Understanding Eczema
in Different Skin Tones

Dr Catherine Fernando

IYASU Healthcare

East Lothian's Private GP Service

Explains how lifestyle and medical therapy can help eczema

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Eczema (also called atopic dermatitis) is a long-term skin condition that causes dry, itchy, and inflamed skin. It affects people of all ages and all skin colours around the world—not just those in Western countries.

For a long time, most medical information was based on how skin conditions look on lighter skin, which means eczema in darker skin has often been misunderstood or missed. Healthcare professionals are now working to improve this.

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How Common Is Eczema in Skin of Colour?

Research shows that:

• Eczema is more common in Black and Asian children than in White children in some countries.

• Black children may have more severe symptoms, be diagnosed later, and sometimes respond less well to treatment.

• Genetics may play a role, but we don’t yet fully understand why.

 

What Can Trigger or Protect Against Eczema?

Eczema can be influenced by many factors, including genetics, the immune system, and the environment.

Common triggers

These can make eczema flare up:

• Soaps, detergents, and bubble baths

• Wool or synthetic clothing (e.g., polyester)

• Allergens such as dust mites, pollen, animal hair, and mould

• Certain foods in some children (e.g., milk, eggs, nuts)

• Stress or poor sleep

• Hormonal changes (e.g., before periods, pregnancy)

Possible protective factors

These may help reduce risk:

• Breastfeeding for the first 3 months

• Using moisturisers on newborns at risk

• Growing up in rural areas or with early exposure to farm animals

• Having a dog in early life

Not all factors affect every person the same way.

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How Eczema Can Look Different on Darker Skin

On brown and Black skin, inflammation may not appear red. Instead, it may look:

• Dark brown, purple, grey, or ashy

• Very dry with fine scaling

• More thickened from rubbing and scratching

Other features may include:

• Small bumps around hair follicles

• Itchy nodules (called prurigo)

• Darkening or lightening of the skin after healing (called dyspigmentation)—this can take months to fade and may be distressing

Eczema can also affect different areas of the body:

• Darker skin may show more extensor involvement (outer arms/legs) instead of skin folds.

 

Other Conditions Linked to Eczema

People with eczema may also have:

• Asthma

• Hay fever

• Food allergies

• Skin infections (bacterial, viral, or fungal)

A rare but serious infection called eczema herpeticum can happen with the cold-sore virus. Seek urgent medical help if you notice:

• Sudden clusters of painful blisters

• Fever or feeling unwell

• Involvement around the eyes

 

Impact on Mental Health and Daily Life

Eczema affects more than the skin. It can lead to:

• Poor sleep

• Low confidence or social withdrawal

• Missing school or work

• Avoiding sports due to heat, sweating, or clothing irritation

• Stress— which can make eczema worse

Emotional support is an important part of treatment.

 

Barriers to Care

Some people with skin of colour may:

• Have more difficulty accessing care

• Be less likely to receive timely diagnosis

• Face financial challenges related to treatments and appointments

These issues are increasingly recognised, and healthcare systems are working to address them.

 

Cultural Practices and Treatment

In many cultures, people try herbal or traditional remedies before seeing a doctor. Some may help, but others can:

• Cause allergic reactions

• Make eczema worse

Talking openly with your healthcare provider about all products you use helps create a safe, personalised plan.

 

How Eczema Is Treated

Treatment is similar for all skin types and focuses on:

1. Moisturising daily (the most important step)

2. Avoiding known triggers

3. Treating flare-ups with prescription creams (e.g., steroids or calcineurin inhibitors)

4. Using newer medicines when needed, such as biologics or JAK inhibitors

A personalised plan improves control and confidence.

 

Key Takeaways

• Eczema affects people of all skin colours, but may be more severe and less recognised in darker skin.

• Symptoms can look different—redness may appear purple, grey, or dark brown.

• Skin colour changes after inflammation are common and may take time to fade.

• Eczema can impact mental health and daily life, not just the skin.

• Open discussion, cultural understanding, and a holistic approach lead to better care.

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Everyone deserves access to accurate diagnosis, supportive care, and effective treatment. If you are struggling with eczema, make an appointment to see Dr Catherine Fernando at IYASU Healthcare.