Eczema Looks Different on Melanated Skin — Here's How to Treat It

It's one thing to experience a difficulty with locking moisture in your skin from time to time, but if the occasional itchiness and dryness linger, causing your skin to feel scaly, patchy, or like sandpaper, you may have eczema. Those with the skin condition know it can be quite a challenge to get under control, especially when flare-ups seem to keep developing overnight with no clear cause.

For anyone with melanin-rich skin, this condition may be even more challenging to navigate, especially because Black skin is typically underrepresented in dermatological research, with only 4.5 percent of medical textbooks showing conditions on dark skin, according to a study published in "Social Science & Medicine." This makes it difficult to recognize and identify what skin conditions are presented and how you're supposed to treat them, as well as advocate for a proper diagnosis.

That's why we chatted with Jessica Shepherd, PhD, chief medical officer at Verywell Health, who recently helped launch its Health Divide: Skin Conditions and Darker Skin, to discuss how eczema looks on melanated skin, what causes it, and how to care for it.

Jessica Shepherd, PhD, is the chief medical officer at Verywell Health.

Sharon Wong is a UK-based consultant dermatologist.

"Eczema is a common inflammatory skin condition that causes dry, itchy, red, or scaly skin and affects about 10 percent of all people in the US," Dr. Shepherd tells PS. "It's generally not harmful but can be uncomfortable if left untreated."

It's a chronic condition where an overactive immune system leads to an impaired skin barrier that can cause dry, itchy skin and even skin infections. It can appear as early as infancy and usually shows up on the face, elbows, and knees. From there, it can eventually spread to other parts of the body.

Medically, it's called atopic dermatitis, and dermatologists typically diagnose eczema by its appearance and occasionally by biopsies to exclude any other issues. What makes the skin condition more complicated, however, is that it manifests itself differently for everyone.

Eczema can be caused by a few things including genetics, environment, stress, or even allergies and asthma. If someone in your family has eczema, you're more likely to develop it at some point during your life. Your environment can play a role as well — air pollutants, harsh detergents or soaps, low humidity, smoking, and more can all cause outbreaks. Other factors like being stressed, having asthma, or allergies are likely to cause inflammation.

Research has shown that eczema is more common on dark skin and more likely to be misdiagnosed. In fact, eczema is more likely to affect Black children than those of other ethnicities. According to the National Eczema Association, 20 percent of Black children in the United States have some form of eczema. That's compared to 13 percent of Asian children, 13 percent of Native American children, 12 percent of white children, and 11 percent of Hispanic children. When it comes to adults, 11 percent of Hispanic adults are diagnosed with eczema, with nine percent of Asian adults and eight percent of both Native American and Black adults being impacted by the skin condition.

Most symptoms tend to be the same for people with darker versus lighter skin; however, those with darker skin may also experience changes in skin color on the affected area, swelling or oozing, or a thickening of the skin.

Treatment of eczema on melanated skin is more or less the same, but what's more important is recognizing and diagnosing the condition early on. While eczema is more common on darker skin, it's often misdiagnosed or not managed properly. This is mostly due to the condition being less noticeable on darker skin and healthcare providers not being familiar with treating darker skin. That can then lead to delayed treatment, which can make managing eczema more difficult.

If you do identify the condition, there are a few key steps to take. "When eczema is flared, pare back to simple skin care," UK-based consultant dermatologist Sharon Wong says. First, it's best to stay away from irritants and cut out all soaps, fragrances, and detergents as necessary; this is to ensure the skin isn't exposed to further irritation and make sure it's not stripped of its natural oils. Dr. Wong also advises not to use plant or natural oils, as these aren't as effective as moisturizers for eczema and may potentially trigger further sensitivity.

Instead, be prepared to moisturize a lot using specially formulated creams. There are many lotions on the market that are specifically tailored for those with sensitive skin and/or eczema; they can help soothe flare-ups and prevent new ones from happening. "It's not uncommon that during a severe flare-up involving a large surface area of the body, your skin will require 500 g of moisturizer every one to weeks," Dr. Wong says. This means it's essential to top up on moisturizer throughout the day and pay close attention to particularly flared areas of the skin. When it comes to perfumes or anything you directly spray onto your skin, try a test patch before using it all over your body.

The specific ingredients include ceramides (found in the CeraVe Moisturizing Cream ($15)), glycerin (a top ingredient in the Curel Daily Healing Lotion ($11)), and liquid paraffin, which is often in thicker moisturizers like the Epaderm Ointment ($19), as these "will essentially act like a plaster while the skin barrier is broken down during a flare-up, which allows the skin to heal," Dr. Wong says. When it comes to body wash, you should also look out for soap alternatives, such as the Dove Sensitive Skin Unscented Beauty Bar ($12) or the Aveeno Skin Relief Moisturizing Body Wash ($11).

CeraVe Moisturizing Cream

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$15

$15 at Target

Curel Daily Healing Lotion

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$11

$11 at Target

Epaderm Ointment

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$19

$19 at Amazon

Dove Sensitive Skin Unscented Beauty Bar

From

$12

$12 at Target

Aveeno Skin Relief Moisturizing Body Wash

From

$11

$11 at Target

As much as what you put on your skin matters, it's also important to consider internal aggressors that could be leading to your eczema manifesting externally. Try to keep stress under as much control as possible, and wear loose-fitting clothes since tighter options can cause friction that further aggravates the skin. Since dramatic temperature changes can lead to flare-ups, try changing the temperature of water when showering or bathing. Obvious as it may sound, washing clothes and sheets regularly can also help prevent pollutants from making contact with skin. With eczema, every little thing you can do makes a big difference.

Tori Crowther is a freelance beauty journalist and former PS UK editor.

Natalia Pérez-Gonzalez is an Afro-Latina journalist who is passionate about stories at the intersection of culture, identity, and health.