Skin Discolouration and Eczema

Skin pigmentation alterations occur when the normal complexion is altered by eczema.

As a dermal clinician, one of the most important factors in our consultations with our clients is asking what their skin phototype is. This is crucial in order to avoid hyper-pigmenting our clients with our treatments and to provide them with the pre and post care instructions after treatment to avoid any adverse effects.

What skin type do you have?

The Fitzpatrick Classification describes skin type, which defines skin tones via a phototype, which is determined by the amount of melanin in the skin. We do not observe only the individuals’ skin colour that we physically see, but we also ask clients what their ethnicity/background is to really grasp how their skin responds to pigment. As mentioned in an early post, all skin is different. We could have a client who appears to be skin type II, but when asked if they burn in the sun, they may say “no,” and if I had treated them as skin type II, they would have had some sort of adverse reaction and pigmentation.

Fitzpatrick Skin Type Classification Scale

Skin type | Characteristics

I. White skin, freckles

II. Pale skin, freckles rare

III. Light/light brown skin, no freckles

IV. Light brown/olive skin, no freckles

V. Skin brown

VI. Skin black

Skin changes are induced by either persistent eczema or scratching in response to eczema itch. These alterations can cause two kinds of pigmentary skin changes in eczema patients:

• Hyperpigmentation: Refers to areas of skin that are darker than normal in comparison to the rest of the skin.
• Hypopigmentation: Characterised as loss of pigment, manifested as lighter areas of skin then the general skin tone. Inflammation causes melanocytes to be stimulated, therefore increasing melanin synthesis. As a result, pigment is transported to the epidermis. Pigment is also produced when the skin is damaged by itching or scratching, explaining why they are so susceptible to pigment changes.

Although pigmentary changes are more visible in darker skin types, they can develop in any skin type and can be problematic and upsetting for anybody suffering from eczema.

How are different skin types affected?

Addressing the underlying eczema and inflammation is the most effective method to improve pigmentary changes. However, discolouration can remain for extended periods of time even after the eczema has been managed.

On lighter skin types, the usual diagnosis is inflamed, red or dark pink areas with dry, itchy skin, which may leak tiny vesicles in severe outbreaks.

On darker skin types, inflammatory responses are more difficult to identify because they appear as different phases of discolouration and are more subtle, thus erythema is frequently not visible. As a result, the intensity of eczema may be misjudged. Individuals with darker complexions are more likely to experience post-inflammatory hypo and hyperpigmentation.

How to treat pigmentary changes

Although there are no particular treatments for pigmented skin changes, it is essential that eczema be identified and treated in people of all skin types. Prompt intervention will aid in the reduction of long-term post-inflammatory pigmentation.

Both types of pigmentation may ultimately go away. It is crucial to note, however, that hyperpigmentation changes might continue even after the eczema has been treated appropriately.