Decoding The Differences in Eczema on Black Skin

Curated by Claudia Shannon / Research Scientist / ishonest

But like many other skin conditions, eczema can look different on different skin tones. Skin with less pigment may turn blotchy, ruddy, or red in areas affected by the condition, whereas the affected areas can range from gray to brown to purple on skin tones with more melanin.

Understanding how eczema can show up on your skin can help you look out for signs of the condition and know when to get them checked out by a doctor. Here’s the lowdown on how eczema may appear on black skin.

What is eczema?

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Let’s quickly review the basics of eczema before diving into how it can look on different skin colors.

In a nutshell, eczema is group of skin conditions infamous for a characteristic symptom: intensely itchy, dry patches of skin.

Eczema is divided into seven types:

  • atopic dermatitis
  • contact dermatitis
  • neurodermatitis
  • dyshidrotic eczema
  • nummular eczema
  • seborrheic dermatitis
  • stasis dermatitis

(And yes, you can have multiple types of eczema at the same time, in case you were curious.)

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Doctors don’t know the exact cause of eczema, but some think it could be the result of an overactive immune system responding to a random trigger with tons of inflammation.

It can take a bit of time for an eczema flare to pop up after you’re exposed to a trigger, so it’s not always easy to figure out what’s causing the reaction. Using a scented soap, being around cigarette smoke, wearing nickel jewelry or a polyester sweater, and even getting a splash of fruit juice on your skin can all be possible triggers for an eczema flare.

The symptoms can be a drag, but they usually don’t lead to major health problems for most people. However, sometimes eczema can become very itchy, causing you to scratch it until it bleeds. That, in turn, can make the condition worse and put you in the “itch-scratch cycle.”

Another potential concern with eczema (besides the distracting itch!) is that it might weaken your skin barrier and leave you vulnerable to infections and other issues.

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That’s why it’s a good idea to talk with a doc about your symptoms. There’s no cure for eczema, but treatments can help you manage flares and feel better.

Prevalence of eczema in Black people

Eczema is super common, affecting nearly 32 million people in the United States alone, according to the National Eczema Association. And it affects people of all skin tones and ethnicities.

The prevalence of eczema among Black people and African Americans is 10 percent, almost the same as the prevalence of eczema in white people, which is 11 percent. The condition affects about 13 percent of people who identify as Native American, Asian, or Pacific Islander.

The Skin of Color Society reports that eczema is the second most frequent skin disease to affect African Americans. But it may be underdiagnosed in this population.

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A 2018 study found that less than 5 percent of the images in general medicine textbooks showed conditions on dark skin. That may make it more difficult for doctors to recognize and diagnose eczema on skin with more pigment.

Symptoms

Typically, for all skin tones, eczema is dry and very itchy. But the inflammation can also cause a stinging or burning sensation, and the dryness can make skin feel tight. Depending on the type of eczema, affected skin may appear:

  • scaly
  • crusty
  • bumpy
  • blistered
  • thickened
  • oozing
  • swollen

On black skin, eczema can cause changes in skin color, but the exact hue may vary. Affected areas could look:

  • lighter than surrounding skin
  • whitish
  • grayish
  • brown
  • purple
  • darker than surrounding skin

Eczema, plus any scratching from the itch and any thickening (called lichenification) of the skin, can cause changes in color. You might notice hyperpigmentation, where the affected area looks darker, or hypopigmentation, where the area looks lighter than the surrounding skin.

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Researchers have also recently found that eczema can come with more inflammation in African Americans than in European Americans, which may impact the effectiveness of treatment.

More research is needed to help doctors understand how eczema can impact people with different skin tones.

Diagnosis

To diagnose eczema, a doctor or dermatologist will take a look at your skin and ask about your family medical history. They may also ask whether you have any related conditions, like asthma, allergies, or sensitivities.

The doctor may also use a patch test or lightly scrape a sample of your skin to send to a lab, just to make sure an infection or some other condition isn’t to blame for your symptoms.

Treatment and management

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Although the different types of eczema have slight variations in treatment, the basics are the same. But some research suggests atopic dermatitis can be more difficult to treat (and require higher doses of some medications) in African Americans.

Here are some ways to treat and manage eczema:

  • Avoid irritants. The first line of defense against eczema is to root out potential triggers, such as fragrances, harsh soaps, hot water, and allergens. If you know what causes your flares, try to avoid those triggers.
  • Build your barrier. Keep your baths or showers at a lukewarm (not hot) temperature, and try not to stay under the water for more than 5 or 10 minutes. After bathing, always pat your skin with a towel until it’s slightly damp, and then apply a topical medication (if your doctor has recommended one) and a fragrance-free moisturizer to restore the skin’s barrier and prevent dryness.
  • Fight a flare. If you’re experiencing a period of worsening eczema, talk with your doctor about whether using a topical steroid for a little while could help relieve your symptoms.
  • Take meds. If you have severe eczema, your doctor may prescribe an oral or injectable medication to help keep your immune system in check on a regular basis.
  • Treat skin post-flare. Lingering changes in color, even after a flare has calmed, are common in black skin. If you do have hyperpigmentation or hypopigmentation, your doctor may prescribe a retinoid in combination with other meds to help treat the spot. However, retinoids may cause further irritation, so connect with a doctor to see if the potential benefits outweigh the risks.

tl;dr

Eczema can affect people of all skin tones but may show up in different ways, depending on how much pigment is in your skin.

Affected areas may appear gray, brown, or purple on darker skin, whereas lighter skin tends to turn red and blotchy. Regardless of your skin tone, eczema can make your skin itchy and dry.

If you have symptoms of eczema, connect with a doctor or dermatologist to get it checked out. They can help diagnose what’s going on and recommend a treatment to offer relief from that itch you worried would never go away.

Read more on: skin, eczema


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