Everything You Need To Know About Eczema and Skin Discolouration

Eczema, also known as dermatitis, is a condition characterised by itchy skin inflammations. Usually, it causes skin hyperpigmentation that may last long after healing. With this in mind, we have put together everything you need to know about eczema and skin discolouration.

The condition can affect people of all colour and ages. If it affects you during childhood, the chances are that you will outgrow it by your tenth birthday. However, in some people, the symptoms might persist for the rest of their life. Subsequent attacks may take a toll on your skin, leaving it thickened and discoloured.

Is it still possible to enjoy flawless and glowing skin after eczema? Read on to find out. 

What is Eczema?

Eczema manifests as patches of inflamed, itchy, rough and cracked skin. The affected areas are usually reddish and blistered. Depending on your age and other contributing factors, the disorder manifests in different areas of your skin. Typically, the rash appears on your face, wrists, and hands.

The disease is prevalent among people with a history of allergies or asthma. Children are more prone to this skin condition, but adults can also get it. Environmental factors, as well as some of the foods that you eat, can trigger it or make it worse. The disorder is chronic, and no cure exists as of now. Fortunately, it is possible to manage the symptoms.[1]

Types of Eczema

Knowing the type of eczema that you are dealing with helps you to choose the medication and preventive measures. The term 'eczema' typically refers to any condition that causes inflammation, irritation, and discolouration of the skin. This broad interpretation gives rise to seven different forms of eczema:

Atopic Dermatitis (AD)

One of the most prevalent forms of eczema, the type affects over 10% of all skin colours and ethnicities. It usually manifests in childhood, getting milder and more manageable with age. Often, asthma and hay fever accompany the condition.

A combination of genetics, immune system problems, environmental triggers and dry skin are likely causes of AD. These are factors that leave your skin less protected from irritants and allergens.

Symptoms:

  • Rashes in the creases of your knees and elbows
  • Lighter or darker pigmentation on affected areas
  • Infection when you scratch fluid-filled bumps

Dyshidrotic Eczema

This type of eczema primarily affects the skin on your hand and feet. The condition is more prevalent among women than in men. Typically, the irritation comes from allergies. Exposure to substances like cobalt and nickel, and having damp hands and feet can also cause dyshidrotic eczema.  

Symptoms:

  • Discoloured, scaly, flaky and cracked skin
  • Blisters on your palms, toes and the bottom of your feet
  • The affected area can be itchy and painful     

Contact Dermatitis

Everything You Need To Know About Eczema and Skin Discolouration

Susan Nedorost, MD

Dermatology Professor,

University Hospitals

 Cleveland Medical Center,

Allergic contact dermatitis usually develops to small, non-protein molecules such as preservatives or metals. Atopic dermatitis patients can also develop contact dermatitis to plant proteins such as oat or dandelion.[2]

As the name suggests, this type of skin disease results from an allergic reaction to things that come into contact with your skin. When caused by irritants such as latex and metal, the condition is referred to as allergic contact dermatitis. However, if the reaction is as a result of substances such as chemicals and detergents, it's known as irritant contact dermatitis.

Symptoms:

  • Itchy, stingy, and reddish skin
  • Fluid-filled blisters and hives on the contact area
  • Your skin may thicken and become scaly

Neurodermatitis

This skin disorder results from a localised itch. A good example is an insect bite. Neurodermatitis is similar to atopic dermatitis, and it causes thick, scaly patches to form on the infected area. It can affect any area of your body, including genitals. The condition can also be triggered by stress, especially in people with other skin diseases such as psoriasis.[3]

Symptoms:

  • Thick and scaly patches
  • Bleeding and infection when you scratch the patches
  • When relaxed or asleep, the affected area can be overly itchy

Nummular Eczema

This form of eczema gets its name from the Latin name nummular, which means coin. It manifests as small, round spots on your skin. Insect bites, allergic reaction from contact with metals and chemicals are its possible triggers. Other types of eczema and dry skin can also trigger it.

