars can be due to pigment changes or skin damage from scratching and rubbing.

During an eczema flare-up, skin cells called melanocytes can go into overdrive and produce more melanin, which creates skin color. This can lead to hyperpigmentation, or darkening of the skin. Scratching can make the cells release even more melanin. The dark spots will fade, but it can take several months.

After an eczema flare-up, dark spots can appear where the eczema patches were. Exposure to sunlight can make them worse.

Eczema can also lighten the skin, called hypopigmentation. As eczema patches begin to heal, they leave behind areas of skin that are lighter than the surrounding area.

Lighter skin may also develop due to pityriasis alba, a mild form of eczema more common among children. These areas will not tan and typically resolve within a year. However, it may take several years for some people.

Steroid creams used to treat eczema can also lighten the skin, but the discoloration fades when the medication is stopped.

Eczema patches can be itchy and uncomfortable, leading to scratching or rubbing the affected area. When the skin becomes damaged, some marks or scars can develop.

• Lichenification is rough, thickened areas of skin that can develop. They are dry, hardened, and marked with lines.
• Keloid scars are raised scars that are larger and darker than the originally inflamed area.
• Hypertrophic scars are also raised areas but develop in the area of the eczema patch and are not as dark or large as keloid scars.

Learn more about how eczema looks and feels on skin of color.

The primary way to improve skin pigmentation changes is to treat the underlying eczema and inflammation. Many eczema scars will fade over time on their own, but it can take months or even years, even after the eczema is treated. Some treatments may speed up the process.

To treat darkened eczema scars at home, apply over-the-counter (OTC) topical skin-lightening creams, but follow the directions carefully. If you notice irritation, stop using the product and call a dermatologist or doctor.

There are many skin lighteners, but none are approved by the Food and Drug Administration. OTC products containing hydroquinone or mercury have been banned and may be harmful.

Some common ingredients that may lighten hyperpigmentation include:

• retinoids, derived from vitamin A
• kojic acid
• arbutin
• vitamin C
• vitamin E
• niacinamide

Some botanical extracts may have skin-lightening properties, but their effectiveness is uncertain. These include:

• aloe vera
• mulberry
• soy

Home remedies for raised scars can include pressure garments or silicone gel sheets. They flatten the scars and, over time, may reduce their appearance and help keep them from returning.

Qualified practitioners can also prescribe or administer treatments for pigmentation scars, which include:

• Chemical peels: Superficial chemical peels may help the appearance of scars.
• Laser therapy: Laser treatments are safe options for reducing the appearance of scars with few side effects.
• Hydroquinone: Once a popular skin lightener, concerns have been raised about the toxicity of hydroquinone. A prescription formulation is available, but make sure you discuss the possible risks with a dermatologist.

Treatments for keloid and hypertrophic scars include:

• cortisone injections, usually done in a series
• laser or other light treatments, which may flatten raised areas
• surgery, though keloids can grow back after the procedure
• cryotreatment, or freezing, which can treat small areas and may need several applications
• ligature, in which the scar is tied off with a surgical thread and, over time, may fall off
• bleomycin, an anticancer agent derived from bacteria found in soil, has shown some promise in treating eczema scars
• intralesional 5-fluorouracil, which can be used topically on keloid scars

Your dermatologist may use a combination of treatments to minimize the appearance of eczema scars.

Learn more about treating and managing advanced eczema.

One of the most effective ways to avoid scarring is to prevent eczema flares. Take note of when your eczema flares up. Be aware of factors that may lead to itchy rashes, including dry skin, environmental triggers, allergies, stress, or specific skin care products.

Stick to gentle cleansing products, short baths and showers, and unscented soaps and moisturizers. Use unscented sunscreen and cover your skin when out in the sun.

If you experience a flare-up, try not to scratch. Scratching not only extends the itch-scratch cycle but increases the likelihood of scarring.

Use cool compresses, anti-itch creams, and oral medications as directed to ease itching. Oatmeal baths may also be beneficial.

Learn 8 ways to manage eczema itch.

If your eczema is leaving you with dark patches or raised scars, a dermatologist can work with you to find treatments or preventive medications to minimize flare-ups. Eczema is not deadly, but it can disrupt sleep and daily activities.

Eczema scars can appear as dark or light patches or raised areas of skin. Though pigment changes may fade, raised scars like keloids and hypertrophic scars may need professional treatment.

Talk with a dermatologist about ways to treat and prevent eczema scars.