Eczema, also known as atopic dermatitis, is a chronic skin condition that affects people of all skin types. However, it can present differently on skin of color, leading to challenges in diagnosis and treatment. Understanding these differences is essential for improving care and ensuring patients of all backgrounds receive accurate treatment.
Eczema is characterized by:
Eczema can appear anywhere on the body, though it commonly affects the arms, legs, and face.
“The itching itself causes people to scratch the skin, and depending on your age, eczema can present a little differently in various body locations. As a dermatologist — I treat both adult and pediatric patients — I’m able to see eczema manifest in different stages. Often, in infancy, we see it on the cheeks and the extensor surfaces, like the arms and legs. As kids get older, it tends to affect the areas in the creases, like the folds of the arms and legs,” says Dr. Candrice Heath, M.D., Clinical Assistant Professor (Adjunct) in the Department of Urban Health and Population Science and the Center for Urban Bioethics at Temple University Lewis Katz School of Medicine in Philadelphia.
The presentation of eczema on darker skin tones differs significantly from how it manifests on lighter skin. Traditionally, medical textbooks and resources show eczema as red, scaly patches. However, this description doesn’t always apply to skin of color.
“It can present in various ways, but one common thread is that patients with eczema often feel itchy — so much so that we sometimes call it ‘the itch that rashes’ because the scratching can lead to breaks in the skin, perpetuating a cycle of irritation,” Dr. Heath adds.
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Because eczema can look different on skin of color, it is sometimes underdiagnosed or misdiagnosed. It’s crucial to recognize these variations early to prevent complications such as:
“It’s important to highlight that although itchy skin is common, eczema is a condition with many treatment options available, and even more treatments are emerging. So, there’s really no reason for people to suffer unnecessarily. Whether eczema is mild or severe, there are interventions that can help,” Dr. Heath notes. “I’d say if eczema is interfering with your life — for example, if itching keeps you up at night, or if your family members tell you to stop scratching and you don’t even realize you’re doing it — that’s a sign it has become part of your daily life in a way that may need more attention.”
If you’ve tried managing your eczema at home with gentle cleansing products and moisturizing, but you’re still uncomfortable or itching regularly, Dr. Heath notes that it’s a good time to bring it up with your healthcare team.
“Your primary care team can either help you directly or refer you to a dermatologist, especially if the eczema is significantly impacting your quality of life,” Dr. Heath notes.
Patients, particularly in communities of color, may face barriers in receiving accurate diagnosis and treatment. Here are some strategies for advocating for your care:
“It’s also important to advocate for yourself because only you know what it feels like to have your skin in that condition. Sometimes the affected areas are covered, and people may not know that the condition is impacting your sleep or causing you to miss work. So, even if your skin looks fine on the day you see the doctor, if you’re experiencing symptoms that are really affecting your life, you deserve to have that conversation about treatment options,” Dr. Heath shares.
Eczema treatments range from moisturizers to prescription medications. However, it’s important to choose treatments that address both the condition and any pigmentation changes that may occur.
“Keeping notes on how your skin reacts to treatments over time can be helpful. It’s good to track not only when your skin feels okay but also when it’s at its worst. Documenting these things can help your care team tailor treatments for you. It’s also important for patients with skin of color to understand that eczema can look different, and if you feel unheard, don’t give up. Seek out another clinician if necessary,” Dr. Heath advises.
Many eczema patients face challenges such as multiple treatments, misdiagnosis and the need for stronger medication. Dr. Heath shares that there can also be issues with insurance coverage, where a prescription may be approved but in a limited amount.
To address this, she says, “It’s helpful to bring your prescriptions and skincare products to your appointments so your care team has all the information they need. And, as new treatments emerge, sometimes we have to try older options first due to insurance requirements, but it’s part of a process to get you the most effective treatment.”
The landscape for eczema treatment is rapidly evolving. New drugs that work by targeting specific immune pathways are making systemic treatment more effective and accessible to younger patients, including infants.
“There’s been a lot of progress. We’re familiar with topical medications like steroids, but now there are newer options that don’t contain steroids and work through different scientific pathways. Moisturizing the skin remains a critical part of managing eczema because the skin barrier is not as strong in those with the condition, and there are better moisturizers available now,” Dr. Heath shares.
“The most exciting developments are systemic treatments, like pills or injections, that target the immune system and help reduce eczema from within. These treatments can reduce itching, rashes, and even pigmentation issues. The good news is that many of these new drugs are being approved for use in younger patients, which allows us to treat eczema earlier and prevent long-term complications,” Dr. Heath adds.
Understanding the differences in how eczema presents on skin of color is essential for proper diagnosis and treatment. By recognizing symptoms early, advocating for yourself, and working with healthcare professionals familiar with diverse skin tones, you can achieve better outcomes and avoid long-term complications.
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