Q: What are some special considerations when treating eczema in people of color?

Dr. Maples: Eczema in people of color is treated the same as for eczema in all patients – but there are special considerations. Atopic dermatitis, a form of eczema, can look different on certain skin tones. For example, a rash on skin of color can appear as darker brown, purple or gray patches. In addition, atopic dermatitis tends to cause more severe symptoms in skin of color.

When treating people with skin of color, it’s important to get a correct diagnosis. Sometimes dark brown spots can be mistaken for post-inflammatory hyperpigmentation (a darkening of the skin) when it’s actually active atopic dermatitis. If this occurs, moisturizers may not be enough in terms of treatment.

When treating eczema, you always want to start with the basics: a good skin care regimen.

  • After baths, moisturizers are essential. Use a thick cream or ointment-based moisturizer, preferably one that contains ceramides to help restore the skin barrier.
  • Moisturizers should be applied immediately after your bath.
  • Use soap-free and detergent-free cleansers to protect the integrity of the skin barrier.
  • If you have moderate or severe eczema, apply moisturizers several times per day.

Topical anti-inflammatory medications such as corticosteroids or calcineurin inhibitors are often necessary to treat eczema. A special consideration in skin of color is to avoid overuse of higher potency topical corticosteroids. These medications can cause hypopigmentation, or a lightening of the skin. This can be more obvious in people of color – and it’s often more bothersome to them. Consider topical calcineurin inhibitors or phosphatase esterase inhibitors instead.

If eczema is still uncontrolled even after moisturizers and topical treatment, the next step may be biologic medications. There is one biologic available for eczema – dupilumab. This injectable medication targets cells that begin the immune response that causes skin inflammation. Many patients with moderate to severe eczema are able to achieve clear skin or almost clear skin using dupilumab.

Hopefully in the not-too-distant future, there will be new eczema therapies that can treat people with skin of color.

Q: When should people of color see a specialist for treatment?

Kelly Maples, MD: When basic skin care and topical anti-inflammatory medications are not effective, or eczema is impacting quality of life, that’s when you should consider going to a specialist such as an allergist or dermatologist.

Allergists can help when:

  • your skin is not responding to mild to moderate topical corticosteroids or topical calcineurin inhibitors
  • you’re having trouble sleeping due to eczema
  • you’re concerned about the appearance of your skin

Allergists can also help identify eczema triggers and set up a plan to prevent symptoms before they develop.

Kelly Maples, MD, FACAAI, is a board-certified allergist and immunologist at Children’s Hospital of The King’s Daughters in Norfolk, Virginia. She is also Associate Professor of Pediatrics and Internal Medicine at Eastern Virginia Medical School. She is on the American College of Allergy, Asthma & Immunology (ACAAI) Board of Regents and is Chair of the ACAAI Dermatology Committee.

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