Darkened Skin on Face

[sunny81]

Hi there,

This is actually a question for the experts in the skin clinic, but it would be useful to hear from sufferers as well.

The history.

I am of Indian origin, born and bred in the UK. 31 years old and had eczema all of my life. Most times been under control but had horrible flare ups when I cut steroids and switched to western herbal treatment when I was around 22-23, I soon stopped - started steroids problem solved. Steroids have kept my skin "controlled" since.

I still occasionally get flare ups on body and face but again its controlled.

I use Elecon ointment on face and body on eczema patches (as advised by my dermatologist).
Aveeno cream as moisturiser.
Cetraben cream in the shower as soap.

My concern.

On my face I have now dark patches. On the whole the skin has darkened as I was fair skinned. My dermatologist says its a result of eczema and may return to its normal colour in the future. My question is how can I fix the facial skin so it returns to its normal tone?

PS If I apply Elocon to the face its no more than a few days in a row.

Thank you

[ckbridgett]

Good afternoon!
Yes, the skin can become darker with eczema, and this is associated with the habitual rubbing and scratching that can be part of having eczema. Once the eczema has been treated successfully, after several months the skin can return to its usual colour, as long as any acute eczema in the meantime is treated quickly, without any re-emergence of habitual rubbing and scratching.
See www.atopicskindisease.com/articles/SkinColour
Best wishes
DrB

[sunny81]

Thank you DrB

How much steroid (Elocon ointment) should be applied to the face and for how many days to be safe?

If eczema flare up hasnt calmed down by the Elocon cream after 3-5 days, should one continue to use??

Thanks very much!

[Dr Anton Alexandroff]

Good evening!

I would prefer if you would use a milder steroid for example eumovate or betnovate 1:4 dilution or synalar 1:4 - 1:10 dilution.
But if you must to use Elocon , I would recomend to use it sparingly on face and no more that 3-4 times a week.
If it does not help, please consult your dermatologist about alternatives such as tacrolimus (protopic) or pimecrolimus (elidel) - these do not contain steroids but can still work well for patients with ezcema, especially on face and neck.
And I agree that it is a good idea to try to stop scratching, and also do not forget to use emollients generously (long term).
with best wishes,

[sunny81]

Thanks for your reply Dr.

I have tried protopic but unfortunately did not help at all. Just stung when there was any exposure to the sun.

Is there a moisturiser that you would recommend?

[ckbridgett]

Hello again, sunny81!
"Which moisturiser would you recommend?" is a "frequently asked question", and there are always as many answers as there are practitioners and patients. My answer is that it is not necessarily what you use, but how you use it!
The best moisturiser is the one that is used, and preference is more important than prescription.
Ointments are generally more effective, but creams are usually easier to use.
In clinic I always discuss the advantages of "a little and often" rather than the "liberal" use that is often recommended.
It is also worth altering the frequency of application depending on the weather, just as one alters the layers of clothing one puts on each day. This time of the year onwards, in England, my skin needs more frequent treatment than in the warmer summer weather, for example.
For some tips on how to use moisturisers, see www.atopicskindisease.com/articles/TT10
Let me know if that is useful.
All the best,
DrB

[Dr Anton Alexandroff]

Hello again, sunny81!

Protopic (tacrlolimus) often stings for the first month of use or so but this often settles if you carry on with it.
Have you tried pimecrolimus (Elidel)? It works in a similar way to Protopic but tends to sting less.

best wishes,
Dr Anton Alexandroff
Consultant Dermatologist
Bedford and Leicester
www.alexandroff.org.uk

[sunny81]

Thanks very much for the information.

I currently use Aveeno as it keeps the dryness at bay for longer than most other mousturisers ive found.

With regards to the protopic i used it for around two months and saw no significant improvement so i stopped using it.

My other concern is the prolonged scratching episodes that occur some nights. Even though i moisturise very well.
The struggle continues.

Thanks again to both for your help

[Dr Anton Alexandroff]

Hello again,

you probably had a long enough trial of Protopic. I would still consider Elidel.
Aveeno is fine, many patients like it and it is very natural too.
regarding scratching - I would suggets to try moisturizers as advised above and you would probably still need either topical steroids or Elidel in addition, at least to start with and then at times of flares.

with best wishes,

Dr Anton Alexandroff
Consultant Dermatologist
Bedford and Leicester
www.alexandroff.org.uk

[sunny81]

Thank you Dr Alexandroff

I will speak to my gp about getting some Elidel.


Regards

Sunny