Eczema And Black Skin
A US study found that eczema is actually more common in Black people than white people, with 19.3% of Black children having atopic dermatitis, compared to 16.1% of white and 7.8% of Asian children.
Another study found that Black children are 1.7 times more likely to develop the condition.
Genetic and environmental factors influence your risk of developing eczema. Typically, those with a family history of eczema or other atopic diseases are more likely to have the condition.
How Is Seborrheic Dermatitis Different In Black People
According to 2019 research, seborrheic dermatitis was found to be among the top diagnosed skin conditions in Black people, especially Black women. However, differences in the appearance of seborrheic dermatitis on black and brown skin can lead to inequalities in the diagnosis and treatment of this condition.
Although seborrheic dermatitis is commonly described as red, scaly, patchy skin, this condition can often appear differently on Black skin. In addition to the symptoms of seborrheic dermatitis mentioned above, in Black people or other people of color, this condition may also appear as:
- hypopigmentation, or lightening of the skin
- curved or petal-like lesions along the hairline
- flaking or hypopigmentation on the scalp in infants
Due to the differences in how seborrheic dermatitis can present itself, it can sometimes be more difficult for Black people and other people of color to receive an accurate diagnosis for this condition.
Epidemiology Of Atopic Dermatitis In Diverse Racial And Ethnic Groups
The prevalence of AD varies by country and has been increasing in recent years. The International Study of Asthma and Allergies in Childhood studied 385 853 participants in 60 countries from 1999-2004 and demonstrated a prevalence of eczema ranging from 0.2% to 24.6%. In general, countries in Africa and Oceania have a higher rate of eczema and countries in the Indian subcontinent and Northern/Eastern Europe have a lower rate. In Africa, the eczema prevalence ranges from 4.7% to 23.0% however, there is wide variation between neighbouring countries and even amongst cities within the same country. In the Asia-Pacific region, 17.8% of children ages 6-7 years have been diagnosed with AD, with prevalence ranging from 4% to 30% in different countries. Clinic-based investigations similarly demonstrate high variability in the reported prevalence of AD.
A similarly disproportionate prevalence of AD in Black children has been observed in Europe. A UK study demonstrated that, based on dermatologist examination, 16.3% of London-born Black Caribbean children vs 8.7% of White children had AD. The increased risk in Black children persisted after adjusting for potential cofounders. A clinic-based study in south-east London found AD to be the most frequently diagnosed dermatologic condition in Black children, affecting 36.5% of those seen.
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Ashley Lora The Eczema Warrior
At Aveeno, we are committed to advancing skin health equity and advancing eczema awareness and education gap in skin of color.
Eczema is the second most frequent skin disease to affect African Americans, but experts believe it may be underdiagnosed. This is due in part to the fact that historically, physicians have been trained primarily to diagnose eczema on white skin. In fact, a recent study found that less than 5 percent of the images in general medicine textbooks showed conditions on darker skin and the standard outcome measures used have poor reliability and validity in patients with very dark skin, making it even more difficult for doctors to recognize and diagnose on skin with more pigment.
People of color are also half as likely as white patients to see a dermatologist for the same conditions. Black children with eczema are 30 percent less likely to see a doctor for their eczema than white children, and those who see a doctor tend to have more visits and receive more prescriptions than white children, indicating more severe disease.
How Different Skin Types Are Affected
The features of eczema differ depending on the persons skin type.
On paler skin, the typical pattern is inflamed, red or dark pink patches, with dry itchy skin, which in severe flares may ooze with small vesicles .
On darker skin, inflammation is more difficult to detect, as it is seen as various stages of hyper-pigmentation and is more subtle, so often redness is not seen. As a result, the severity of eczema can be underestimated.
Post-inflammatory hypo- and hyper-pigmentation are a much greater concern in people with darker skin, as it can take months for this to resolve and the discoloration can sometimes be a greater concern than the eczema itself.
Another feature of eczema, more commonly found in darker skin, is follicular prominence. This is where the eczema appears in small, itchy bumps or papules on the skin mainly on the trunk and forearms. Dry skin and scale can also be more prominent, as its white or grey colour shows up most noticeably.
A UK longitudinal study into ethnic variations in atopic eczema reported that children with darker skin were more likely to develop atopic eczema than their white counterparts and were six times more likely to develop severe eczema.
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Inclusion Of Black Patients In Clinical Trials And Product Development
There is a belief that most studies are not done on people of color, Reggie said. Therefore, the science is most likely based on white people. Ashley spoke to the challenge of treating patients of different ethnicities with different skin types if they werent represented in clinical trials. Eczema does not look the same on darker skin, she said. It makes me question how well a dermatologist can treat skin of color if people with dark skin arent included in these studies.
