Eczema on Dark Skin: An Expert Explains

Treating dry patches of skin often involves using topical corticosteroids to improve affected areas. Other topical medications for eczema include calcineurin inhibitors, which help prevent the skin changes that can occur from long-term treatment with topical steroids.

If eczema symptoms don’t improve after trying topical medications, a healthcare professional may recommend treating eczema with ultraviolet light (phototherapy) and systemic medications, including dupilumab, JAK inhibitors, and other immunosuppressive medications.

It’s just as important to follow a preventive skin care regimen, as well. This means regularly applying a thick moisturizer to the skin, taking lukewarm showers, and using gentle products with little to no fragrances.

Research has shown that eczema tends to be worse among Black people than white people.

In addition to dealing with itchy, flaky skin, Black people with eczema may also experience changes in their skin color due to inflammation from the disease. While some of these changes may be temporary, they can be quite distressing to patients.

It’s important for healthcare professionals to learn to recognize changes in eczema symptoms in darker skin types. Black people may experience a delay in diagnosis and appropriate treatment if their doctors have trouble recognizing eczema changes in their skin.

There’s a higher prevalence of atopic dermatitis (a form of eczema) in African American children compared to their European American counterparts. African American children are almost twice as likely to develop atopic dermatitis.

This disparity may be due to a complex relationship between many factors, including environmental triggers, socioeconomic status, and access to healthcare. There may also be genetic and biological influences, but more research is needed to help determine exactly how these affect the rates of eczema in Black people.

Hopefully, with better representation of Black skin in clinical studies and research in the future, we’ll be able to identify important clues surrounding the disease.

Scratching eczema patches can lead to a few different types of skin changes.

Chronic itch can lead to chronic scratching, and this can result in thickening of the affected skin, which is also known as lichenification.

Scratching can also lead to changes in skin color, including patches that appear darker (hyperpigmentation) or lighter (hypopigmentation) than the rest of the skin. While these symptoms may be temporary, it can take months of eczema treatment for the color changes to reverse.

When used appropriately, topical corticosteroids don’t affect skin pigmentation. However, with chronic overuse of steroids, you can see decreased pigmentation of the skin.

Other potential effects of chronic overuse of topical steroids on the skin include the appearance of stretch marks (known as striae) or fine blood vessels (telangiectasias).

With that said, failing to treat eczema can also cause changes in skin color. That’s one of many reasons why it’s important to find an effective treatment.

In dark skin, eczema may be darker brown or gray or have a purplish hue. There may be less redness on dark skin than lighter skin types, as well.

It’s important for healthcare professionals to look closely to identify symptoms of eczema that are specific to darker skin. People with dark skin and eczema may have fine scaling and bumps, which tend to be located around the hair follicles.

A healthcare professional can carefully examine the skin to diagnose eczema.

The condition tends to affect patients in certain parts of the body, which can vary by age.

For example, in babies and young toddlers, eczema tends to affect the face, although it can be located anywhere. In older children and pre-adolescents, eczema affects the arms, legs, and the skin behind the ears. In adolescents, young adults, and adults, eczema can be worse on the hands and scalp and can also affect areas around the eyes.

It’s very important to note other symptoms that the patient reports, as well. Itch is a hallmark sensation associated with eczema. In cases where the diagnosis is not clear or there are other potential conditions that may be causing symptoms, a healthcare professional may order a skin biopsy to help clarify the diagnosis.

If you have eczema symptoms, talk with your primary care doctor or a dermatologist. While applying moisturizer regularly can sometimes help symptoms, you may need prescription medications to treat eczema.

There are many treatments available that can vastly improve your quality of life if you have eczema.

Dr. Sarika Manoj Ramachandran is an ABMS board certified dermatologist at Yale Medicine and medical director of the Branford, Connecticut, location. She is also an associate professor of dermatology at Yale School of Medicine. Her clinical and research focus is in medical dermatology, with a special interest in rheumatologic dermatology conditions such as cutaneous lupus, scleroderma, and morphea.