Expert perspectives: Why is eczema more common among Black people?

Although eczema may appear at any age, it usually develops in childhood.

A 2014 study analyzed data from the 2005–2006 National Health and Nutrition Examination Survey to learn how eczema affects children in the United States. It found that eczema affected an estimated:

• 19.3% of African American children
• 16.1% of European American children
• 7.8% of Hispanic children

The most common type of eczema is atopic dermatitis (AD).

More research is necessary to learn why eczema is more likely to affect Black children. Multiple factors likely play a role, including genetic and environmental factors.

“We know that there’s a strong familial trait to eczema, and a lot of it has to do with a genetic component,” Dr. Jeffrey T. S. Hsu told MNT. Dr. Hsu is a board certified dermatologist and the co-founder and co-director of Oak Dermatology in Naperville, IL. He specializes in the treatment of skin of color.

Children may inherit genetic mutations from their parents that raise their risk of eczema. A 2015 review found that many of these mutations occur more often in certain ethnic groups than in others. This may help explain the differences in the rates of eczema to some extent.

A 2021 review reports that exposure to certain chemicals, pollutants, and allergens may also increase the risk or severity of eczema. For example, people are more likely to develop eczema if they live in urban areas or have exposure to allergens, such as dust and mold.

Due to housing discrimination and other forms of structural racism, Black people may have an increased risk of harmful environmental exposures. However, more research is necessary to understand the role of specific environmental risk factors.

Psychosocial stress may also increase the risk and severity of eczema.

Eczema typically causes an itchy, inflamed rash or scaly patches of skin. These symptoms present differently depending on the color of the person’s skin.

“In white Americans, the color appears pink or red, whereas in Black Americans, it tends to appear violaceous [purple], brown, or gray,” said Pritchett.

Other common symptoms of eczema include:

• itching
• swelling
• dry, cracked skin
• unusually warm skin
• oozing, weepy, or crusty sores

Black people with eczema are also more likely to have:

• follicular accentuation, or bumps around the hair follicles
• papular eczema, or small bumps that often appear on the torso, arms, or legs
• lichenification, or thickened or firm skin
• dark circles around the eyes
• long-term skin discoloration

“Black Americans may develop dark or light discoloration of the skin that can last for many months after the eczema resolves,” Pritchett said. In some cases, this discoloration may negatively affect a person’s self-image and quality of life.

The early diagnosis and treatment of eczema are important for relieving symptoms and reducing the risk of scarring and discoloration.

“If we are able to get patients on the right treatment to reduce inflammation, and we educate them about what to do and what not to do so they stop scratching, then we are much more likely to prevent long-term discoloration and scarring,” said Dr. Hsu.

However, many Black people with eczema may not get the treatment they need.

In a 2017 study in the U.S., researchers analyzed healthcare utilization data from 2001–2013. Among children with eczema, Black children were less likely than white children to have visited a doctor for the condition. However, Black children who had visited a doctor received more prescriptions and were more likely to see a dermatologist. This suggests that they might have had more severe eczema by the time they received treatment.

The study authors note that financial or insurance barriers to care did not fully explain the gap in care. They highlight the need to identify and address other potential factors, such as social stressors, understanding of eczema, trust in the medical system, and access to care.

Black people may face several barriers to getting a diagnosis and treatment for eczema. Some of these barriers relate to gaps in knowledge about the condition. Others are due to larger disparities in healthcare access.

Gaps in knowledge

Gaps in eczema-related knowledge among Black people and their doctors may contribute to delays in diagnosis and treatment.

“A lot of Black Americans and skin-of-color patients don’t realize they’re more at risk for this condition, so they may not seek treatment,” said Dr. Hsu.

“Even if they do seek treatment, physicians are not getting a broad education regarding different skin tones, so a lot of physicians, especially non-dermatologists, tend to misdiagnose eczema,” he continued.

In a 2018 study, researchers analyzed imagery from popular medical textbooks. The images in most textbooks underrepresented dark skin and overrepresented light skin. Overall, less than 5% of the images showed dark skin.

A 2020 analysis that focused specifically on dermatology textbooks also found limited representation of skin of color.

“We need to educate medical students, residents, and dermatologists on how to diagnose eczema in darker skin by increasing the number of photographs that are available in textbooks and online resources,” said Dr. Pritchett.

“We need to increase representation of Black, Indigenous, and People of Color in research,” she added.

To raise awareness of eczema symptoms in People of Color, the American College of Allergy, Asthma & Immunology and the Allergy & Asthma Network have launched the website Eczema in Skin of Color. This website includes an image gallery and other resources to help people recognize symptoms of eczema in skin of color.

Healthcare access

Broader disparities in healthcare access may also pose barriers to eczema diagnosis and treatment.

A 2021 study in the U.S. found that Black people are more likely than white people to:

• lack health insurance
• have no usual source of medical care, such as a primary care physician
• face financial barriers to accessing medical care and paying for treatments

Dr. Candrice Heath told MNT that improving health equity and ensuring access to dermatologists is important for reducing the impact of eczema among Black people.

Dr. Heath is a board certified dermatologist and an assistant professor of dermatology at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. She is also the National Secretary-Treasurer of the Skin of Color Society, an organization that promotes awareness of skin-of-color dermatology.

“This is an exciting time in science and medicine due to the advancing treatments in AD,” she told MNT. “Striving for health equity ensures that these treatments will be accessible to everyone.”

If someone suspects that they might have eczema, they should make an appointment with a doctor.

The recommended treatment for eczema is similar across racial and ethnic groups.

Doctors typically encourage people with eczema to minimize their symptoms by:

• bathing regularly, using lukewarm water and gentle cleansers
• applying moisturizer at least once a day and preferably after bathing
• avoiding scented and harsh skin care products
• avoiding heavily fragranced detergents, fabric softeners, and other cleaning products
• avoiding certain fabrics, such as wool, angora, or mohair, as they may contain lanolin or irritate the skin

A doctor may also recommend one or more of the following treatments:

• topical medication, such as a medicated cream or ointment
• oral or injectable medication
• phototherapy

It is also important to limit triggers that make eczema symptoms worse. These triggers will vary among individuals, but they can include factors such as stress or diet, in addition to those in the list above. A healthcare professional can help a person identify their triggers and take steps to limit their exposure to them.

Eczema has a higher prevalence among Black children than among white children. The condition also tends to be more severe in Black people.

Gaps in eczema-related knowledge — including some doctors’ inexperience in treating skin of color — may lead to delays in diagnosis and treatment in Black people. Many Black people also face other barriers to accessing medical care.

Getting treatment for eczema can help relieve the symptoms and reduce the risk of long-term scarring and skin discoloration. If a person thinks that they may have eczema, they should speak with a doctor as soon as they can. The doctor may recommend changes to their skin care routine, medication, or other treatments and might refer them to a dermatologist.