Context:

Atopic dermatitis, a prevalent form of eczema, manifests differently on darker skin tones, often appearing as ashen gray, purple, or darker brown, which complicates diagnosis. Individuals with darker skin may experience extensive dryness, appearing as dull, ashy, flaky skin that can lead to cracking and thickening with prolonged scratching. The condition can also cause small, itchy bumps and significant pigment changes post-flare, with hyperpigmentation or hypopigmentation lasting for extended periods. Prevalence of atopic dermatitis is higher in Black, Hispanic, Asian, and Pacific Islander children compared to their white counterparts, with environmental factors and access to care contributing to these disparities. Treatment strategies focus on managing dryness, irritation, and pigment changes, emphasizing daily moisturization, careful product selection, and sun protection, with advanced treatments for severe cases if necessary.

Dive Deeper:

• Atopic dermatitis on darker skin presents unique challenges in recognition due to its appearance as ashen gray, purple, or darker brown, deviating from the typical red rash associated with the condition. These color variations can lead to misdiagnosis or oversight by healthcare providers, making awareness crucial for proper care.

• Individuals with darker skin are more likely to experience pronounced and widespread dryness, resulting in dull, ashy, and flaky skin that resembles a sandpaper texture. This dryness can lead to cracking, especially on the hands, feet, and joints, and may cause lichenification, where the skin thickens and becomes leathery due to persistent scratching.

• Atopic dermatitis in darker skin can manifest as small, raised bumps known as papular eczema, which can be intensely itchy and are often mistaken for other skin conditions. These bumps can appear on the chest, back, arms, or legs and may include follicular accentuation, resembling goosebumps around hair follicles.

• Following a flare, areas affected by atopic dermatitis might heal with hyperpigmentation or hypopigmentation, particularly noticeable in darker skin tones. These pigment changes can be distressing, often persisting for months, as the skin color gradually returns to normal.

• The prevalence of eczema is higher among Black, Hispanic, Asian, and Pacific Islander children compared to white children, with symptoms often being more severe. Factors such as environmental conditions, limited access to healthcare, and structural racism contribute to these disparities, impacting the consistency and quality of care received by affected individuals.

• Managing atopic dermatitis in darker skin involves specific strategies to address dryness, irritation, and pigment changes. Key recommendations include daily use of thick creams or ointments, avoiding harsh skincare products, and employing prescription creams for flare management. Sun protection is also emphasized to prevent further pigment alterations.

• Advanced treatment options like light therapy or immune-targeting medications may be necessary for severe cases, while caution is advised when considering herbal remedies due to potential exacerbation of the condition. Consulting with a dermatologist experienced in treating darker skin is crucial for effective management.