Eczema, also known as atopic dermatitis, is a common skin condition characterized by itchy, inflamed, cracked, and rough skin. For many sufferers, eczema tends to come and go in flare-ups throughout their lifetime. During a flare-up, the skin can become extremely irritated, red, and scaly. Once the flare-up resolves, the skin often returns to its normal, healthy state. However, in some cases, eczema can leave behind permanent changes to the appearance and texture of the skin.
What causes the skin changes in eczema?
Eczema causes several changes in the skin that can potentially lead to permanent effects:
- Inflammation – Eczema is characterized by inflammation in the skin. This inflammation damages the skin cells and weakens the skin barrier.
- Scratching – The intense itch of eczema leads to excessive scratching, which further damages the skin cells and barrier.
- Lichenification – Constant scratching and rubbing of the skin causes thickening of the skin (lichenification). This results in leathery, scaly patches.
- Infections – The broken skin barrier allows bacteria, viruses and other germs to penetrate and infect the skin.
- Dryness – Eczema commonly causes very dry, flaky skin due to an impaired skin barrier.
These changes from eczema flare-ups can potentially lead to permanent alterations to the appearance and feel of the skin if the damage is severe enough.
Does the skin go back to normal after mild-moderate eczema?
In many cases of mild to moderate eczema, the skin is able to return to normal after a flare-up resolves. Here are some factors that allow the skin to recover fully:
- Mild inflammation – If inflammation has been relatively mild, the skin cells may not be severely damaged.
- No lichenification – Without thick leathery skin patches, the skin barrier remains intact.
- No infections – The skin can heal normally if no infections have occurred.
- Proper treatment – Effective topical treatments reduce inflammation and allow the skin to heal.
- Good skin care – Gentle cleansing and regular moisturizing helps restore the skin barrier.
With appropriate treatment and skin care, the skin often has the ability to fully repair itself back to its pre-eczema state even after bouts of mild to moderate eczema. Any related marks or discoloration also tend to resolve within a few weeks to months.
Can the skin return to normal after severe eczema?
In severe, chronic eczema cases, there may be permanent changes to the appearance and feel of the skin. Some examples include:
- Thickened skin (lichenification)
- Excess pigmentation or discolored patches
- Thin or wrinkled skin
- Permanent dryness and scaling
- Scarring from severe infections
- “Cracked glass” appearance of skin creases
These effects are often seen in people who have struggled with uncontrolled, severe eczema over many years. The chronic inflammation destroys collagen and elastin fibers in the skin, making the skin less elastic. Long term scratching and rubbing leads to thick leathery skin. Frequent infections can permanently scar the skin.
While the condition may eventually go into remission, some of these effects linger even when the active eczema resolves. The skin barrier never fully recovers to keep moisture in the skin. However, with continued proper treatment and moisturizing, the skin may slowly start to reflect some improvement over time.
Treatments to help skin recover from eczema
Certain treatments and techniques can aid skin recovery after eczema flare-ups and minimize any permanent changes:
- Corticosteroid creams – These are effective at reducing inflammation when used appropriately under medical supervision.
- Calcineurin inhibitors – These specialized creams suppress inflammation and help restore skin barrier function.
- Phototherapy – Light therapy helps control inflammation and allows the skin to heal.
- Wet wraps – Wet wraps soothe inflammation and deeply hydrate the skin to expedite healing.
- Bleach baths – Bleach baths combat infections and reduce inflammation to aid skin recovery.
- Moisturizers – Hydrating the skin daily helps restore the protective barrier and prevents cracks.
In addition to medical treatments, lifestyle measures can also improve outcomes:
- Use mild cleansers and lukewarm water to avoid damaging the skin barrier
- Keep skin moisturized throughout the day
- Take short, lukewarm showers instead of hot baths
- Avoid vigorous scrubbing or irritating the skin
- Reduce stress through techniques like meditation and yoga
- Wear soft, breathable fabrics like cotton
- Use hypoallergenic laundry detergent
Can natural/alternative remedies help the skin recover?
There are some natural and alternative therapies that may aid skin healing after eczema flare-ups. However, keep in mind that these remedies have limited scientific evidence so far. Some options include:
- Aloe vera – Has anti-inflammatory and antimicrobial properties that may soothe eczema-damaged skin.
- Coconut oil – An emollient that helps moisturize and heal dry, cracked skin.
- Oatmeal baths – Help relieve itching and discomfort.
- Probiotics – May reduce inflammation and restore good bacteria on eczema-prone skin.
- Fish oil supplements – Omega-3 fatty acids found in fish oils reduce inflammation.
- Evening primrose oil – Helps decrease dryness and scaling.
- St. John’s Wort – May provide anti-inflammatory benefits for eczema recovery.
It’s a good idea to check with a dermatologist before trying these alternative remedies, especially before using any herbal supplements internally. Certain natural products can cause allergic reactions or interact with other medications.
Preventative steps to maintain healthy skin
Once the eczema flare has resolved, consistent skin care and preventative steps are key for maintaining normal, healthy skin. Recommendations include:
- Keep skin moisturized daily to strengthen the barrier
- Avoid known triggers like irritants, allergens, and stress
- Take short, lukewarm showers instead of hot baths
- Use gentle, fragrance-free skin cleansers and laundry detergents
- Wear soft, breathable fabrics next to the skin
- Use humidifiers to keep indoor air moist during dry weather
- Take antihistamines as needed to control allergic reactions
- Apply medicated creams occasionally to prevent flare-ups
- Consider probiotic and fish oil supplements for their anti-inflammatory effects
With diligent skin care and avoidance of triggers, many people find they can keep eczema under control and maintain healthy looking skin over the long term.
When to see a dermatologist
Consult a dermatologist if you have any concerns about permanent eczema-related skin changes. A dermatologist can assess your skin and provide medical treatments to improve the appearance and feel of affected skin. Newer treatments like biologic medications can specifically target the inflammatory process to help damaged skin heal.
A dermatologist can also provide guidance on proper skin care, prescriptions for medicated creams, recommendations for preventing flare-ups, and advice on minimizing skin damage from scratching. With professional help, you have the best chance of restoring your skin back to its original healthy state.
Conclusion
For mild to moderate eczema, the skin often has the ability to fully return to normal within weeks to months after a flare-up when properly cared for. However, severe, chronic eczema can leave behind permanent changes like thickened or discolored skin. While these effects may not completely resolve, the skin can still show improvement over time with consistent treatment. Using medicated creams, following preventative steps, and seeing a dermatologist can all help maintain healthy skin after eczema. With a multifaceted approach, it is often possible to achieve skin that looks and feels close to your normal state.