In People of Color, eczema often looks like dry or thickened patches darker than the surrounding skin. You may also see dark circles and bumps around hair follicles.
Eczema is a common skin condition that causes inflammation and intense itching. People who have eczema may experience periodic flare-ups throughout their lifetime.
Most descriptions of eczema — red, inflamed, and scaly skin — describe eczema on lighter skin tones. For people of color, patches of eczema can actually be quite different in appearance. They may also experience additional symptoms, as well.
Below, we’ll describe eczema in greater detail, how it looks in dark skin, and ways to treat it.
When people talk about eczema, they’re often (but not always) referring to atopic dermatitis.
While many people first develop eczema as children, it can happen at any point in your life. It’s often a long-lasting condition that has occasional flare-ups.
Eczema is common
According to the American Academy of Dermatology (AAD), 1 in 10 Americans has eczema, with the condition being more common in children of African and Asian descent.
It’s also often
Your skin serves as an important protective barrier between your environment and the rest of your body. People with eczema have changes associated with this skin barrier.
An important function of the skin is to retain moisture. Individuals with eczema tend to have a leakier skin barrier, which allows water to escape more easily. This leads to drier skin that’s easily affected by things like climate and irritants.
An overreaction of the immune system also plays a role in eczema. Because of this, coming into contact with common irritants in your environment can easily activate the immune system, leading to a flare-up.
Currently, there’s no way to prevent developing eczema. However, if you have eczema, there are steps that you can take in your daily life to help reduce the risk of having a flare-up.
- Avoid triggers. Try to avoid the things that cause your flare-ups. These can be different for every individual but can include things like soaps, fragrances, or stress.
- Moisturize frequently. Use a fragrance-free lotion, cream, or ointment to add moisture to your skin. Good times to moisturize include right after showering and anytime your skin feels dry.
- Choose products carefully. Some soaps, detergents, and skin care products can irritate the skin and cause a flare-up. Focus on using fragrance-free products. Try to test them on a small area of skin before using them on larger areas.
- Change your shower routine. Try to limit the length of showers to about 10 to 15 minutes total, using water that’s warm but not hot. When you’re done showering, gently pat yourself dry with a clean towel and moisturize.
- Mind the temperature. Remember that some conditions can increase the risk of a flare-up. For example, colder temperatures can lead to drier skin that may require additional moisturizing.
- Clothe carefully. Aim to wear loose-fitting, breathable clothes while avoiding tight-fitting garments. Additionally, wash any new clothes prior to wearing them for the first time.
A combination of genetics and environmental factors is believed to increase your risk for eczema. Let’s explore this in more detail below.
There’s a genetic component to eczema. Because of this, you may be at a higher risk for developing eczema if a parent, sibling, or another close relative has it.
Several genetic factors that are associated with eczema have been identified. For example, genetic variations leading to changes in the skin protein filaggrin have been strongly associated with eczema.
This suggests that additional genes related to the skin or the immune response are involved in the development of eczema in this population.
Some examples of these include:
- exposure to airborne irritants like cigarette smoke and pollution
- fast food consumption
- temperature extremes
- living in an urban area as opposed to a rural area
How exactly these environmental factors work together with genetic factors to increase the risk of eczema is unknown. More research is needed to determine this.
Many images of eczema show how it appears on light skin — red, scaly, and inflamed. However, eczema looks quite different on dark skin tones.
Some signs to look for are patches of skin that:
- appear darker than the rest of your skin (hyperpigmented), which can include looking purple, ashen grey, or dark brown
- are very dry or scaly
- feel warm to the touch
- have an intense itch
- may be thickened (lichenification)
Eczema may also appear at different locations. In people with light skin, eczema is often found at the bends of the elbows and knees.
Although eczema can also be found in these areas on people of color, it’s often located on extensor surfaces like the fronts of your arms or legs.
Additionally, there are some eczema symptoms that are more unique to dark skin, including:
- dark circles under the eyes
- papular eczema, which is when small bumps appear on your torso, arms, or legs
- follicular accentuation, in which bumps occur around your hair follicles
- prurigo nodularis, which are areas of skin that have become firm and thickened due to frequent scratching
Tips for coping with eczema
Here are ways to sooth your skin and help relieve symptoms:
- Pamper your skin. Use gentle skin care methods. This includes regular moisturizing, using fragrance-free skin care products, and avoiding hot showers.