Ashley expressed a similar sentiment about different types of treatment. Certain companies create skin products that do not account for skin of color, she said. There are steroid creams that cause severe burns, but the same products dont always have the same impact on people without skin of color. Not all dermatologists think about those issues when they prescribe medicine to people of color.
Reggies 4-year-old daughter, Bailey, also lives with eczema and has experienced similar challenges with treatment of her dry skin. Her flare ups have caused her to scratch to the point of bleeding, Reggie said. But with many of the steroids they prescribed for Bailey, not only did they change the texture of her skin, they changed the color of her skin. The dermatologists never told us this could happen for Bailey, that her skin color could change.
Which Symptoms Are Similar Among Skin Tones
- Itching: It may be bad enough to disrupt your focus at school or work.
- Skin thickening from scratching: This may appear very dark on darker skin tones.
- Scratches: These may show up as marks or cuts and could lead to infection.
- Swelling: Fluid buildup or infection usually causes this.
- Oozing: This is often the result of seeping or leaking of fluid from edema.
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Diagnosis And Treatment Of Darker Skin Poses Unique Issues
byKate Kneisel, Contributing Writer, MedPage Today September 2, 2021
In the U.S., the prevalence of atopic dermatitis is higher among African Americans, at almost 20%, compared with European Americans and Hispanic Americans .
In addition, the prevalence of childhood AD has been growing over the past 2 decades, with an increasing representation of African-American children being a major contributing factor, noted Jonathan Silverberg, MD, PhD, MPH, of George Washington University School of Medicine and Health Sciences in Washington, D.C.
“The observed differences are likely multifactorial. However, one contributing factor is poor disease control and greater disease persistence in African-American/Black children, which suggests there are racial disparities. As a field, we need to do a better job assessing and managing AD across all patient races and subsets,” Silverberg told MedPage Today.
The trend may also reflect a growing number of AD diagnoses resulting from increased access to healthcare, said Danny Del Campo, MD, of Chicago Skin Clinic.
“Other factors include environmental and daily habits that ultimately influence the allergic immune response. Excessive bathing is a frequent factor and chronic disruption of the skin barrier is likely a key player in the increased prevalence of AD,” Del Campo told MedPage Today.
Management of post-inflammatory pigmentary changes often depends on the location on the body and the degree of severity, noted Del Campo.
Vitiligo In Dark Skin
In this condition, skin becomes depigmented. The loss of color causes large, white patches to appear. Vitiligo occurs in up to 2% of the population but is most noticeable in those with dark skin. Vitiligo is thought to develop when melanin-producing cells are damaged, though no one is certain why this happens. A genetic susceptibility perhaps triggered by a factor in the environment may result in an autoimmune disorder, causing destruction of pigment cells.
When vitiligo hits the scalp, hair turns white — and it’s occasionally the cause of prematurely gray hair.
Treatment includes various procedures to “re-pigment” the skin. One such method is controlled exposure to UV light, called phototherapy. This can help increase the amount of melanocyte cells at the skin’s surface.
Another approach uses the topical eczema oinment tacrolimus, which is sometimes effective. When applied to the skin twice daily, research shows, normal pigmentation may return, although it may take months. Still another approach is the use of strong steroid creams, which can be effective if used on certain areas of the body such as the face and neck.
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How Does Eczema Affect Black Americans
According to the National Eczema Association, 20.2% of African American children in the U.S. are reported to have atopic dermatitis, a common form of eczema, compared with 13% of Asian children, 13% of Native American children, 12.1% of white children, and 10.7% of Hispanic children. The exact reason eczema affects more African American children is unknown, but experts believe it to be a combination of genetics and the environment.
Mutations, or changes, in certain genes can affect your skins protective barrier. When the barrier is disrupted, your skin is more susceptible to irritants and allergens in the environment. Your body then mounts an immune response, which can cause eczema symptoms to flare.
In a 2018 study, researchers analyzed the skin at a molecular level, focusing on African Americans and white Americans with eczema. They discovered that different gene mutations and immune system proteins were involved in the development of eczema between the two groups. They also found that African Americans developed more inflammation than people of European descent. These differences may explain why it is more challenging to treat eczema in the Black population and why higher doses of medication may be needed to manage symptoms.
Eczema Affects All Skin Colors
Eczema is a common disease affecting mostly children, and it does not discriminate against skin color. Light skin and dark skin tones are equally affected.
Similar symptoms appear in dark skin as in light skin:
- Changes in skin color on the eczema patch
- Thickening of the skin
In atopic eczema, which presents in flare-ups, skin also feels dry and tight, even in periods of remission. Intense itching can impede sleep and cause children to become irritable.
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What Are The Symptoms Of Eczema
The most important thing to remember is that eczema and its symptoms are different for everyone. Your eczema may not look the same on you as it does on another adult or on your child. Different types of eczema may even appear in different areas of the body at different times.
