With seasonably colder months fast approaching, dealing with dry, itchy skin every now and then is common. But if you are one of the nearly 32 million Americans who have eczema, then you know there is a big difference between an occasional rough skin patch and living with the disease.
For many, managing eczema is tricky because the symptoms are sporadic. They range from mildly parched irritation in small, concentrated areas to widespread, unbearably painful inflammation. Flare-ups seem to magically appear overnight but will often take a heck of a lot longer to get under control.
And if your skin is melanin-rich, then the disease is even more troublesome for you than for others.
First of all, when it comes to dermatological education and research, Black skin is notoriously underrepresented, if not outright excluded. A study published in Social Science & Medicine—a peer-reviewed academic journal covering social science research on health—estimates that less than 5% of medical textbooks illustrate conditions on dark skin. Not only do these biases in literature make diagnosis and treatment difficult for doctors, but they also impose enormous barriers for us to recognize and advocate for skin concerns like eczema on our own.
Also, despite the fact that eczema is one of the most common skin conditions we face in our community, the lack of awareness, representation and education are oftentimes why we inadvertently suffer for years. Nonetheless, they are also reasons why we at TheHub.news have decided to get the lowdown on the disease so we all understand how eczema shows up on our skin, as well as how it is diagnosed and treated.
So, please keep reading to discover more about eczema from board-certified dermatologists with real experience in treating skin of color, and learn what you can do if you believe you have it.
What Exactly is Eczema?
Also known as atopic dermatitis, eczema is a sort of umbrella term that encompasses a series of chronic skin conditions by which an overactive immune system creates a weakened skin barrier that triggers itchy, dry, scaly skin, blisters and skin infections.
Doctors say the reason why eczema is complicated is because it does not present as the same across the board. In fact, there are several forms of the skin condition that vastly range in appearance and severity. It can appear as early as babyhood, usually showing up on the face, knees and elbow, and then, as we age, spread to varying parts of our bodies.
Why are Black People More Prone to Eczema?
According to dermatologists, more research is necessary to learn why eczema is more likely to affect Black people, but multiple scenarios such as environmental factors and genetic traits, play significant roles for us. “Some people are born with a genetic tendency to develop eczema,” says Caroline Robinson, MD, a Chicago-based, board-certified dermatologist and founder of Tone Dermatology to Women’s Health. “However it is not completely understood why some people develop a more severe form than others or when it develops.”
The MD further explains that in addition to strong familial traits, reports have also shown how exposure to certain chemicals, allergens and pollutants—dust and mold, for example—may also increase the likelihood of developing the disease and the risk of its severity because Black skin doesn’t retain as much water as white skin. So, for us, our natural predisposition for dry skin may also serve as a basis for why eczema is so common.
What Does Eczema Look Like on Black Skin?
As we Black folk come in a wide range of shades, experts describe how the appearance of eczema will vary based on skin tone. Boston-based dermatologist Dr. Uchenna R. Okereke agrees: “Eczema on Black skin presents itself as ashen gray, purple or violaceous, red-brown or dark brown,” she explains to InStyle. She also adds that while eczema is usually thought to appear as patches of dryness (scaling, crusting, scratches or thickening of the skin), it can also turn up in other forms. “It can appear as little bumps, papules, thickened plaques, lichenoides, or what we call a follicular presentation, and this presentation is more common in persons with darker skin tones.”
How Can You Treat Eczema in Black Skin?
There are several ways to treat eczema, but clinicians specify how they mostly depend on the severity of the case. At any rate, gentle skin cleansing and the liberal use of moisturizers is the mainstay of treatment.
“Moisturizers are one of the most important treatments,” says Laura Scott, MD, board-certified dermatologist and associate director of the Skin of Color division at the University of Miami Miller School of Medicine, per Women’s Health. “We need to restore lost water and seal it in, so thick creams or ointments are the backbone to any eczema treatment, as they can prevent flare ups.”
Both doctors warn that when it comes to additives such as fragrance, color and certain ingredients such as retinoids and alpha hydroxy acids, less is definitely more. These components have a tendency to dry out or irritate the skin, which, owing to weakened skin barriers, poses a problem for individuals with eczema. As a result, products like these tend to seep into the skin more easily, robbing the skin of its moisture. Emollient, over-the-counter products like Vanicream Moisturizing Cream or CeraVe Moisturizing Cream are safe, effective over-the-counter options.
“I utilize a combination approach in treating eczema which consists of medicated topical emollients, thick moisturizers, free and clear detergents, and gentle cleansers, such as Dove Irritation Care Body Wash,” Dr. Okereke shares. “It’s a fragrance-free body wash that cleanses and nourishes the skin with a thick, extra moisturizing lather that your skin will absolutely love.”
For more severe cases, she says a prescribed oral or injectable medication may be needed.
Can Eczema Cause Additional Injury to the Skin?
Seeing as Black people are inherently prone to dark spots and scarring, experts also caution against leaving eczema untreated because it can exacerbate post-inflammatory hyperpigmentation. The best way to remedy the issue is to immediately treat the affected area as soon as a flare-up begins so it addresses both problems without stirring up further irritation.
“Oftentimes, the hyperpigmentation is more psychologically disturbing to the patient than the eczema flare,” explains Dr. Okereke. “It can last several months, even years.”
However, if you are indeed dealing with both conditions altogether, she recommends over-the-counter products that contain gentle, moisture-rich ingredients such as Vitamin E or seek the assistance of a dermatologist for a more targeted treatment. Dr. Okereke elaborates: “Topicals that we utilize to treat hyperpigmentation such as hydroquinone, can potentially irritate the skin, therefore, a thoughtful plan is required to effectively manage both conditions without precipitating a flare-up.”
The Final Takeaway
Although eczema is one of the most common skin diseases our community faces and navigating its challenges is because of the fact it’s mostly depicted on white skin – a main reason why so many of us don’t realize we are living with it – it is also important to remember that every dry patch that will appear on our skin is not an indicator of the disease. Doctors note that if the patches aren’t itchy, then an eczema diagnosis is unlikely.
In many cases, eczema is completely manageable with over-the-counter, mild, hydrating cleansers and moisturizers or by the use of specialized ointments or steroid creams. But it’s best to defer to a dermatologist as soon as you can if experience consistent itching in your dry patches.
Doctors also point out that food is rarely a trigger of eczema, but if you suspect your diet could be a contributing factor, then be sure to reach out to an allergist right away.