- Don’t scratch. While this is a good rule of thumb for anyone with eczema, repeated scratching of eczema on dark skin can potentially lead to skin thickening and pigmentation changes.
- Use sunscreen. If your eczema has caused hyperpigmentation, going out in the sun can worsen it. If you’re going to be outside, be sure to apply sunscreen first.
- Apply topical corticosteroids carefully. Topical corticosteroids are often used for eczema. However, they can cause skin to temporarily become lighter than normal (hypopigmentation). Take care to only apply them to the affected area and only as your doctor instructs.
While much of eczema care focuses on preventing flare-ups from occurring, there are also treatments that you can use when symptoms occur.
Generally speaking, eczema treatments are very similar across all races and ethnicities. They often involve the combination of medications with other therapy types.
There are several types of medications that may be recommended for people with eczema, such as:
- Over-the-counter medications. Topical anti-itch creams containing hydrocortisone (with caution) or oral antihistamines (Benadryl, Zyrtec, Allegra) may help to ease symptoms.
- Prescription topical treatments. These topical treatments help to ease itching and inflammation. Examples can include topical corticosteroids and calcineurin inhibitors like tacrolimus (Protopic) and pimecrolimus (Elidel). If using a corticosteroid cream, ointment, or lotion on your skin, be careful to follow your doctor’s directions. Using too much may cause hypopigmentation, a lightening of that area of the skin.
- Oral corticosteroids: Oral corticosteroids like prednisone may be prescribed on a short-term basis for severe flare-ups.
- Biologics: The FDA has recently approved an injectable biologic called dupilumab (Dupixent) to treat severe cases of eczema.
- Antibiotics: Scratching eczema-affected skin can potentially lead to a bacterial skin infection. These can be treated using topical or oral antibiotics.
In addition to medications, there are several other types of therapy to treat eczema.
- Light therapy. Light therapy may be an option if eczema is persistent or doesn’t respond well to medications. It involves exposing the skin to small, controlled amounts of UV light. However, it may not be recommended for dark skin tones if hyperpigmentation is a concern.
- Wet dressings. This treatment may be helpful when eczema is widespread. It involves wrapping the affected area using topical corticosteroids and wet bandages.
- Stress relief techniques. Stress can sometimes trigger an eczema flare-up. Because of this, it may be beneficial to try stress-relief techniques like yoga or meditation.
Help finding healthcare professionals to treat eczema
You can use the resources below to help find a dermatologist in your area that treats eczema:
- American Academy of Dermatology (AAD). The AAD website provides a search tool that you can use to find a board-certified dermatologist in your area. You can use the search filters to find a provider who focuses on skin of color.
- Skin of Color Society (SOCS). The SOCS aims to raise awareness and champion excellence in the treatment of dermatologic conditions in skin of color. They’ve compiled an extensive searchable list of providers on their website.
- National Eczema Association. The National Eczema Association website also has a search tool that you can use to find a doctor or other healthcare professional in your area who specializes in treating eczema.
Eczema can often be controlled through maintaining good skin care habits and preventing things that could trigger flare-ups. However, it’s still possible that you’ll experience occasional flare-ups from time to time.
People of color who have eczema have a higher risk for developing a condition called post-inflammatory dyspigmentation. This is a noticeable change in skin pigmentation, which can be either:
- hyperpigmentation, in which an area is darker than the surrounding skin
- hypopigmentation, which is when an area is lighter than the surrounding skin
These pigmentation changes often fade over a period of months. However, severe eczema that results in frequent scratching or rubbing can lead to lasting changes.
Additionally, data from a 2018 study published in the journal Annals of Allergy, Asthma, and Immunology showed that Black people with eczema have higher levels of inflammation in the skin.
This can lead to eczema that’s more difficult to treat, making timely intervention even more important in managing the condition.
Often, eczema in people of color, especially Black people, can appear darker than the surrounding skin, feel dry or thickened to the touch, and is intensely itchy.
It may also be accompanied by other symptoms like dark circles under the eyes and bumps around hair follicles.
Treatment of eczema aims to promote gentle skin care while avoiding things that can trigger flare-ups. When a flare-up does occur, medications and other therapies can be used to help ease symptoms.
Eczema can be more severe in people of color, leading to potentially permanent pigmentation changes or skin thickening. Because of this, taking steps to both manage the condition and seek care for it is very important.