Are you living with a rash, itchy skin, or rashy skin? Do you think maybe you have hives?  Maybe the better question to ask is,  “Do I have eczema?” Although eczema is a common skin condition, not all skin conditions are eczema. Eczema is a serious chronic skin condition that can be mistaken for other conditions. There are four main reasons eczema can be hard to figure out:

  • There are seven different types of eczema.
  • Eczema skin lesions, or skin abnormalities, can vary.
  • Eczema looks different on Black skin and brown skin than it does on white skin.
  • Other conditions look similar to eczema.

As a result, people can experience symptoms and not get the right treatment due to misdiagnosis or delayed diagnosis.

There are many different types of eczema

Eczema is a very common skin condition. It affects 31.6 million people in the United States. Eczema is not a single condition, but rather a grouping of several types of skin conditions, not all of which are related to each other. In fact, there are 7 different types of eczema. Each type of eczema has its own unique triggers and causes. Treatment options may vary depending on the type of eczema a person has.

Photo of woman scratching her arm, wondering if she has eczema.

What are the different ways eczema can appear on skin?

People can have differing skin abnormalities associated with eczema.  These variations in how eczema looks and feels may leave people  guessing for the cause, especially if their skin condition and symptoms are not improving. That is when you should be wondering, “Do I have eczema?” Some variations of skin abnormalities associated with eczema include:

  • thinning of the upper layers of skin
  • reddening of the skin on people with light skin.
  • dark brown, ashen gray, or purple skin in people with darker skin
  • rash that looks like goosebumps
  • patches of skin that are darker in color than the surrounding skin
  • patches of skin that are lighter in color than the surrounding skin
  • thickening of skin patches caused by chronic scratching.
  • indented streaks or streaks of darker or different colored skin
  • dilated or broken blood vessels on the surface of the skin
  • excessively dry skin

What are other indicators of eczema?

Some additional indicators of eczema are:

  • itching
  • flaking
  • cracking
  • swelling
  • open oozing skin
  • crusting
  • dry skin
  • sensitive skin

Video: Is my Itchy Skin Eczema?, with Kelly Maples, MD

Do I have eczema… or do I have some other skin condition?

Some people may develop a skin condition that may appear to be eczema or involve  similar symptoms to eczema.  These skin conditions may include:

  • psoriasis
  • scabies
  • allergies
  • hives
  • ringworm
  • acne
  • cutaneous t-cell lymphoma
  • Netherton disease
  • hereditary angioedema
  • chronic idiopathic urticaria

Many of these conditions may have similar appearances to eczema or even overlap with eczema. That’s why it is very important to work with an allergist or dermatologist for diagnosis and treatment.

Why is eczema harder to diagnose on Black skin or brown skin?

Perhaps more than any other medical specialty, doctors need to look at the skin to make an accurate diagnosis. And though it shouldn’t be surprising, skin conditions often appear differently on different skin colors.

Like most areas of medicine, non-white skin types are underrepresented in the literature. Medical  textbooks and journals might be chock-full of pictures, but often the majority show white people. Doctors in training may have limited resources to help them learn to identify skin conditions in non-white people – though that has begun to change in recent years.

Imagine a doctor in a rural part of the country with limited diversity. An African American arrives at the office with itchy skin. The doctor may have limited experience treating Black patients, so they reference a textbook only to find out that what they are seeing is not found in a textbook. They may then do an online search, only to find similar limitations. This could lead to a misdiagnosis or a delay in diagnosis and treatment.

The Eczema in Skin of Color website offers doctors and patients information and an image gallery to identify symptoms on different skin colors. This resource is designed to help people of color get an accurate and quicker diagnosis of eczema.

“Do I have Eczema?”  – A patient story

Sometimes it’s hard to tell if you have eczema – for both patients and doctors. Angela is a 35-year-old African American woman. She has a history of allergies but is otherwise healthy. Several months ago, she started having patches of itchy skin. At first, Angela thought it might be a new laundry soap she used, so she switched back to her old one, but the itching got worse. She tried several over-the-counter lotions, which provided limited relief.  Angela made an appointment with her primary care doctor, who listened to her symptoms, did a physical exam, but didn’t observe anything obvious. The doctor thought it might be a new allergy and suggested Angela start taking over-the-counter allergy medication.

Several months go by and Angela is miserable. The allergy medicine did nothing to help her symptoms. She developed several patches of thick, itchy skin. The constant itching is causing her to lose sleep. Angela finally decided to make an appointment with a dermatologist who had experience treating African American patients. The dermatologist listened to Angela’s story, evaluated her skin, and noted thickened patches of darker skin where she complained of itching. He diagnosed her with eczema and started treatment. After nearly a year of symptoms, Angela finally had a diagnosis and was hopeful the treatment would provide relief.

See an allergist or dermatologist if your skin is not improving

There is something you can do if you have a persistent rash, dry or itchy skin, or think you have hives. Go to a board-certified allergist or dermatologist to get a thorough evaluation – or to get a second opinion if necessary. It is not uncommon for eczema to be misdiagnosed. There is no need for you to suffer with pain, itching, lack of sleep, or even anxiety and depression as well as other quality of life issues. You deserve to get relief and feel better.

While eczema is a chronic skin condition, it is treatable. The correct diagnosis of eczema is an important first step. If you think you may have eczema or a similar skin condition, make an appointment with an allergist or dermatologist.

Reviewed by:
Weily Soong, MD, is a board-certified allergist and immunologist and Chief Medical Officer with Allervie Health (previously Alabama Allergy & Asthma Center). Dr. Soong also serves as Medical Director of the Clinical Research Association of Alabama.