Atopic Dermatitis in People of Color

This article is for people of color living with atopic dermatitis (AD) and their care partners, or anyone who wants to learn more about AD. The goals of this activity are to increase awareness about AD in people of color and help people engage in shared decision-making with their doctors.

You will learn about:

• What AD is and what causes it

• Symptoms of AD and what it may look like depending on your skin tone and your race/ethnicity

• AD management and treatment

• Possible side effects of treatment

• Questions to ask your doctor

Atopic dermatitis, or AD, is a chronic inflammatory (long-term swelling) skin condition and the most common type of eczema.

Anyone can have AD at any age, but it tends to happen more often in children, usually before age 5. Certain racial or ethnic groups may also be at a greater risk for AD. In the United States, more Black or African American children have AD compared with children of other races/ethnicities.

AD is thought to be caused by a combination of your genes (traits you inherit from your parents) and your environment.

Changes (mutations) in genes that affect your skin can be passed on, so AD often runs in families. These changes can also happen more often in certain racial or ethnic groups.

Exposure to allergens (substances that cause allergic reactions) in your environment like dust or pollen can also increase your chances of AD. People who have asthma or allergies, or a family history of them, are more likely to have AD.

AD can be different for different people. It can range from mild to severe and can develop on any area of your skin.

Symptoms can include:

• Dry, itchy skin that may be swollen, raw, cracked, scaly, or thickened

• Skin with tiny bumps

• Rashes or patches, especially on your hands, wrists, feet, ankles, inside of your elbows and knees, upper chest, neck, face, eyelids, and scalp

• Scalp or face patches that bubble up and ooze, especially in babies

With AD, you often have patches of skin that are a different color from the rest of your skin, but these areas can appear differently depending on your skin tone and your race or ethnicity.

In people with lighter skin, patches often look red and scaly. People who are Asian may have red patches covered with thick, silvery scales. And people with darker skin or brown or black skin, usually have patches that look dark brown, purple, brownish-grey, or ashen grey.

In addition to how patches may look, Black or African American people may also have AD symptoms such as:

• More skin dryness or bumpy skin

• Dark circles, folds, or lines around the eyes

• Hard or more thickened skin, including on the palms of the hands and soles of the feet

• More severe itching 

• Healed skin that looks darker or lighter than the surrounding skin

Closeup of an African American teen's forearm and elbow showing skin that is bumpy and darker brown in color due to AD.

If you or your child have symptoms, contact your doctor. You may also see a dermatologist who specializes in treating skin conditions, or an allergist who specializes in allergies.

You may need to try different ways to manage AD over time. For some people, symptoms can get worse (a flare-up), then get better or go away. One of the best ways to help manage AD is to try to prevent flare-ups that can be triggered by factors such as sweat, stress, allergens, and skin irritants such as certain fabrics, soaps, detergents, and cleaners. Sometimes, though, flare-ups can happen without any known cause.

Talk to your doctor about ways to manage AD, including self-care and a skincare routine. Your doctor may also recommend treatments, depending on your age and how severe AD is, that may be used alone or in combination such as:

• Medicines you apply to your skin, such as crisaborole, desonide, pimecrolimus, tacrolimus, or ruxolitinib

• Medicine given by injection, such as dupilumab

• Wet dressings applied to your skin

• Light therapy (phototherapy) that exposes your skin to controlled amounts of light

AD treatment is similar for people of all races and ethnicities, and the goals are the same for all skin types -- to prevent flare-ups while helping improve your skin and your quality of life.

Common side effects that may happen with medicines used to treat AD can include:

• A skin reaction where medicine was applied or injected, such as mild pain, burning, itching, or stinging

• Eye problems such as inflammation, infection, itching, or dryness (dupilumab)

• Headache (desonide, pimecrolimus)

• Cough, fever, or ear, nose, or throat infection (desonide, pimecrolimus, ruxolitinib)

Some medicines you apply to your skin may also cause skin thinning or changes in skin color, such as lighter areas. Long-term light therapy may cause skin aging and an increased risk of skin cancer.

Not all possible side effects are listed here -- be sure to ask your doctor or pharmacist for a full list.

Even if AD treatment is working, you may still have flare-ups. So track your symptoms in a diary and record any changes, flare-ups, and triggers to discuss them with your doctor.

Questions you can ask your doctor can include:

• How can AD symptoms look?

• Are there triggers that could be causing flare-ups or making AD worse?

• What self-care and skincare routine do you recommend?

• Are there any lifestyle changes I should make?

• What treatments are available and what are their side effects?

• What should I do if I start to feel stressed or depressed?

Congratulations!

You have successfully completed the program Atopic Dermatitis in People of Color.

View Additional Materials on this topic that you may find useful:

Atopic Dermatitis

Who Gets Atopic Dermatitis?

What Are the Symptoms of Atopic Dermatitis?

How Is Atopic Dermatitis Treated?

Eczema (Atopic Dermatitis) Causes and Strategies for Prevention

Living With Atopic Dermatitis

Eczema (Atopic Dermatitis) Treatment