Symptoms:

  • Coin-shaped spots
  • The affected skin may become scaly and itch

Hand Eczema

This eczema only affects your hands. Its seen in people who work with irritants such as detergents, hair products, and industrial chemicals. This kind of irritation is common among health care, factory, and laundry workers.

Symptoms:

  • Red and itchy skin
  • Dry, cracked and blistered hands

Stasis Dermatitis

This is one of the most uncomfortable and painful forms of eczema. It results from weakened veins which leak fluid onto your skin. This fluid causes your skin to swell, itch, redden, and become painful. It affects the legs when valves that ensure proper circulation malfunction. The results are blood pooling which damages your veins.

Symptoms:

  • Swollen legs
  • Formation of varicose veins- thick, damaged veins in your legs which appear blue or dark purple. 
  • Dry and itchy skin
  • Open sores may also develop

The connection between Eczema and Skin Discolouration

From the above types of eczema and symptoms associated with each, it evident that the disorder comes with dry and itchy skin. When you give in to the itch, your skin becomes inflamed. As your skin heals from the localised irritation, melanin production increases, causing skin discolouration.

This form of skin darkening is known as post-inflammatory hyperpigmentation, PIH in short. It is the same kind of discolouration seen after the skin heals from trauma. Also, PIH can result from any diseases that inflame the skin, such as inflammatory acne.

PIH, just like eczema, can affect people of all races, but it is more noticeable in dark-skinned people. Your skin is capable of getting rid of the discoloured skin by natural regeneration and exfoliation. However, there is no way of telling how long this can take. 

Can Eczema Cause Hypopigmentation?

Eczema is also associated with hypopigmentation. Typically, this discolouration manifests with chronic eczema. It manifests as light patches on normal skin.[4]  

In dark skins, hypopigmentation is more pronounced than in people with light and brown skin. These patches usually affect sun-exposed areas of your face, as well as the head, upper back and trunk.

How does eczema and skin discolouration Look on Dark Skin?

The redness that comes with eczema is only visible on light skin. On black and brown skin, the disease tends to take a dark brown, ashen grey or purple appearance. Nevertheless, the treatments used to manage eczema and discolouration are universal irrespective of the skin type.

Apart from the characteristic discolouration, the disease can also present symptoms that are unique to black skins. For example, in African Americans, small bumps on the arm, legs, torso and hair follicles have been observed. In contrast, such symptoms are rare in Caucasians.[5]  

Other unique symptoms in black-skinned eczema sufferers include extensive skin dryness as well as dark circles around the eyes. Lastly, upon resolution, the disease may leave dark-skinned individuals with a more significant change in pigmentation.   

How to Treat Eczema and Skin Discolouration

Since there are no known eczema treatments, the medication given targets at controlling the symptoms. Eczema and skin discolouration require separate approaches. The critical factor though, is identifying and eliminating the eczema trigger.

Eczema treatments are based on the type and the symptoms. Possible ones are antihistamines, moisturisers, corticosteroids, light therapy, and immunosuppressants.

Once you manage the symptoms, PIH begins to fade gradually. Sometimes, you may require help in getting rid of hyperpigmentation. The treatments below may come in handy.

Caution!

PIH treatments should not be used on broken or infected skin. Instead,  wait until the eczema clears before dealing with the discolouration. 

Laser Therapy

This treatment involves the use of laser beams to target the discoloured layer or layers. The type and intensity of the laser depends on the severity of your condition. Once the skin cells are damaged, a fresh, less blemished skin layer takes their place.  

To begin with, work with your dermatologist to choose the most appropriate laser procedureMore importantly, the treatment should be done by an expert. Reason being, in the hands of a quack, laser treatments can damage your skin. In particular, there is the danger of post-inflammatory hyperpigmentation, especially in dark-skinned people.

Topical Creams

Eczema and skin discolouration

Ni'kita Wilson

Cosmetic Chemist,

V.C. Ideation and Innovation,

Voyant Beauty, Chicago

Treatments containing ingredients like vitamin C, licorice root, and kojic acid help reduce hyperpigmentation by inhibiting tyrosinase, an enzyme responsible for the formation of skin-darkening melanin. [6]

These are creams which treat discolouration by reducing or interfering with your skin's production of melanin. Creams which fit these criteria are usually hydroquinone, corticosteroid-based or naturally formulated topical skin lightening creams.       

