Though you might see a lot of pictures of eczema on lighter-toned skin, it affects people of all different skin colors and tones. In fact, children who are Black may be more likely to have eczema than other children. (Kids are more likely than adults to have eczema).
One study showed about 1 in 5 African American kids have eczema, compared with about 1 in 6 white kids and 1 in 12 Asian kids.
Eczema is more common in people with a family history of the condition. But genetics aren't the only factor. Both your genes and your environment (air quality, exposure to allergens like dust and mold) appear to affect whether you get eczema. That’s likely why kids who grow up in places with dirtier air -- like cities and areas that have industry pollution -- are more likely to develop eczema.
Which Symptoms Are Similar Among Skin Tones?
- Itching: It may be bad enough to disrupt your focus at school or work.
- Skin thickening from scratching: This may appear very dark on darker skin tones.
- Scratches: These may show up as marks or cuts and could lead to infection.
- Swelling: Fluid buildup (edema) or infection usually causes this.
- Oozing: This is often the result of seeping or leaking of fluid from edema.
Which Symptoms Are Different for Darker Skin Tones?
One of the biggest concerns for people with darker skin who have eczema is splotchy changes in skin color, or discoloration. Whether from scratching or from the eczema itself, darker skin tones can darken further (hyperpigmentation) or lighten (hypopigmentation). Hyperpigmentation is especially common in children with darker skin.
Your doctor can treat your eczema and inflammation, and that should help reverse your skin changes. But it can take several months for your skin to get better, even after your eczema goes away.
Initial color changes from eczema may be harder to see, however. Instead of the clear bright red that shows up on lighter skin, eczema on darker skin tends to show up as purple, grayish, or darker brown patches. That can make it harder to see for both you and your doctor.
Itching from eczema may be more of an issue for African Americans. They’re also more likely to have serious forms of the condition.
Are There Unique Eczema Symptoms on Darker Skin Tones?
Yes. For example, small bumps on your trunk, arms, and legs (papular eczema) happen much more often in people with darker skin. These bumps may grow around hair follicles and look like goosebumps (follicular accentuation).
Eczema is also more likely to cause serious skin dryness and dark circles under the eyes in people with darker skin tones. Repeated rubbing and scratching of these areas can lead to thickened skin and raised bumps (prurigo nodules).
How Does Skin Tone Affect Diagnosis of Eczema?
Doctors may find it harder to diagnose eczema on darker skin tones because the rashes and inflammation are often harder to see. That makes it even more important that you tell your doctor about all of your symptoms, however small. You should also mention any family history of eczema or skin problems that may not have been diagnosed.
If the color changes aren’t obvious, your doctor will look for other common symptoms like skin that is swollen or warm to the touch as well as itchiness or dry, scaly skin.
Do Doctors Treat Eczema Differently Depending on Skin Tone?
Though different symptoms may require different approaches, eczema treatments are largely the same. This usually means:
- A schedule for bathing and moisturizing: It might help to bathe and moisturize closer to bedtime. That can also help with your sleep. But don’t get the water too warm, or that could make your skin drier. Apply moisturizer while your skin is still damp.
- Topical meds to control eczema outbreaks: These might include corticosteroid creams, calcineurin inhibitors, topical janus kinase inhibitors, and others.
- Oral medications: Drugs in pill form to help control serious inflammation. The corticosteroid prednisone is often prescribed. Doctors only use these medicines for short periods because of possible serious side effects.
- Drugs for infection: Dry, splitting, and scratched skin can get infected. Your doctor may prescribe antibiotic cream or drugs to clear it up.
- Monoclonal antibodies: In serious cases of eczema, doctors sometimes use a relatively new injectable “biologic” medication called dupilumab (Dupixent) or tralokinumab (Adbry).
- Mild sedation, like antihistamines, to help with sleep: This could be especially helpful for kids.