Eczema on Dark Skin: Common Triggers, Symptoms, Treatment

Eczema on dark skin often looks purplish, brown, or ash-gray. The redness that is a typical symptom of eczema on lighter skin is harder to see on people of color. For this reason, eczema may be misdiagnosed more often in darker-skinned people. In addition, symptoms may be more severe, and scars may be more problematic.

If you have darker skin, it is important to find a healthcare provider that understands how to manage eczema in people of color, manage triggers, and treat symptoms so that you can maintain your lifestyle without anxiety or concerns over your skin.

Eczema Prevalence in People of Color 

About 31.6 million, or 10% of all people in the United States, have some form of eczema, also called atopic dermatitis. It affects people of all ethnicities and skin colors.

Of all Americans with eczema:

• 10% are Black or African American
• 11% are White
• 13% are Asian or Pacific Islander
• 13% are Native American

While this data suggests somewhat similar rates of diagnosis among different racial backgrounds, data collected by the National Health and Nutrition Examination Survey (NHANES), found that eczema is more common in people with specific ancestries.

A 2019 study found similar results. After analyzing ethnic and racial differences, researchers found that higher rates of atopic dermatitis were found in Africa and Central and South Pacific islands vs. Northern and Eastern Europe.

But the numbers by themselves may not tell the full story. Diagnosis, exposure to eczema triggers, and severity of symptoms can vary between ethnic groups.

Eczema Triggers and Risk Factors

Eczema is caused by inflammation in the skin. A variety of factors can contribute to inflammation in eczema, including environmental factors, genetics, and immune system hyperactivity.

Environmental triggers include:

• Climate and temperature
• Stress
• Allergens
• Skin irritants, including certain fabrics

Where you live, and your community environment can play a role in your exposure to eczema triggers. For example, exposure to dust, pollution, cockroaches, or mold can make eczema symptoms worse. Living in an urban environment puts you at higher risk for exposure to these triggers and can put you at higher risk for developing atopic dermatitis.

In addition, genetic mutations that affect skin health are more common in some ethnic groups compared to others. Experts believe that this may help explain why people of color may experience greater severity of eczema symptoms.

Lastly, where you live can impact your ability to find suitable healthcare and could postpone diagnosis, making symptoms more severe. Some people of color may find it harder to find a provider who speaks their language, understands their culture, or is experienced with the symptoms of eczema on dark skin.

Symptoms of Eczema on Darker Skin

Eczema appears differently on darker skin than it does on lighter skin tones. On lighter skin, eczema usually appears red and dry. However, the appearance on people of color is generally darker.

The difference in appearance is important for several reasons. First, a person of color who believes that they might have eczema may see pictures online that look different than the symptoms that they are experiencing. Furthermore, some physicians are not familiar with eczema on dark skin and may misdiagnose the condition as a result.

Since eczema on darker skin does not appear red, healthcare providers can look for other characteristics to make a diagnosis. Other signs of eczema include:

• Dryness
• Scaling or cracking of the skin
• Intense itching
• Open sores on the skin
• Skin swelling
• Skin that is warm when touched

People of color may also experience small bumps on the skin called papules. They may also experience hypopigmentation, which causes lightening of the skin, or hyperpigmentation, which causes darkening of the skin. Hyperpigmentation is more common in people of color.

Misdiagnosis of Eczema in People of Color

The National Eczema Association has stated that eczema is not only more common in darker skin, it is often misdiagnosed or mismanaged. This may be due to healthcare providers’ lack of knowledge on treating darker skin or other environmental factors. Misdiagnosis can also occur because skin patches may be less visible on darker skin.

Lack of Provider Knowledge

There is some evidence that medical students and healthcare providers may not receive adequate skin-care training in people with darker skin tones.

A 2018 study analyzed several thousand anatomy images from books used at top medical schools and found that White skin tones were widely overrepresented. Only 4.5% of the images included were of dark skin tones.

Environmental Factors

Environmental factors that may increase the risk of developing eczema in both lighter and darker skin tones include:

• Climate
• Living in urban areas
• Poor nutrition
• Pollutants
• Tobacco smoke
• Water hardness

Because these factors can cause other skin or related conditions, there is a possibility for misdiagnosis.

Less Access to Care

Data from the U.S. Department of Health and Human Services (HHS) shows that Black people have less access to healthcare for a variety of reasons.

A primary contributing factor is the lack of health insurance. Non-Hispanic Blacks are 70% more likely than non-Hispanic whites to not have health insurance.

HHS also points out that Black families also face geographic barriers, living in areas with less access to health care facilities.

Meeting With Your Dermatologist

To get the best care for eczema, you may want to find a dermatologist who specializes in skin of color. There are a few organizations that can help, including:

The American College of Asthma, Allergy, and Immunology also provides a Shared Decision Making Tool through the Eczema in Skin of Color website that can be helpful.

When you meet with your provider, you can expect a physical examination and an evaluation of your symptoms. You will also have the opportunity to ask questions.

Physical Examination

To achieve a diagnosis, a primary healthcare provider or dermatologist will perform a physical examination. In most cases, visual observation is adequate to make an eczema diagnosis. In some situations, a provider may also collect a skin sample to examine the tissue.

A provider will also gather your medical and family history during your appointment.

Questions to Ask

Before your appointment, write down a list of questions for the healthcare provider so you don’t forget to ask something important.

Some questions to ask may include:

• What caused my eczema?
• What are the long-term effects of eczema?
• Will eczema affect any of my other medical conditions?
• What are my treatment options?
• What treatment options would you recommend for eczema?
• How long will treatments take before I see results?
• Are there any side effects of these treatments?

Educate yourself as much as you can about your eczema diagnosis. This will help empower you to make educated decisions about the treatment you receive.

Eczema Treatment for Darker Skin

Eczema treatment is the same for people of lighter skin and darker skin. But since misdiagnosis is more likely to occur in people of color, treatment may begin at a later stage when symptoms are more severe. Also some symptoms may be more persistent in darker-skinned people.

For instance, in people of color, darker spots are more likely to remain on the skin after an eczema flare-up and can be a source of concern for months or even years after the eczema has cleared. So the treatment protocol may involve dealing with pigment changes.

There are no specific pigmentation treatments following eczema recovery, but early treatment can help to prevent post-inflammatory pigment changes.

Eczema treatment for darker and lighter-skinned people typically involves:

• Over-the-counter topical skin creams to keep the skin moisturized
• Prescription medications to manage inflammation and redness
• Managing exposure to allergens, irritants, and triggers

Many people also find that wearing non-abrasive clothing and taking warm, moisturizing baths can help manage inflammation, itchiness, and redness.

If you experience lasting pigment changes from eczema, there are some solutions to consider. However, it is important that the eczema flare-up has completely resolved before addressing skin color changes.

Solutions for lasting pigment changes (eczema scars) can include home remedies such as over-the-counter skin lighteners, make-up, or silicone gel sheets to smooth the skin. In-office procedures may include laser treatments, chemical peels, or microneedling.

Summary

Eczema can affect people of any skin tone and may present differently on darker skin. It can be missed or misdiagnosed by healthcare providers because research shows institutions are not teaching providers how to treat darker skin. It’s necessary for people with darker skin to be aware of the symptoms of eczema, and for healthcare providers to have expertise in treating darker skin.

If you have dark skin and think you may have eczema or another skin condition, make an appointment with a primary care provider or a dermatologist who specializes in dark skin to find the best treatment plan for you. You may also want to learn as much as you can about eczema to feel empowered in your disease management.