Can Eczema Cause Scarring?

While eczema doesn’t cause scars directly, the resulting itching, scratching and healing process can, in certain circumstances, lead to scarring. Here’s what you need to know about eczema and scarring, as well as scar treatment and prevention. 

What causes scarring?

Scarring is a natural part of your skin’s healing process. “Scars are secondary to something like scratching, itching, digging in the skin or infection,” says Dr. David Pariser, dermatologist at Pariser Dermatology Specialists in Norfolk, Virginia and a former President of the American Academy of Dermatology. 

Itch is one of the most common symptoms of eczema. Basically, if you scratch until you bleed or ooze, scarring is a risk. “While eczema itself won’t scar, scratching and breaking the skin below the level of epidermis (when bleeding begins) can increase the risk of scarring,” said Dr. JiaDe (Jeff) Yu, a board-certified dermatologist at Massachusetts General Hospital in Boston.

Skin infections are also a common problem for people with eczema. “Scratching also increases the risk of infection, which can further damage the skin and contribute to an eczema flare,” said Dr. Vivian Shi, professor of dermatology and director of clinical trials at the University of Washington in Seattle. The damage from skin infections can lead to scarring.

Scarring on skin of color

Scarring can be especially visible if you have skin of color. While not technically a scar, people with skin of color can also experience skin pigmentation changes due to other eczema-related skin issues or after using certain eczema treatments. For example, skin of color is more prone to spots of hyperpigmentation (darkening of the skin) and hypopigmentation (lightening of skin). These changes in skin color can look like scars (even though they are not scars), and they can last for months or years, even after eczema is treated.

Ways to prevent scarring 

There is no magic cure to get rid of scars completely. The best option is to avoid getting them in the first place. If you have eczema, this means having an effective eczema care routine to help prevent itch, inflammation and skin barrier breakdown, which can all lead to skin injury and infections.

“Try to treat the eczema and itch so as not to scratch,” said Dr. Yu. “If scratching is inevitable, I would recommend thick emollients on the broken skin, such as Vaseline or Aquaphor, to aid in wound healing. Keeping the areas covered, if possible, and out of the sun is important to prevent discoloration. If there is yellow/honey colored crusting, there may be a concern for infection and topical antibiotics may be necessary,” advised Dr. Yu.

Dr. Shi also said using gentle pressure or cool compresses can help prevent scratching. She also advised people with eczema to “keep nails trimmed short to minimize damage if scratching does occur.”

Treatment options for scars

According to the American Society of Plastic Surgeons, scars may improve and fade over the first two years depending on the severity and location on the body. However, after two years, it’s not likely the scar will fade anymore. If you have eczema, there are some treatment options that can help improve the appearance of scars.

“Unfortunately all scar treatments currently on the market do not have robust scientific evidence saying they are better than just using Vaseline,” said Dr. Yu. “However, anecdotally, patients have told me that topicals such as Mederma, Derma-E scar gel, Bio-Oil and hydrocolloid bandages are helpful.”

Dr. Shi added, “For eczema-prone skin, silicone gel sheets or scar creams can help soften scars while being gentle on sensitive skin.” She also suggested using petroleum jelly on open sores or wounds to facilitate and speed-up wound healing. “Using a thick, fragrance-free moisturizer daily can support the skin’s natural repair process,” she said.

For any scar treatments, it’s important that you talk to a dermatologist or plastic surgeon who has expertise in eczema. You should go to someone who understands eczema, can assess your scars and make the most appropriate recommendation (while not aggravating or irritating your already-sensitive skin). 

Tips and takeaways

If, despite your eczema care, you still end up with cuts, scrapes or other injuries, you can try to minimize scarring. Here are some basic ways to prevent injuries from scarring: 

• Moisturize and keep skin moist
• Change any bandages daily to keep wounds and injured skin clean
• Avoid scratching and picking at scabs or crusts
• Minimize sun exposure to any injured areas — sunlight can cause unwanted darkening of fresh, new skin

“Preventing eczema flares is the best scar prevention,” said Dr. Shi. “Flares can be prevented by strategically avoiding known triggers and keeping the skin well moisturized. Flares should be treated promptly with prescribed medications to reduce inflammation and itching.”