Eczema, also known as atopic dermatitis, can cause inflamed, itchy, and scaly patches of skin. While it’s commonly depicted on lighter skin tones as red or pink, it often looks different in people of color, appearing purple, brown, gray, or hyperpigmented on darker skin. This article explores how eczema presents in people of color, its causes, symptoms, and treatment options, and the importance of recognizing these differences for effective care.
Eczema by the Numbers
The National Eczema Association reports that 1 in 10 people in the U.S. experience eczema. Atopic dermatitis is the most common form, and though it affects individuals of all skin tones, research shows that eczema is more prevalent and severe in Black children compared to white children. Black children also have more frequent eczema-related doctor’s visits, resulting in higher out-of-pocket costs. Additionally, adult-onset eczema is more common in Asian countries compared to Western nations. Black and Hispanic children are more likely to experience severe eczema compared to white children.
Symptoms of Eczema in People of Color
While eczema is often shown as red or pink on lighter skin tones, it can appear quite different in darker skin tones. Some common signs include:
- Hyperpigmentation: Darker patches of skin, which may appear purple, brown, or gray.
- Hypopigmentation: Lighter patches, typically seen during healing after a flare-up.
- Bumps: Small, raised bumps on the chest, back, arms, or legs, often near hair follicles (follicular accentuation).
- Thickened Skin: Areas of skin that are thickened, firm, and may have raised bumps (prurigo nodules).
- Dry or Cracked Skin: Skin that feels very dry, scaly, or cracked.
- Warmth: Affected areas may feel warm to the touch.
- Intense Itching: Eczema often itches intensely, leading to scratching.
In people of color, eczema is frequently found on the fronts of the arms or legs, especially in people of African descent, in contrast to lighter skin, where eczema is typically located in the inner creases of the elbows and knees.
Why Do People of Color Get Eczema?
Several factors contribute to eczema in people of color, and research suggests skin barrier differences, genetic factors, environmental influences, and immune system reactions may play a role.
- Skin Barrier: The skin barrier helps protect against environmental irritants. People with eczema often have compromised skin barriers, leading to moisture loss and irritation. Some studies suggest that skin barrier differences in Black and Asian populations may affect eczema development.
- Genetics: Genetic variations, especially in filaggrin, a skin protein, are strongly linked to eczema. However, studies show that the filaggrin gene’s effect is weaker in people of African descent, suggesting other genetic factors might be involved.
- Environment: Environmental factors such as exposure to pollutants, fast food, and urban living can increase the risk of eczema. However, more research is needed to understand how these factors interact with genetics and skin barriers in people of color.
- Immune System: Eczema is an immune response, where the immune system overreacts to environmental triggers. Research is ongoing to understand immune system differences among racial and ethnic groups in relation to eczema.
Preventing Eczema
Currently, there’s no known way to prevent eczema, but flare-ups can be managed with some key strategies:
- Avoid Triggers: Identify and avoid substances that cause flare-ups (e.g., certain soaps, fragrances, or stress).
- Moisturize Frequently: Use fragrance-free lotions or creams to keep the skin moisturized, especially after showers.
- Choose Products Carefully: Use gentle, fragrance-free products and test them on a small patch of skin before full use.
- Shower Routine: Limit showers to 10-15 minutes with warm (not hot) water. Pat skin dry gently and apply moisturizer.
- Mind the Temperature: Cold weather can dry out skin, so moisturize more during winter months.
- Clothing Choices: Wear loose-fitting, breathable clothing and wash new clothes before wearing them.
Coping with Eczema
Managing eczema involves soothing and protecting the skin:
- Gentle Care: Regular moisturizing and avoiding hot showers can help soothe irritated skin.
- Don’t Scratch: Scratching can worsen the condition and lead to skin thickening or pigmentation changes.
- Use Sunscreen: If eczema causes hyperpigmentation, sunscreen can prevent further darkening.
- Corticosteroids: Follow your doctor’s instructions on the use of topical corticosteroids to avoid hypopigmentation.
Treatment for Eczema
Eczema treatments are generally similar for people of all ethnicities and focus on managing symptoms and preventing flare-ups. Treatments include:
- Medications:
- Over-the-counter hydrocortisone or antihistamines can help reduce symptoms.
- Prescription topical treatments like corticosteroids or calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) may be prescribed.
- Oral corticosteroids (e.g., prednisone) may be used for severe flare-ups.
- Biologic therapies like dupilumab (Dupixent) or tralokinumab (Adbry) can be used for severe eczema.
- JAK inhibitors like abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are also available for treating moderate to severe eczema.
- Other Therapies:
- Light therapy may help but can be risky for darker skin tones due to the risk of hyperpigmentation.
- Soak-and-smear techniques and occlusion therapy (covering treated areas with plastic wrap) can lock in moisture.
- Stress relief techniques like yoga may help prevent flare-ups.
Finding a Healthcare Professional
If you need specialized care, consider using these resources to find a dermatologist:
- American Academy of Dermatology (AAD): Offers a search tool to find board-certified dermatologists.
- Skin of Color Society (SOCS): Provides a directory of doctors who specialize in treating skin conditions in people of color.
- National Eczema Association: Offers a search tool to help you find eczema specialists in your area.
Outlook for People of Color with Eczema
Eczema can often be managed with good skin care, but flare-ups may still occur. People of color are at higher risk for post-inflammatory dyspigmentation (changes in skin pigmentation) due to eczema. This can result in either hyperpigmentation (darker skin) or hypopigmentation (lighter skin), which may fade over time. However, frequent scratching or inflammation can lead to lasting pigmentation changes.
A 2019 study found that African Americans with eczema tend to have higher levels of inflammation, which may make eczema more difficult to treat. Timely and appropriate treatment is important for managing symptoms and preventing complications.
The Bottom Line
Eczema is often portrayed through the lens of lighter skin tones, but it affects people of color in unique ways. Eczema in people of color may appear darker, thicker, and more intensely itchy, and it can be more severe, leading to permanent skin changes. Understanding these differences and seeking care early is essential for managing eczema and maintaining skin health.
Credit: Jill Seladi-Schulman, Ph.D. – Healthline, Joan Paul, MD, MPH, DTMH, Dermatology