Eczema is usually itchy. For many people, the itch can range from mild to moderate. But in some cases, it can become much worse and you might develop extremely inflamed skin. Sometimes the itch gets so bad that people scratch it until it bleeds, which can make your eczema worse. This is called the itch-scratch cycle.
What to look for:
Aveeno Sees A Bump In Black Consumers
In trying to close the educational gap, Aveeno connected with Black consumers, showing that the brand cares about their experience within the health and wellness space, and is actively trying to level the playing field.
Using data from Harris Brand Platform, we compared Aveenos consumer demographics pre- and post- campaign. While African Americans still make up a minority of Aveenos consumers, we see a slight increase in African American consumers who report using Aveeno products. The overall percentage of Black consumers increased from 11.5% to 13% .
Purchase consideration among Black consumers familiar with the brand increased even more substantially. The percentage of Black consumers who reported that they would either possibility or absolutely consider purchasing products from Aveeno increased by 4% after the campaign launched . The percentage of Black consumers who said that they were not likely or would never consider purchasing Aveeno products decreased almost 4% from 13.5% to 9.6%.
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References And Further Information
Skin Deep is a website that contains images of people with different skin tones to help patients and doctors better understand and describe symptoms of different skin conditions: .
The PDF document below shows what eczema can look like on different skin tones.
Eczema On Black Skin: Nea Community Members Share Their Experiences
Recent NEA research has shown that eczema poses unique challenges to Black Americans. Not only is the disease more common in African American communities, its also more expensive to treat out-of-pocket, harder to control and more likely to result in severe dryness, rashes, flaring and infection. Three members of NEAs community who are Black shared their experiences.
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New Website Spotlights Unique Differences Of Eczema In People Of Color
In a mutual commitment to address disparities in treating eczema in skin of color, the American College of Allergy, Asthma and Immunology, along with Allergy & Asthma Network, are partnering to create EczemaInSkinofColor.org, a website to aid physicians and patients in recognizing eczema in people with all skin types.
Eczema affects nearly 32 million people in the United States, and it impacts all skin colors and ethnicities. But if you search online for eczema symptoms, youll likely read descriptions and find photos of bright red, bumpy, inflamed patches on light skin.
In people of color, eczema can be uniquely different in appearance. It is often hard to identify because the redness may be obscured in darker skin. Instead, eczema may present as dark brown, purple or ashen gray. As a result, misdiagnosis or delayed diagnosis can occur.
Studies show eczema and atopic dermatitis are more common in Black Americans, especially in children. They may have more itchiness and inflammation that requires higher doses of medications to get relief. Black and Hispanic children tend to develop more severe cases of atopic dermatitis compared to white children. They are also more likely than white children to miss school due to eczema.
The website also includes:
Eczema treatment is the same for all skin tones, but it is more effective when diagnosed early. Thats why proper diagnosis is so important for people of color.
EczemaInSkinOfColor.org was created with support from Pfizer.
Why Do African American Kids Have Higher Rates Of Eczema
Although African American adults are slightly less likely to have eczema compared to people of other races, 20% of Black children have eczema, which is almost double the rate found in white, Asian, Native American, and Hispanic children.
Experts are still determining the exact factors that contribute to these numbers, and theyre learning more all the time. Recent studies have shown exposure to irritants, both indoor and outdoor, can lead to higher cases of eczema. African Americans tend to live in heavily urban settings with irritants and allergens such as pollution, humidity, ultraviolet radiation, harsh water, dust, mold, and more. These triggers can leave one with a compromised immune system and make people susceptible to eczemaand often, more severe cases of it.
Additionally, new research analyzing genetic factors of eczema is finding certain mutations affecting the skin barrier cells and skin immune cells can be passed down through families, and these mutations are more common in some ethnic groups, like people of African descent, compared to others.
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What Does Eczema Look Like In Darker Skin
Most people think of eczema as a red, dry, and itchy rash how it appears in light skin. However, in dark skin, including brown skin, dark brown skin, Black skin, and other darker skin tones this redness may be difficult to see. Eczema flare-ups tends to look darker brown, purple or ashen grey in color. In the absence of characteristic redness, skin swelling, warmth, dryness/scaling or itching and oozing may help patients and physicians confirm the diagnosis. Lichenification is also one of the eczema symptoms that may appear differently in darker skin tones. The itching due to eczema has been shown to have a greater impact in Black patients, who are also more likely to have severe disease.
Beyond differences in severity, skin color and symptoms of eczema, unique forms of atopic dermatitis may be seen in darker skin tones. Black Americans more commonly develop small bumps on the torso, arms and legs . Sometimes, bumps develop around hair follicles and resemble goosebumps .
Black Americans also tend to have more extensive skin dryness and dark circles around their eyes. People who repeatedly rub and scratch the eczema-prone areas may develop skin thickening and firm, raised bumps on the skin called prurigo nodules.