Eczema is a skin condition that can affect people of all different skin colors, races, and ethnicities. The disease is thought to be caused by an autoimmune disorder that occurs when the skin’s protective barrier is broken down by environmental or internal triggers. Eczema can be treated with a variety of topical treatments, but it can be difficult to find the best solution for each person’s unique symptoms.
In this article, we will explore some of the major differences in symptoms and treatment options for eczema in darker skin tones.
Why is Eczema Misdiagnosed on Darker Skin?
Eczema is often misdiagnosed in those with darker skin tones, due to the fact that it presents differently when compared to lighter skin tones and can appear brown, purple, or grey. Whereas in lighter skin, it usually just appears as dry red patches.
Most of our historical and modern-day medical illustrations predominantly feature lighter-skinned people, which may be why many doctors miss signs of eczema when it does not present as red, itchy patches as taught in most medical schools.
There are also different types of eczema that are more common in certain skin types or ethnic groups for example people of color may also be more likely to develop a form of eczema called papular eczema, which appears as small goosebump-like protrusions.
According to the American Academy of Dermatology, there is a lack of research done on what treatments work best for black patients with eczema and other skin conditions. This makes it difficult for doctors to diagnose in a timely manner, so they often prescribe ineffective or untested treatments.
Untrained eyes may mistake eczema for other skin conditions such as psoriasis or seborrheic dermatitis. Healthcare professionals need to be aware of how skin conditions like eczema affect people with darker skin to help people find a treatment that works for them sooner rather than later.
How Is Eczema Diagnosed?
A diagnosis of eczema is often made based on the history and physical examination findings. A skin scraping or biopsy may be taken to help confirm a diagnosis. The dermatologist will usually carry out a skin prick test or patch test to identify any substances that may be causing eczema.
A skin prick test involves pricking the skin with a small needle and then placing a drop of allergen extract on the prick. A patch test involves taking some allergen extract, spreading it on an area of non-broken skin on the back or arm, and then waiting 48 hours for any reaction.
Symptoms of Eczema on Darker Skin
There are some eczema symptoms that are more common in dark-skinned populations than in light-skinned populations. These include:
- Itching & burning
- Small bumps around hair follicles
- Brown, purple or grey pigmentation
- Cracking of the skin
- Fine scaling of the skin
- Crusting or scaling of the skin
- Oozing from the cracks in the skin.
In addition to dealing with the common symptoms associated with eczema, people of color who suffer from eczema may also experience changes in their skin color due to inflammation from the flare-up. While some temporary changes may be distressing to patients, they can also pass over time. The important thing is to stay positive and seek different opinions.
There are various factors that may contribute to a lack of parity. Environmental triggers, socioeconomic status, and access to healthcare among other things all have an effect. Genetics or biology may also be a factor, but exactly how these factors contribute to eczema in people of color needs more research.
Prevalence of Eczema
Eczema is very common in the US with over 31.6 million people in the US having some form of eczema. That is about 10.1% of the population!
It is estimated that 9.6 million children under 18 in the U.S. have eczema, and one-third of them have moderate to severe eczema. Childhood eczema has been on the rise for the past 20 years. The rate of adults with eczema also increased from 8% to 12% since 1997.
Studies from the National Eczema Association show that up to 20.2% of African American children in the United States have eczema. This contrasts with rates of 13% for Asians, 13% for Native Americans, 12.1% for white, and 10.7% for Hispanic children.
The treatment for eczema varies depending on its severity, but usually includes:
- Corticosteroids – When used appropriately, topical corticosteroids don’t affect skin pigmentation. They can, however, be damaging to the skin if used repeatedly and in high quantities. In the long-term, you may see your skin lose some of its natural pigmentations and some areas of eczema may often become thinner. If you need to resort to cortisone-based creams or ointments, remember that they should not be used on sunburns. If you are pregnant or breastfeeding, discuss your options with your doctor.
- Moisturizers / Ointments – There are many over-the-counter treatments for eczema, but they may not work for everyone. A dermatologist can help you find the best treatment option for your skin type or you can try your luck with some promising natural oils and ointments.
- Topical antibiotics – There are many topical antibiotics for eczema available on the market. They work by reducing inflammation and reducing the symptoms of eczema such as redness, itchiness, and dryness. Antibiotics are often prescribed to treat eczema, but topical antibiotics are not the most effective treatment and may have adverse side effects such as allergic reactions and changes in body odor.
