Eczema is a chronic inflammatory skin condition that affects people of all races and ethnicities. Monica Veloz, a style and beauty influencer who’s lived with eczema since high school, remembers when her symptoms first appeared on her face as a teenager and she didn’t recognize them as eczema at all.
“Latinos always think they can diagnose,” says Veloz. “And they have something in the cupboards they can whip up to help you.”
For Veloz and her Afro-Latina family, home remedies were the first response. She thought her symptoms must be “just a rash” or possibly ringworm.
“But I got to the point where I was so inflamed that I didn’t want to go to school,” she says. “Once my mom saw how much I was struggling, she made an appointment with the doctor.”
Finally, Veloz had a name and cause for her symptoms — and a path to treatment. While she still values home remedies like oatmeal baths, she encourages medical care as the first step.
“Go see a doctor first, for diagnosis and medical treatment,” she says.
But eczema doesn’t look or act the same on every skin color. For millions of people with darker skin tones, for example, eczema rash isn’t always red, even though most medical sources list red patches as a common symptom. Much of what doctors have learned about eczema in the past has come from studies on people who are White.
Even though that narrative is changing with more intentional diversity in clinical trials and broader definitions of what eczema looks like, it’s important to know more about how eczema may look for you, your culture, and your life.
How Common Is Eczema in People of Color?
Eczema symptoms most commonly start in childhood. Research shows that Black children get eczema in greater numbers than White children, and their eczema tends to be more severe and constant. Researchers aren’t able to pinpoint the exact reason for these differences.
These disparities are influenced by a combination of factors, including genetics, environmental exposures, stress, and unequal access to dermatologic care.
One key reason for the difference in severity may be missed or late diagnoses, says Roopal V. Kundu, MD, professor of dermatology and medical education at Northwestern University Feinberg School of Medicine.
“Redness is one of the classic signs we’re taught to look for, but when someone has more melanin in their skin, that redness can be masked,” she says. “That can delay diagnosis.”
Because the signs of eczema on darker skin tones don’t always match textbook descriptions, people sometimes self-diagnose dry skin, a rash, or some sort of fungal infection instead.
What Eczema Looks Like on Darker Skin
On lighter skin, doctors describe eczema as red, inflamed, scaly patches. On darker skin tones, redness is harder to see. Instead, eczema patches tend to be:
- Gray
- Brown
- Purple
Eczema rashes on darker skin tones can also have different textures and features than rashes on White skin do.
“Because there are some biological differences with the skin beyond melanin, there are other components of the skin that are a little different,” says Kundu.
Eczema in darker skin often shows up as:
- Bumps around hair follicles
- Thickened skin (lichenification, which can happen from scratching)
- Skin swelling
Having more melanin also puts you at risk for visible marks on your skin that can last long after the inflammation improves, a condition called post-inflammatory hyperpigmentation.
“Post-inflammation hyperpigmentation is often the most upsetting symptom for people,” says Kundu. “We often have to treat both the eczema and the pigment left behind, and pigment takes time.
The Emotional Impact of Visible Skin Disease
Aside from the physical discomfort of the itch-scratch cycle eczema rashes cause, it can also affect your sleep, concentration, and mental health.
“People are literally uncomfortable in their skin,” Kundu says. “And it’s visible. That makes it especially distressing.”
Veloz remembers wanting to hide during flare-ups. Over time, showing up bare-faced in her videos on her YouTube channel MonicaStyleMuse and sharing her experience helped her feel less alone.
“It opened up conversation for people who looked like me,” says Veloz.
Not only was she someone living with eczema, but she was an Afro-Latina living with eczema. And she wanted people to see what that was like and know they aren’t alone.
“You'd be surprised at how many people can relate to your story,” says Veloz. “Lean into your community.”
Culture Matters: Getting the Right Care
Cultural practices and beliefs can influence how you manage your eczema. Kundu says that when doctors understand those preferences, you get better care.
“That may affect whether we recommend ointments, creams, or oils, and how we build a treatment plan that actually works for someone’s life,” she says.
Access also matters. People of color are less likely to see a dermatologist, and many feel more comfortable with providers who understand their skin and cultural context.
“My mom was very adamant about having either a Latino doctor or a Black doctor,” says Veloz. “And that's how I kind of navigate my adulthood too. [Find] doctors who look like you, who talk like you, because 9 times out of 10, they've seen this before.”
Kundu feels hopeful about the positive shift toward more inclusive and comprehensive care for skin of all colors at a high level within the American Academy of Dermatology, for example, and also continues to encourage people of color to learn what they can about their skin’s unique makeup.
“Understanding what eczema can look like on your skin tone is empowering,” Kundu says. “It helps you say, ‘This might be me, and I should get it checked out.’”
