ECZEMA IN SKIN OF COLOUR
At Aveeno, we are committed to advancing skin health equity, eczema awareness, and addressing the education gap in skin of colour.
In the US, Eczema is the second most frequent skin disease to affect Black skin, 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 US 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.
A US Study also showed that people of colour 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.
This is why we collaborate with industry experts and healthcare professionals, like the Canadian Dermatology Association, to help advance health equity, creating more positive health outcomes for Canadian consumers and patients. And while organizations like the Canadian Dermatology Association are making inroads to increase awareness, education and improve barriers to care, it’s imperative everyone, regardless of colour, be proactive in their own skin care, becoming knowledgeable about your symptoms and being able to explain to your healthcare provider in detail what you’re experiencing will be helpful in your diagnosis.
HOW IS ECZEMA DIFFERENT IN SKIN OF COLOUR
Eczema can look quite different on darker skin tones. Eczema is commonly thought of as a red, dry, and itchy rash – how it appears on lighter skin tones. But redness can be a challenge to detect on darker skin tones which may make diagnosis more difficult.
On darker skin, patches may appear darker than the rest of the skin, looking purple, ashen grey, or dark brown.
When examining your skin, your healthcare provider will look for an area of unimpacted skin first – skin without lesions, to determine the difference in colour and texture compared to areas where you have active symptoms.
Studies have shown that melanin-rich skin does not retain as much water as lighter skin tones, which means that in general, black people are more likely to have dry skin. Although eczema can be found anywhere on the body, eczema on black skin is often found on the fronts of the arms and legs.
Other signs to look for:
- Very dry or scaly skin
- Intense itching
- Skin thickening (lichenification)
- Dark circles under the eyes
- Small bumps on torso, arms, or legs (called papular eczema)
- Bumps that develop around hair follicles and resemble goosebumps (called follicular accentuation)
A major concern for black skin is the discoloration associated with eczema. Researchers believe black skin with eczema has higher levels of inflammation. The scratching secondary to the irritation, look of redness and itch of eczema can lead to discolorations, in which an area is lighter or darker than the surrounding skin. This discoloration can last for months, even after the eczema is treated.
Given the tendency to develop long-lasting pigmentary changes in skin of color, it’s important to diagnose and treat atopic dermatitis early and aggressively.
ECZEMA IN CHILDREN OF COLOUR
Eczema is particularly common in babies and young children, with 10 to 15% of Canadian children under 5 affected. The risk for severe atopic dermatitis (AD) may be 6 times higher in black children compared to white children and is also thought to be more treatment-resistant.
Although AD severity improves for some patients in adolescence, it can be a lifelong issue affecting performance in school. One study found that black children were 1.5 times more likely to be absent for 6 days over a 6-month period compared to white children. 
 ELSEVIER. (2022). Pediatric dermatology, an issue of Dermatologic Clinics.
 Wan, J., Margolis, D. J., Mitra, N., Hoffstad, O.J., Takeshita, J. (2019). Racial and ethnic differences in atopic dermatitis related school absences among US children. JAMA dermatology. Retrieved 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537763/