Eczema on Dark Skin

Eczema impacts people of all skin colors and ethnicities. However, the skin condition is often misdiagnosed in people with darker skin because eczema looks different on different skin tones.

This article discusses what eczema looks like on darker skin tones, as well as how to diagnose and treat it.

Quick Facts About Eczema  

Eczema is caused by inflammation in the skin. A variety of factors can contribute to inflammation in eczema, including environmental factors, genetics, and immune system hyperactivity.

Environmental triggers include:

• Climate and temperature
• Stress
• Allergens
• Skin irritants, including certain fabrics

Eczema usually begins in childhood. It affects 15%–20% of children worldwide, but it can develop in people of all ages. About 1 out of every 4 people report having their first eczema symptoms in adulthood.

It Can Affect All Skin Types

About 10% of all people in the United States have eczema. It affects people of all ethnicities and skin colors.

Of all Americans with eczema:

• 10% are Black
• 13% are Asian or Pacific Islander
• 13% are Native American

Eczema in Children 

Anyone can get eczema, regardless of skin tone. However, according to the National Health and Nutrition Examination Survey (NHANES), which evaluates the status of adult and childhood health and nutrition in the United States, eczema is more common in people with specific ancestries.

The NHANES found that 19.3% of Black children have eczema. In contrast, 16.1% of White children and 7.8% of Asian children have eczema.

A 2019 study found similar results. After analyzing ethnic and racial differences, researchers found that higher rates of atopic dermatitis were found in Africa and central and South Pacific islands vs. northern and Eastern Europe.

Additional data from the Centers for Disease Control and Prevention (CDC) found that the prevalence of eczema or other skin allergies increased significantly for children between 2000 and 2010, especially among Black children.

The data showed that frequencies of eczema increased from:

• 8.6% to 17.1% among non-Hispanic Black children
• 5% to 9.9% among Hispanic children
• 7.6% to 12.6% among non-Hispanic White children
  

Symptoms of Eczema on Darker Skin

Identifying Eczema on Dark Skin 

Eczema appears differently on darker skin than it does on lighter skin tones. On lighter skin, eczema usually appears red and dry. However, on darker skin tones, eczema can appear:

• Dark brown
• Purple
• Ashen gray

Since eczema on darker skin does not appear red, healthcare providers can look for other characteristics to make a diagnosis. Other signs of eczema include:

• Dryness
• Scaling
• Itching
• Skin swelling

Short-Term Pigmentation Changes 

Eczema can cause skin pigmentation (color) changes in both lighter and darker skin tones. Although the pigment changes are not typically permanent, they can remain on the skin for several months.

There are no specific pigmentation treatments following eczema recovery, but early treatment can help to prevent post-inflammatory pigment changes.

If skin discoloration that's either lighter or darker than normal is bothersome, see a healthcare provider.

Reasons for Eczema Misdiagnosis on Darker Skin

The National Eczema Association has stated that eczema is not only more common in darker skin, it is often misdiagnosed or mismanaged. This may be due to healthcare providers' lack of knowledge on treating darker skin or other environmental factors.

Misdiagnosis can also occur because skin patches may be less visible on darker skin.

Provider Knowledge

There is some evidence that medical students and healthcare providers may not receive adequate skin-care training in people with darker skin tones.

A 2018 study analyzed several thousand anatomy images from books used at top medical schools and found that White skin tones were widely overrepresented. Only 4.5% of the images included were of dark skin tones.

Environmental

Environmental factors that may increase the risk of developing eczema in both lighter and darker skin tones include:

• Climate
• Living in urban areas
• Poor nutrition
• Pollutants
• Tobacco smoke
• Water hardness

Because these factors can cause other skin or related conditions, there is a possibility for misdiagnosis.

Eczema Risk Factors on Darker Skin

The National Eczema Association reports that family history also plays a role in why some populations have more severe eczema. Eczema tends to run in families with a history of eczema, allergies, hay fever, asthma (narrowing and swelling of the airways, causing difficulty breathing),  and other allergic conditions.

You are also at a higher risk of getting eczema if you are diagnosed with allergies or asthma or if you have a family history of other inflammatory skin conditions.

Eczema Flare-Ups on Darker Skin

Eczema symptoms during a flare-up (a time when symptoms worsen) are similar in dark and light skin tones and can include:

• Skin color changes on affected areas
• Itching that may lead to marks from scratching
• Swelling
• Oozing
• Thickening of the skin, also called lichenification

A flare-up may be less noticeable on darker skin because the skin patches are less visible or because redness isn't as apparent.

When to See a Dermatologist

A dermatologist is a healthcare provider who specializes in skin, hair, and nail conditions.

If you think you may have eczema or any other skin condition, you should make an appointment with a dermatologist.

Physical Examination

To achieve a diagnosis, a primary healthcare provider or dermatologist will perform a physical examination. In most cases, visual observation is adequate to make an eczema diagnosis. In some situations, a provider may also collect a skin sample to examine the tissue.

A provider will also gather your medical and family history during your appointment.

Questions to Ask 

Before your appointment, write down a list of questions for the healthcare provider so you don't forget to ask something important.

Some questions to ask may include:

• What caused my eczema?
• What are the long-term effects of eczema?
• Will eczema affect any of my other medical conditions?
• What are my treatment options?
• What treatment options would you recommend for eczema?
• How long will treatments take before I see results?
• Are there any side effects of these treatments?

Educate yourself as much as you can about your eczema diagnosis. This will help empower you to make educated decisions about the treatment you receive.

Summary

Eczema is an inflammatory skin condition. It can affect people of any skin tone and may present differently on darker skin. It can be missed or misdiagnosed by healthcare providers because research shows institutions are not teaching providers how to treat darker skin. It's necessary for people with darker skin to be aware of the symptoms of eczema, and for healthcare providers to have expertise in treating darker skin.

A Word From Verywell

Having eczema can be frustrating and painful. Some people with eczema may even feel embarrassed. But receiving a proper diagnosis may provide some relief since there are many treatment options available.

If you have dark skin and think you may have eczema or another skin condition, make an appointment with a primary care provider or a dermatologist who specializes in dark skin to find the best treatment plan for you. You may also want to learn as much as you can about eczema to feel empowered in your disease management.