The appearance of eczema can vary significantly across skin tones. To better understand eczema across the skin spectrum, ESC spoke with Canadian dermatologist and pediatrician Marissa Joseph, MD, FRCPC, about eczema and skin of colour.
While all skin has colour, when the dermatology community uses the term “skin of colour” we are referring to richer or deeper skin tones, and we recognize that conditions can affect different ethnicities in different ways. As such, skin types can impact our clinical decisions. As a researcher with a special interest in this area of focus, my hope is to create meaningful change and representation so that everyone can have good clinical outcomes with how we treat eczema.
Presently, there are significant gaps in how healthcare providers approach eczema treatment – and other skin conditions – across the skin colour spectrum. Often, healthcare professionals are taught in school about the recognition of skin disease, and it tends to be described in what we would call “white skin.” This has always been reflected in our traditional medical textbooks. There is a need for change because we recognize that there are significant differences across these groups of patients of various skin tones and the way their eczema may be treated.
Eczema is typically characterized by dry, itchy skin that can crack, ooze, bleed, and become rough and/or thick in texture. It is often described as red; however, this is more common in lighter skin tones.
In deeper skin tones, there may be no redness. Instead, it may appear purplish, grayish, or possibly red-brown or even dark brown. It may also present in different areas like on top or in front of the knees and elbows, and not behind or in the folds, as commonly characterized in lighter skin.
Repeated flaring and scratching can also affect skin changes, such as skin thickening, where the skin appears to be thicker and lined. Raised bumps (called prurigo nodules) are also common in deeper skin tones.
Skin pigment changes are very common in eczema and occur almost universally among patients with deeper skin tones. They are not usually permanent, however, they can be very distressing to the patient.
Hyperpigmentation (hyper meaning ‘more’ or ‘excess’) is when the affected skin is darker than the background skin, and hypopigmentation (hypo meaning ‘less’ or ‘under’) is when affected skin is lighter than the background skin. These pigment changes often happen after a flare and are a common complication.
Early intervention and treatment can help address pigment changes from inflammation, and it is important to speak with your doctor if you have any concerns about your medications or skin changes caused by eczema.
Eczema Society of Canada thanks Dr. Marissa Joseph for her volunteer contribution to this educational content.
Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific healthcare needs with a qualified healthcare professional.
Sign up for Eczema Society of Canada’s e-newsletter to get the latest news and expert tips delivered right to your inbox.
Learn about the different types of eczema, tips for managing flares, and more.