Hydroquinone is however banned for use in cosmetic products in most countries due to its association with health risks. Additionally, corticosteroids should not be used for long-term skin treatments. 

Creams that use natural skin lightening ingredients are therefore safer. Such ingredients include arbutin, liquorice, aloe vera, niacinamide, and vitamin C. Other properties to look for in creams include anti-inflammatory, antioxidant and skin moisturization abilities.

Chemical peels

As the name suggests, these involve the application of acidic solutions on the skin to peel a layer or layers of the hyperpigmented skin. Chemical peels can be superficial, medium, or deep depending on the seriousness of the condition. Simply stated, the effectiveness of the treatment depends on the strength/ concentration of the acid used.

Superficial peels target the topmost layer of the skin. On the other hand, deep peels are more penetrative for drastic results. There are also some mild DIY kits sold OTC for use at home. Deeper peels are, however, not recommended for people with dark skin.  Doctors warn that such peels can cause bleaching or hypopigmentation.

Retinoids

Retinoids improve the appearance of discoloured skin by reducing epidermal melanin production. Other mechanisms include blocking transcription of tyrosinase and enhancing skin cell turnover.[7]

Moreover, they help your skin fight pigmentation by boosting collagen production. The medication is a useful anti-ageing agent for reducing wrinkles and fine lines. A popular retinoid recommended for PIH is Tretinoin.

Facial Acids

Facial acids work by exfoliating the skin to reveal newer and lighter skin. Others, such as kojic acidAzelaic acid and l-ascorbic acid (vitamin C), are depigmenting agents. These mechanisms help to leave your skin smooth and evenly toned.

You can find them OTC either on their own or as ingredients in topical lotions and creams. Other examples of AHAs are glycolic, lactic, citric, malic, and tartaric. Notably, they work best with mild hyperpigmentation.

Tips on Effective Management of Eczema and Skin Discoloration

  • Moisturise and drink lots of water, especially in summer to fight off dry skin.
  • Wear loose-fitting clothes to avoid unnecessary friction which can cause eczema flare-ups.
  • Always carry out a patch test before starting with any topical eczema and discolouration medication. The test helps you to keep off products that can trigger allergic reactions. [8]
  • Protect your skin from pigmentation-inducing UV rays by wearing high SPF sunscreen and protective clothing, such as hats.
  • Shower in lukewarm water- hot showers strip your skin of natural oils and leave it too dry.
  • Keep track of everyday things that you are allergic to; such as soaps, pollen, chemicals, and fabrics.
  • Try your best not to rub or scratch the affected skin
  • Do what makes you happy and if not, find a way to relax, try aromatherapy and massages. A stress-free life will keep your eczema and discolouration in check.

Conclusion   

Eczema or dermatitis is a skin condition that is characterised by itchy and irritated skin. Even so, it manifests in various forms based on the triggers, the affected areas and the symptoms. Scratching of the skin leads to inflammation which triggers excess melanin production. The extra melanin is responsible for the tell-tale skin discolouration.

With proper management of eczema, it is possible to get rid of the hyperpigmentation. The above treatments work by various mechanisms to lighten the darkened areas of your skin. You should, however, use them after your skin heals to avoid causing further damage.

About:

sonia knight

Sonia Knight is the founder of be:skinformed.

Apart from having her own experience with hyperpigmentation, Sonia has gained vast knowledge in the dermatology field. For more info on this, check out our about us page.

Resources

1 Eczema (Atopic Dermatitis) Overview, American Academy of Allergy Asthma and immunology 

3 What's to know about eczema? Medical News Today

4 Hypopigmented patches in an 8-year-old boy, Academy of Family Physicians of Malaysia 

5 Eczema in skin colour: What you need to know, National Eczema Association  

7 Topical Retinoids for Pigmented Skin, Department of Dermatology, Howard University College of Medicine  

8 Allergy skin Test, Mayo Clinic

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