About 10% of Americans – almost 32 million people – have atopic dermatitis (AD). While people of all skin colors, races, and ethnicities can have the condition, it tends to be more severe among Black and Hispanic people.
Left untreated, or poorly treated, atopic dermatitis, has enormous consequences. People with AD have to cope with significant sleep loss at night, due to itching, as well as social stigma, and, if they are younger, miss school days. It can also lead to depression, anxiety, and even skin infections.
Unfortunately, research suggests that people of color often don’t get the care they need. Black and Hispanic children are almost three times as likely to end up in the emergency room for their atopic dermatitis than White ones. This may be because they’re less likely to see specialists like dermatologists (skin doctors), get misdiagnosed by their primary providers, or skip necessary medical care and medications entirely.
Here’s a closer look at health care barriers for Black and Hispanic people, plus ways to help ensure equal access to treatment.
Barriers to Health Care for People of Color
There are a few reasons why Black and Hispanic people with atopic dermatitis don’t get the same level of care as White patients:
Less access to health care. More than 60% of Black adults say that they have less access to quality medical care where they live, according to a 2020 Pew research survey. That can make it harder to find doctors who can treat atopic dermatitis. Research also shows that there are fewer primary care providers and pharmacies where Black Americans live.
Some Black people may also be less likely to have health insurance than White people, and even when they do have coverage, they are more likely to spend more on health care. While the average American family spends just over 10% of their household income on health care costs, for Black people, that’s closer to 20%.
Misdiagnosis. It can be harder to diagnose atopic dermatitis in people of color. Medical school textbooks often show pictures of atopic dermatitis on fair skin, where it shows up as a red rash. But in people of color, atopic dermatitis may look dark brown, purple, or ash gray. People of color are also less likely to see a dermatologist, although when they do go, they are much more likely to be diagnosed with atopic dermatitis.
Social and economic factors. Some people of color may be more likely to live in lower-income neighborhoods, where they are exposed to more triggers like dust, smoke, bugs, or pollution. They may also lack transportation, which can limit doctor appointments. Some people with atopic dermatitis also have food allergies, but they do not have access to allergy-safe foods.
More severe disease. Black and Hispanic people with atopic dermatitis are more likely to have severe, persistent symptoms than White people. There may be some genetic factors that make people of color more likely to have severe atopic dermatitis. One main cause of atopic dermatitis is trans-epidermal water loss (TEWL), or water loss from your skin. TEWL tends to be greater in Black skin. Research also shows that Black people have less fat on the top layer of their skin, which helps to protect against this water loss.
Once atopic dermatitis gets better, people of color are also more likely to have pigmentation changes. Their affected skin may look lighter or darker than the surrounding skin. It may bother patients more than their original atopic dermatitis.
Under-diagnosis of food allergies. Black children are about 40% more likely to have food allergies than White children, which can contribute to atopic dermatitis.
Lack of trust in doctors. Over half of Black adults say they have had at least one bad experience with a doctor. 40% said they had to speak up to get the right care, and a third said they felt rushed. All of these things can make it less likely that you’ll feel comfortable with your health care provider. Also, while about a third of Black patients said they’d prefer to see a doctor with the same skin color, only 3% of all dermatologists in this country are Black.
How to Ensure Equal Access to Treatment
While there are racial disparities when it comes to access to treatment for atopic dermatitis, there are things you can do to help reverse them.
Enroll in clinical trials. New drugs for atopic dermatitis are constantly being developed. A clinical trial is a great way for people to access them. But many people of color don’t take part in clinical trials. A 2023 review published in the Journal of the American Academy of Dermatology found that while Black people make up almost 14% of the population, they make up less than 8% of people in dermatology clinical trials.
Many Black people say they are nervous to do clinical trials because in the past, they have been mistreated. They worry that they will be experimented on or used as a test case. But there are specific safeguards put in place now at major medical centers to prevent that from happening. Clinical trials may also pay for your travel costs. Talk to your doctor to find out if there are any clinical trials right for you. You can also search for them at ClinicalTrials.gov.
Look for culturally friendly providers. It’s important to find a doctor who recognizes the signs of atopic dermatitis in Black or brown skin. Many major medical centers offer Skin of Color clinics, where health care providers mostly treat patients of color. You can also look for a provider on the Skin of Color website. If you mostly speak another language, you’ll want a doctor fluent in your language. Your health insurance company may be able to provide a list of providers. You can also check on the doctor’s website.
