Eczema can be challenging for patients of all skin tones, however studies have shown that black patients care more likely to be diagnosed with atopic dermatitis and eczema than their Caucasian counterparts.
It has also been suggested that the burden of the skin disease is greater on people of color—notable among these was data in the Archives of Dermatology in 2012 that black, Asian and Pacific Islander patients visited physicians for atopic dermatitis more often than white patients.
According to Meghan Feely, M.D., eczema presents in black patients as “active pink to violaceous, ashy or gray-brown patches that may leave residual hyperpigmentation or hypopigmentation [light or dark patches]." Black pediatric patients experience eczema in elbows and knees, as opposed to the inner surfaces of these areas in Caucasian children.
In the Genes
Eczema’s telltale symptom, erythema, or redness, is less visible on darker skin, and, according to Feely, is a “less reliable indicator for assessing disease severity.” She also notes that black patients are prone to lichenoid and papular subtypes of the disease—these varieties are rarer but can help in diagnosis where erythema fails.
Cultural and environmental differences can also lead to increased risk of dermatitis in patients of color.
Feely attributes the physiological difference in part to the increased transepidermal water loss and fewer ceramides in the skin of black patients compared to Caucasian or Asian patients. In addition, past research has found that lack of the protein filaggrin is the root of eczema in Caucasian patients—black patients, on the other hand, show a lower prevalence of this gene mutation, pointing toward the possibility of other genetic factors.
Cultural and environmental differences can also lead to increased risk of dermatitis in patients of color: A 2016 study in Dermatitis found that black patients were more likely to have a skin reaction from paraphenylenediamine (PPD), which is found in black hair dye, among other things. Henna dye mixed with PPD has also been found to cause contact dermatitis.
Treatment
Corticosteroids, a common treatment for eczema, run the risk of causing hypopigmentation in patients with dark skin.
“I use a multimodal approach to caring for patients with eczema that involves adopting a good skincare regimen, medications as needed, and avoiding potential triggers,” said Feely.
For more information on eczema in people of color, head to Dermatology Times (source).
