Eczema in People of Color: Understanding the Challenges and Treatment Options

By Charlie Morkel

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Eczema in People of Color: Understanding the Challenges and Treatment Options

Eczema is a common skin condition that affects individuals of all races and ethnicities. However, research suggests that people of color, particularly African Americans, may face unique challenges when it comes to diagnosing and treating eczema. This comprehensive guide aims to shed light on the specific issues related to eczema in people of color, including the underdiagnosis, different manifestations on darker skin tones, disparities in healthcare access, and the importance of proper treatment and care.

Underdiagnosis of Eczema in People of Color:

Eczema is the second most frequent skin disease to affect African Americans, yet experts believe it is often underdiagnosed in this population. One of the reasons for this underdiagnosis is the historical lack of representation and training in dermatology specifically focused on diagnosing eczema on darker skin tones. Traditionally, physicians have been trained to recognize and diagnose skin conditions primarily on white skin, resulting in a lack of expertise in identifying eczema in people of color.

A recent study highlighted this disparity, revealing that less than 5 percent of the images in general medicine textbooks depicted conditions on darker skin. This lack of representation contributes to the challenges faced by healthcare providers in recognizing and diagnosing eczema on skin with more pigment. Additionally, the standard outcome measures used in diagnosing and assessing eczema have shown poor reliability and validity in patients with very dark skin, further complicating the diagnostic process.

Disparities in Healthcare Access:

Another contributing factor to the underdiagnosis and undertreatment of eczema in people of color is the disparity in healthcare access. Research shows that people of color, including African Americans, are half as likely as white patients to see a dermatologist for the same conditions. This disparity in access to dermatological care can significantly impact the timely diagnosis and appropriate treatment of eczema.

Specifically, black children with eczema are 30 percent less likely to see a doctor for their condition compared to white children. Moreover, when black children do see a doctor for their eczema, they tend to have more frequent visits and receive more prescriptions, indicating more severe disease. These disparities in access to care can lead to delays in diagnosis, inadequate treatment, and increased burden of disease in people of color with eczema.

Manifestations of Eczema on Darker Skin Tones:

Eczema can manifest differently on darker skin tones compared to lighter skin tones. The common perception of eczema as a red, dry, and itchy rash may not accurately represent its appearance on darker skin. Redness, a prominent feature of eczema on lighter skin, can be challenging to detect on darker skin tones, making diagnosis more difficult.

On darker skin, eczema patches may appear darker than the surrounding skin, taking on a purple, ashen grey, or dark brown color. When examining the skin, healthcare providers often look for areas of unimpacted skin first, comparing them to areas with active symptoms to determine the difference in color and texture.

In addition to color variations, other signs of eczema on darker skin may include very dry or scaly skin, intense itching, skin thickening (lichenification), dark circles under the eyes, small bumps on the torso, arms, or legs (papular eczema), and bumps around hair follicles resembling goosebumps (follicular accentuation).

Pigmentary Changes and Discoloration:

A significant concern for people of color with eczema is the potential for discoloration associated with the condition. Researchers believe that individuals with black skin and eczema experience higher levels of inflammation, leading to scratching and subsequent discoloration. The scratching, irritation, redness, and itching associated with eczema can result in areas of the skin becoming lighter or darker than the surrounding skin. This discoloration, known as post-inflammatory hyperpigmentation or hypopigmentation, can persist for months, even after the eczema itself is treated.

Early and Aggressive Diagnosis and Treatment:

Given the tendency for long-lasting pigmentary changes in people of color, it is crucial to diagnose and treat eczema early and aggressively. Timely intervention can help prevent or minimize discoloration and improve overall outcomes for individuals with eczema.

To ensure a proper diagnosis, it is essential for individuals, regardless of their skin color, to become knowledgeable about their symptoms and be able to articulate their experiences in detail when consulting with healthcare providers. Clear communication with healthcare professionals is key to overcoming the challenges associated with underdiagnosis and inadequate treatment.

Treatment Options for Eczema in People of Color:

The treatment of eczema in people of color follows similar principles to those for individuals with lighter skin tones. The mainstay of treatment is gentle skin care and liberal use of moisturizers. Avoiding harsh and fragranced skin care products is important to prevent worsening of the condition. Moisturizing the skin regularly, ideally immediately after bathing, helps maintain skin hydration and alleviate dryness, which is particularly relevant for people of color, as melanin-rich skin tends to have lower water retention capacity than lighter skin tones.

When it comes to bathing, individuals with eczema should opt for short, warm showers or baths rather than hot water, as hot water can exacerbate dryness and trigger itching, leading to worsened symptoms. Using fragrance-free emollients, such as creams and ointments, instead of lotions, can help lock in moisture and provide better hydration for the skin. Natural alternatives like shea butter can also be effective moisturizers for people of color with eczema.

In cases where conservative measures are insufficient, prescription medications may be necessary to manage eczema effectively. Topical corticosteroids are typically the first-line treatment for eczema and can be highly effective in reducing inflammation and relieving symptoms. However, it’s important to note that corticosteroids should be used for limited periods under the guidance of a healthcare professional to minimize potential side effects.

Non-steroidal creams and ointments, such as pimecrolimus (Elidel), tacrolimus (Protopic), and crisaborole (Eucrisa), are alternative options that may be prescribed for individuals who cannot tolerate or are not responsive to corticosteroids. These medications have shown efficacy and safety in diverse skin types, making them suitable for people of color with eczema.

In more severe cases of eczema, phototherapy, which involves light-based treatments, or systemic medications that target the immune system may be recommended. Phototherapy can help alleviate symptoms and reduce inflammation, while systemic medications, such as pills or injections, may be necessary for individuals with refractory or widespread eczema.

It’s important for individuals with eczema, regardless of their skin color, to work closely with their healthcare providers to determine the most appropriate treatment plan based on the severity and specific characteristics of their condition. Dermatologists, in particular, can provide specialized care and guidance in managing eczema in people of color, taking into account the unique challenges and manifestations associated with darker skin tones.

Eczema affects individuals of all races and ethnicities, but there are distinct challenges and considerations for people of color. Underdiagnosis and disparities in healthcare access contribute to inadequate treatment and management of eczema in this population. The manifestation of eczema on darker skin tones differs from its appearance on lighter skin, and awareness of these differences is crucial for accurate diagnosis and treatment. Timely intervention and aggressive management are essential to prevent long-lasting pigmentary changes and optimize outcomes for individuals with eczema. By working closely with healthcare providers, individuals can develop personalized treatment plans that address their unique needs and improve their quality of life. Increasing awareness, education, and access to dermatological care for people of color is an important step toward ensuring equitable and effective management of eczema for all.