Know the signs of atopic dermatitis. You can’t rely on your primary care provider to recognize atopic dermatitis. Both PCPs and dermatologists are less likely to diagnose skin problems in dark skin versus lighter ones, according to a 2024 paper published in Nature Medicine. One good resource is the Eczema in Skin of Color website. It has an image gallery to help you recognize signs of skin conditions, including atopic dermatitis.
Consider telemedicine. Even if you do find a doctor who has experience with skin of color, there are other barriers to care. It can be hard to see a dermatologist if you need to take time off from work. You also need transportation to get there. Another, easier option may be a televisit, where you have a video visit with a doctor. They are able to look at your skin online. Research suggests it may work as well as seeing a health care provider in person.
Talk to your doctor about the cost of treatment. Atopic dermatitis care is very expensive. Over 40% of people who have it spend over $1,000 on out-of-pocket costs each year, according to the National Eczema Association. Black people often have even higher costs, due to more severe disease. Your doctor may be able to offer ways to help, whether it’s providing you with free samples, connecting you to drug assistance programs, or switching you to a different medication. Keep in mind the cost of over-the-counter treatments, too. One of the first-line treatments for atopic dermatitis is frequent moisturizing. But moisturizing products can be expensive. One study found that adults could spend up to $300 a year on over-the-counter moisturizers.
Make sure you have access to safe foods. Some patients with atopic dermatitis have food allergies. But people with food allergies may spend up to 30% more on groceries than those without food allergies. If you have limited options for safe food, or for food made without top allergens like nuts, eggs and milk, there are organizations that can help. Groups like Securing Safe Food, for example, provide allergy-friendly foods to food pantries across the United States.
People with atopic dermatitis who don’t have food allergies may still find that their symptoms flare when they eat certain foods. It’s best to follow a plant-rich diet that’s high in fruits and vegetables and low in processed foods.
Ask about treatments. People of color should avoid topical corticosteroid creams, which can lighten the skin. You should use other creams known as calcineurin inhibitors, such as Elidel (pimecrolimus) or Protopic (tacrolimus). Another option is Eucrisa (crisaborole).
If your atopic dermatitis is more severe, there are other, more effective treatments available, like biologics or JAK inhibitors. People of color are less likely to have access to them. A 2024 study published in The Journal of Allergy and Clinical Immunology found that Black and Hispanic children were much less likely to be given the biologic dupilumab (Dupixent) than White children. Bring those up, if they don’t tell you about them.
Show Sources
Photo Credit: Digital Vision/Getty Images
SOURCES:
National Eczema Association: “Eczema Prevalence, Quality of Life and Economic Impact,” “Eczema on black skin: pictures, symptoms and treatment,” “Science of eczema on skin of color,” “NEA Research Survey on Out-of-pocket Expenses for Eczema,” “A Dermatologist Explains The Basics of Food Allergies and Eczema,” “Social and Economic Factors.”
Journal of the American Medical Association: “Atopic Dermatitis (Eczema).”
The Journal of Allergy and Clinical Immunology: “Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations,” “Racial and ethnic disparities in dupilumab for pediatric atopic dermatitis in Florida.”
Pew Research Center: “5 facts about Black Americans and health care,” “A look at Black and Hispanic Americans’ views on clinical trials.”
The Century Foundation: “Racism, Inequality, and Health Care for African Americans.”
Eczema in Skin of Color: “Social and Economic Factors | Eczema in Skin of Color,” “Eczema in Skin of Color: Diagnosis and Treatment.”
Pediatrics: “The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States.”
Journal of Clinical and Aesthetic Dermatology: “Practice Characteristics of Self-Identified Black Dermatologists in the United States.”
Journal of the American Academy of Dermatology: “Racial and ethnic underrepresentation in dermatology clinical trials.”
Nature Medicine: “Deep learning-aided decision support for diagnosis of skin disease across skin tones.”
Journal of Cutaneous Medicine and Surgery: “Teledermatology in Atopic Dermatitis: A Systematic Review.”
Archives of Dermatology Research: “Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States.”
Pan Foundation: “Tips for saving money on prescription medication.”
Pediatric Dermatology: “State medicaid coverage of over‐the‐counter moisturizers: A cost‐effective management strategy for atopic dermatitis?”
Allergy & Asthma Network: “What Can You Do If You Can’t Afford Allergen-Free Foods?”
American College of Allergy, Asthma & Immunology: “Racial Disparities in Atopic Dermatitis and Food Allergies.”
