Wound Healing
Eczema is a term used for a group of skin conditions that cause red, itchy, inflamed skin. Eczema does not directly cause scars.
However, if you scratch your skin so much that it bleeds, you’ll cause an open wound, which can lead to a scar—a normal part of the healing process.
Wounds heal in overlapping stages: hemostasis, inflammation, proliferation, and remodeling.
Hemostasis: During the first phase of wound healing, your immune system releases chemicals that cause your blood to clot and stop the bleeding. This starts right after you’ve scratched through your skin. Inflammation: This stage of healing has a bad reputation, but a little inflammation is important for wound healing. Chemicals in your immune system cause cells to fight infection and remove bacteria from the affected area. During this phase, your skin will likely be swollen, red, warm, and painful. Inflammation usually lasts two to three days. Proliferation: The proliferation phase sets the stage for rebuilding your skin. A protein called collagen lays down fibers that fill in the damaged area. Your skin might be light pink in color during this phase, which often begins around three days after injury. Remodeling: This phase is also called the maturation phase. It usually starts around three weeks after your skin is injured, but it can last for up to a year or more. During this phase, scar tissue continues to form and “remodel” itself.
Features
Eczema scars can present differently based on your skin color.
Skin color is determined mainly by cells that produce melanin, which is made up of brown and black pigment. The more melanin you produce, the darker your skin. The color of your eczema scars are also influenced by melanin.
Healed wounds generally leave scars that eventually blend in with the color of your skin. However, this doesn’t always happen. Abnormal pigmentation (coloring) of an eczema scar often makes it more noticeable.
Hypopigmented scars don’t have enough melanin, making the skin lighter. Hyperpigmentation is caused by excess melanin and makes scars darker.
The shape of your eczema scars can also vary. Normal scars eventually flatten out, making them less noticeable. There are two main types of abnormal scars: hypertrophic and keloid.
Hypertrophic scars are raised above the rest of your skin, but they maintain the size and shape of the original wound. In some cases, hypertrophic scars can flatten out after several years. Keloid scars spread beyond the edges of your original wound and don’t improve with time.
Treatment
Unfortunately, there’s no magic wand for getting rid of eczema scars. Once you have them, you’ve got them for life. But, there are some things you can do to make them less noticeable:
Cover them up: One way to blend your scars with your natural skin tone is to cover them with make-up. This is a temporary solution and it might take some practice to get the color just right. Make it darker: Skin color can be temporarily changed with topical lotions and creams. Sunless tanning lotion contains dihydroxyacetone (DHA). This chemical stimulates melanin production and causes your skin to temporarily darken when it interacts with the surface of the skin. Lighten it up: Scars can be temporarily lightened with bleaching creams. These products contain hydroquinone, mercury, and glucocorticoids which limit your skin’s production of melanin. Flatten it out: Once your wound is closed, apply silicone gel sheets to the affected area. These need to be worn more than 12 hours per day for at least two months. Apply scar cream: Over-the-counter and prescription scar creams can make your scars less noticeable by removing dead skin cells and keeping your skin hydrated. Transform your scar: You can permanently change the appearance of your scar by getting a tattoo over the affected area. However, you’ll need to take extra precautions. Avoid getting a tattoo during a flare-up and make sure your skin is well-hydrated prior to your appointment. Consult with your dermatologist prior to getting a tattoo to determine if it’s an appropriate treatment for you. Try laser therapy: If your scars are hyper- or hypo-pigmented, laser therapy can be helpful for changing the color of your scar. However, these treatments can be painful and have to be performed multiple times. Consult a surgeon: In some cases, keloid scars can be surgically removed. Although the surgery produces another scar, it will be much smaller because the skin is stitched back together.
Prevention
The best way to prevent eczema scars is to avoid scratching. This can be extremely difficult if you have this intensely itchy condition. However, there are ways you can reduce the itching and your urge to scratch:
Add oatmeal to your bath: Soak in a lukewarm oatmeal bath for 10 to 15 minutes. Pat your skin dry and immediately apply moisturizer to trap the water in your skin. Cool it down: Apply a cool, wet washcloth to the itchy area. Pinch around it: Gently pinch your skin near the affected area (but not on it). This can temporarily distract your brain from the itching sensation.
Summary
Eczema scars are a broader category of lasting marks from eczema—usually either hyperpigmentation in healed spots, or scars from scratching during flare-ups. People with eczema often have more melanin in their skin, and flare-ups can be triggered by many different things.
Long-term skin damage from eczema, such as scarring or pigmentation changes, can add another layer of stress when dealing with this chronic condition. However, there are many ways to prevent scarring and improve the appearance of existing scars. Talk to your doctor about possible interventions to improve your quality of life.