- Ultraviolet light therapy – Ultraviolet light therapy or Phototherapy is a type of treatment for eczema that has been shown to be effective in some cases. It is not a cure, but it can reduce the symptoms and severity of eczema. The ultraviolet light therapy is done by using a UVB lamp or a UVA lamp. The UVB lamp emits short waves that are more likely to produce vitamin D in people’s skin, while the UVA lamp emits long waves that penetrate deeper into the skin and can help treat eczema.
- Dupilumab – Dupilumab is a drug approved by the FDA to treat eczema in adults and children over 6 years old. It is an immunotherapy drug that works by blocking the effects of an important protein called IL-4. This protein plays an important role in the development of eczema. The FDA approval of dupilumab means it can now be prescribed by a doctor to patients with moderate-to-severe atopic dermatitis who are not responding to other treatments, or those who cannot use other treatments due to side effects. Dupilumab may also be used as an add-on therapy.
- Oral antibiotics – Oral antibiotics for eczema are a common treatment for moderate to severe eczema. They are usually used in conjunction with topical treatments and can be prescribed by a doctor or purchased over the counter. They are taken by mouth, usually twice a day. The most common side effects of oral antibiotics for eczema include nausea and diarrhea, which often go away after taking the antibiotic for one week or less. People using these medications should drink plenty of fluids and avoid alcohol and caffeine-containing drinks while taking them.
- JAK inhibitors – JAK inhibitors are a relatively new class of immunosuppressants that are used to treat a range of inflammatory skin diseases. They work by inhibiting the Janus kinase (JAK) enzymes, which are responsible for activating certain cells involved in the immune response.
- Calcineurin inhibitors – Calcineurin inhibitors are a class of drugs that are used to treat atopic dermatitis (eczema) and other skin conditions. They work by stopping the immune system from over-reacting to allergens and other external triggers. The most common side effects of calcineurin inhibitors are nausea, diarrhea, and headache. There is also a risk of developing bone marrow suppression if the patient takes the drug for a long period of time.
- Immunosuppressants – The immune system helps to protect the body from infections and other diseases by producing different types of cells that fight off foreign substances like bacteria and viruses. Immunosuppressants are medications that are used to suppress the immune system. They are often prescribed for people who have autoimmune disorders such as eczema. These medications work by reducing inflammation and suppressing the production of antibodies which causes eczema symptoms to worsen.
- Diet changes – Some people who have eczema find that their condition worsens when they eat certain foods or when they drink alcohol. If you suspect this might be the case for you, do some research or talk to your doctor about making some changes to your diet, such as reducing your intake of dairy products or eliminating gluten from your diet.
In addition to the treatment options available, it’s a good idea to have a preventative skincare routine so that symptoms and flare-ups are less frequent and severe. Including applying a thick moisturizer regularly, showering in lukewarm water, and avoiding products with strong, unnatural fragrances.
How to Find a Doctor Who Can Treat Eczema in Dark Skin
The first step in deciding whether or not to seek a second opinion is to determine if you feel satisfied with the medical advice you have received. If your doctor has provided you with a diagnosis and some treatment options, and you are satisfied with the way they have handled your case, then it may not be necessary for you to seek a second opinion. However, if you feel unsatisfied with the diagnosis or treatment options that your doctor has provided, then it may be wise to seek out another medical professional who can provide more information on your condition.
It is imperative for doctors to be able to recognize the symptoms of eczema in darker skin tones. Due to differences in pigmentation among people with different skin types, black people may have a delay in diagnosis and appropriate treatment if their doctor has trouble recognizing these changes.
If you are concerned that you may not have a doctor who is properly trained to diagnose eczema in your skin type, it is always worth calling the clinic before your appointment to confirm you are making the right booking for your needs.
Don’t be afraid to ask your doctor for more information if you do not understand something. It’s important to have an open dialogue with your doctor about your concerns and ask them questions about what they think might be causing your eczema. They will be able to recommend treatments or medications that may help you.
Trust your gut instincts and do your own research to find the best available specialist for your needs. You may also want to take pictures of your skin condition before seeing any doctor so that you have something for them to refer back to if necessary.
Some Truths To Ease Your Mind
With so many advances in technology and an increasing understanding of conditions like eczema, some believe that we are close to a breakthrough and potentially a cure! However, until then, keep your skin hydrated with a thick natural moisturizer and seek professional help if things don’t work out as planned.
Society today is often dictated by beauty standards that are unrealistic or unattainable. We need to start appreciating each other and ourselves for our differences. We all have differences that affect us in different ways, which makes us unique.