Eczema is a common skin condition causing itchy, dry, and irritated lesions. Scratching the lesions can cause changes in the skin, including both hypopigmentation and hyperpigmentation.

Experts are not sure what precisely causes eczema. However, research suggests that genetics and environmental factors play a role.

Eczema causes lesions on the skin that are itchy and dry. Many people feel the urge to scratch the affected skin, which can worsen the irritation. It may cause the eczema to spread to other parts of the body, change color, and become infected.

The change in color can be hypopigmentation, which is a loss of color, or hyperpigmentation, which is a darkening in color.

Read more to learn about the link between eczema and skin discoloration, the treatment options, and more.

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Eczema lesions, also called atopic dermatitis, can be itchy and uncomfortable. Scratching eczema is a common behavior, but it may encourage changes in the skin’s appearance and texture.

Eczema can cause two types of pigmentary skin changes: hypopigmentation and hyperpigmentation. Hypopigmentation is a loss of pigment or color, usually presenting in patches that are lighter than a person’s skin tone. Hyperpigmentation refers to patches of skin that become darker than the skin surrounding them.

Hypo and hyperpigmentation are both more visible on darker skin tones. However, they can appear on any skin tone.

People with eczema can find the change in skin appearance distressing, and it can affect their quality of life. Even after treatment for eczema, the skin may not return to its previous color.

During an eczema flare-up, the body releases cytokines. In an effort to protect the body, they cause inflammation.

The cytokines trigger the release of melanocytes. These cells live in the skin and hair follicles and produce melanin, a skin pigment.

This reaction leads to increased pigment production.

The darker a person’s skin, the more melanin they have. As a result, people with darker skin release more pigment when the reaction occurs.

Eczema looks different depending on a person’s skin type.

On light skin, eczema typically causes inflamed pink or red patches that are dry and itchy. These lesions are harder to detect on dark skin tones.

When people with light skin scratch eczema lesions, hyper and hypopigmentation can occur. Skin pigmentation can progress gradually, and its subtle changes make it hard to detect.

People with dark skin tones are more likely to get hyper and hypopigmentation. They are also more likely to have follicular prominence, which is when eczema presents as small, itchy bumps called papules. These mainly appear on the forearms and torso.

Hyperpigmentation

Darker skin patches, or hyperpigmentation, occurs as a result of inflammation. This triggers melanocytes to increase melanin synthesis, which is the process of making skin pigment.

The increase in synthesis encourages the transferral of pigment to the epidermis, the top layer of the skin. If a person scratches or rubs the skin, this releases the melanin.

Types of hyperpigmentation include:

Post-inflammatory pigmentation

After an eczema flare-up has resolved, it can leave a darker patch of skin. This is post-inflammatory pigmentation.

Although it is temporary, it can persist for months, but it does tend to last longer on dark skin tones.

Sunlight stimulates post-inflammatory pigmentation, so people should cover affected areas and use sun protection.

Lichenification

If a person rubs and scratches at the affected areas of skin, it can thicken. This may leave thick, leathery lesions with visible scratch marks, called lichenification.

These areas of hyperpigmentation may present as gray on dark skin and as dark pink on light skin.

Hypopigmentation

Lighter skin patches, or hypopigmentation, can occur when an eczema flare-up is in the process of resolving.

Eczema hypopigmentation often presents as pityriasis alba, which is low grade eczema marked by pale, scaly patches. It usually causes between one and 20 rounded or oval patches on the neck, face, upper arms, and shoulders.

Pityriasis alba is more common on dark skin tones, and it frequently occurs after a person’s skin has had exposure to the sun. Although the scales and dryness may be more apparent during the winter months, the actual hypopigmentation is more common during the summer.

The lesions usually resolve in 1 year, but they can take 2–3 years to disappear.

There is no specific treatment for pigmentary skin changes. However, eczema is treatable in people of all skin types.

Hyper and hypopigmentation usually fade and resolve on their own. Using a moisturizing cream or ointment can help the dryness, and sun protection will prevent hyper and hypopigmentation patches from worsening.

If a person’s eczema or pigmentation is not resolving on its own, they can contact a doctor or dermatologist to establish a treatment plan. This may include oral and topical steroids, nonsteroid creams, and more.

Hyper and hypopigmentation due to eczema usually resolve on their own.

People struggling to manage their eczema can contact a doctor to receive a diagnosis and establish a treatment plan. Additionally, people who are concerned about patches of hyper and hypopigmentation may also wish to speak with a doctor.

Eczema causes dry, itchy, inflamed lesions. When irritated, the skin can develop patches of hyper or hypopigmentation.

There is no specific treatment for hypo or hyperpigmentation related to eczema, and the conditions will usually resolve on their own over time. A person can see a dermatologist to treat their eczema.