Unfortunately, evidence suggests that people with darker skin tones suffer from higher rates of misdiagnosis when it comes to skin conditions. This means people with darker skin tones who have eczema are less likely to receive proper treatment, and more likely to suffer with discomfort for longer.
At Forefront, we know that accurate diagnosis is crucial. So, we are careful to understand the similarities and differences when we come across the same skin condition in different skin tones. For eczema, this means understanding the risk factors, types, and how symptoms present themselves on different skin tones.
What is eczema?
According to Dr. Michelle Cihla, board-certified dermatologist with Forefront Dermatology, “Eczema is a skin condition that causes the skin to become red, itchy, and inflamed. It commonly appears as dry or scaly patches and can develop anywhere on your body. It isn’t contagious, but develops because of a combination of environmental triggers and genetics.”
Over 30 million Americans have some type of eczema. It can be triggered by typical allergens like pollen, temperature extremes, perfumes and chemicals in common products, or even stress. Usually, eczema appears in “flare-ups”: It’s triggered by something, symptoms pop up for a few days to a few weeks, then it calms down again.
Who does eczema affect?
While eczema can affect anyone at any age, gender, and race, evidence suggests that certain groups may be at greater risk. People who have family members with eczema, people with allergies and asthma, and slightly more women than men are likely to have the condition.
In addition, a National Health and Nutrition Examination Survey found that 19.3 percent of African-American children have a higher likelihood of eczema compared to Caucasian and Asian children. Another study found that Black children with a form of eczema called atopic dermatitis have about a six times higher risk of having severe atopic dermatitis than white children.
What does eczema look like in skin of color?
Generally, eczema presents as a chronic, itchy rash. In lighter skin tones, eczema tends to develop as a red, dry rash.
But in skin of color, eczema looks a little different. Instead, people with eczema in darker skin tones might have symptoms like:
- A rash that looks darker brown, purple, or grey in color.
- Swollen, warm, and scaly skin.
- Small bumps along the torso, arms, and legs that resemble goosebumps.
- Leathery or thickened skin from chronic itching.
- More extensive skin dryness and dark circles around eyes.
- Healed skin that is darker or lighter than the surrounding normal skin (called hypopigmentation or hyperpigmentation).
Recognizing these symptoms is important for providers who may be used to diagnosing eczema in lighter skin only. Eczema in darker skin is common and earlier treatment will provide better results.
The 8 types of eczema
Atopic dermatitis – the most common form of eczema, caused by a malfunction in the immune system and problems with the skin barrier.
Contact dermatitis – a result of skin touching a known irritant and/or allergen.
Dyshidrotic eczema – occurs on the feet and hands as itchy blisters, usually caused by exposure to allergens.
Hand eczema – caused by a combination of genes, irritants, and/or allergens.
Lichen simplex chronicus – results in thick, scaly patches on the skin, often caused by too much scratching and rubbing
Nummular eczema/discoid eczema/nummular dermatitis – usually caused by allergens or very dry skin and appear as round lesions that can weep fluid, especially in older populations.
Seborrheic dermatitis – white or yellow flaky, greasy patches in places with more oil-producing glands, caused by a combination of genetics, hormones, and microorganisms on the skin. In infants, this is commonly referred to as “cradle cap”.
Stasis dermatitis – happens when poor circulation to the legs causes the veins to swell and leak fluid, causing swelling and skin discoloration and itching.
How is eczema treated in skin of color?
The treatment of eczema is similar in people of all races and ethnicities. Depending on the age and severity, treatment options may include:
Prescription topical medications
Dermatologists can prescribe topical creams that help reduce inflammation and itching. Usually, these are steroid creams that come in different strengths. Some newer, non-steroidal topical medications are also available, such as topical calcineurin inhibitors—a type of anti-inflammatory medication formulated to block overactive immune system response on the skin.
Phototherapy
Phototherapy uses various wavelengths of ultraviolet (UV) light to trigger natural processes that reduce inflammation and calm eczema symptoms. It is a simple, non-invasive treatment where a patient is positioned under a specific type of light for a short time.
Biologics
Biologics are oral medications designed to zero-in on the specific parts of the immune system that are overactive in eczema. They work by calming the immune overreaction that fuels flares, and help to reduce redness, itch, and skin damage over time.
Lifestyle modifications
There are also several things you can do at home to improve eczema symptoms. According to Dr. Cihla, it’s also best to know your triggers to avoid exposure to them. She says to make sure you are consistent with your treatment plans and to develop a daily moisturizing regimen to help soothe dry skin.
If you have eczema, don’t bathe in extremely hot water since it can cause dryness. Instead, use lukewarm water, and apply a thick cream or ointment-based moisturizer (ideally one that contains ceramides) immediately after your bath or shower. Any soaps or cosmetic products you use should be perfume and fragrance-free.
A healthy diet can also ensure your skin is getting the nutrients it needs to stay hydrated and heal properly.
Following successful treatment of eczema, individuals with skin of color commonly experience healed skin that may look darker or lighter than the surrounding normal skin. Fortunately, once the eczema is controlled, the skin color typically returns to normal, but this can take several months.
An experienced dermatologist can accurately diagnose eczema
If you suffer from eczema or believe you may have eczema, it is best to schedule an appointment with your local board-certified dermatologist to get a proper diagnosis and treatment plan.
At Forefront, we are aware of the nuances of symptoms in different skin tones, and we have the experience needed to recognize eczema and other skin conditions in any skin color and help you get the treatment that works best for you. Contact us today for an appointment.
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