Atopic dermatitis, often known as eczema, happens in people of all races and socioeconomic backgrounds. But research suggests that it’s more common in people of color, and more severe in both Black and Hispanic people. Black children are about twice as likely as White children to receive a diagnosis of atopic dermatitis (AD), and to have severe AD, for example.
People of color also may have more severe atopic dermatitis because of several social and economic factors. These include things like income, education level, and how much you work. The lower your socioeconomic factors, the more likely you are to have severe atopic dermatitis that sticks around.
Here’s a closer look at how such factors play a role, and what you can do about it.
Social and Economic Factors and Atopic Dermatitis
The relationship between socioeconomic factors and atopic dermatitis can be confusing. The higher your social and economic status, the more likely you are to get atopic dermatitis. But a lower socioeconomic status is linked to more persistent, severe eczema.
Socioeconomic factors that play a role in this include:
Access to care. Some people who have a lower socioeconomic status may not have transportation to get them to the doctor's office. That means they may not get treated – and their atopic dermatitis gets worse.
Income. If you don’t make a lot of money, you may not be able to afford health insurance. You may not know that you can apply for Medicaid, or you may make too much money to qualify. As a result, you may not make an appointment for a dermatologist. If you do see one, you may not be able to afford the medications your medical provider prescribes.
Environmental triggers. Some families may live in homes or apartment complexes with allergens such as mold or dust mites that can trigger an allergic dermatitis flare. Research also shows that people who live in areas with worn-down homes or older homes may have more severe atopic dermatitis. If you live in a lower-income community, you may also be more exposed to pollution, which is linked to atopic dermatitis.
Language barriers. People who do not speak English as a first language may struggle with access to medical care, and to understand their health care providers when they do see them.
Certain bacteria. Some people have bacteria on their skin that doesn’t always cause disease. One common bug is Staphylococcus aureus (S. aureus). It can make atopic dermatitis more severe. S. aureus appears to be more common in low-income, urban communities.
Exposure to stress. If you live in a lower-income neighborhood, you may be more likely to go through stress because it’s harder to access health care, transportation, and healthy food. Stress itself is linked to worse atopic dermatitis.
Other Factors that Impact Atopic Dermatitis Treatment
Even when some Black people do see a doctor, it’s more likely that their atopic dermatitis is missed. Black children are much less likely to see a dermatologist for atopic dermatitis, but when they go, they are three times more likely to get that diagnosis. This suggests that their pediatricians or primary care providers may be missing the signs.
One reason is that AD simply looks different on darker skin. When you think of AD, you probably picture a red itchy rash. But in brown or Black skin, AD can look dark brown, purple, or even ash gray. It can itch more, which causes skin to thicken. Some Black people also develop bumps on their chest, back, arms, and legs. This is a type of AD known as papular eczema.
Black and Hispanic people are also less likely to get prescription medications often recommended for moderate to severe AD. They include:
- Topical calcineurin inhibitors (TCIs). They block calcineurin, a protein that triggers AD. There are two topical creams available: pimecrolimus (Elidel) for mild symptoms and tacrolimus (Protopic) for more severe ones.
- Crisaborole (Eucrisa). This is a type of drug known as a PDE4 inhibitor, and it blocks an enzyme in your skin that can make AD worse. It’s put on your skin twice a day.
- Dupilumab (Dupixent). It’s an injectable biologic medication that blocks proteins in your immune system – interleukin 4 (IL-4) and interleukin-13 (IL-13) – that cause eczema. It’s very effective, but since it’s very expensive, it’s usually only used in kids and adults with moderate to severe eczema that hasn’t responded to other treatments. Another similar drug called tralokinumab (Adbry) can be used in adults and children 12 years and older.
How to Get the Care You Need
If you are Black or Hispanic, it’s important to get treated for your atopic dermatitis. It can have a major impact on your quality of life. Research shows that Black and Hispanic children are much more likely to miss school because of their AD, compared to White children.
Here are some things you can do to help get medical care for AD:
Be aware of signs of atopic dermatitis. You can’t rely on your primary care doctor or pediatrician to let you know they think you or your kid may have AD. Chances are they may not recognize it: Less than 5% of medical textbooks show photos of dark skin, according to a 2018 study published in Social Science & Medicine. The American College of Allergy, Asthma & Immunology launched a website, Eczema in Skin of Color, that includes an image gallery to help you recognize symptoms.
Consider teledermatology. If you have severe AD, you’ll want to be treated at a major medical center. But that can be hard to get to, especially if you don’t have reliable transportation or can’t afford to take an afternoon (or even a whole day) off of work. Teledermatology is one way to make that possible. You’ll either send pictures of your AD to your dermatologist, who will email you treatment recommendations, or you’ll have a video visit where your doctor examines your skin online. One 2024 review found that telehealth worked as well as in-person appointments. Just check with your health insurance to make sure teledermatology is covered.
Look for a Skin of Color (SOC) clinic. These are skin clinics, often at major medical centers, that are staffed by skin doctors who have a lot of experience with skin of color. They’ll be more able to diagnose your AD and be able to work with you to access treatment. They’ll also be more sensitive to social and economic factors in your life that may make your AD harder to control. You may also be able to find a doctor near you through the Black Derm Directory. The American Academy of Dermatology also has a tool that allows you to search for dermatologists in your area with experience with skin of color.
Talk to your doctor about treatments. There are many effective AD treatments out there. If possible, you should limit the use of prescription steroid creams, which can cause your skin to lighten. A better choice is one of the topical calcineurin inhibitors such as pimecrolimus (Elidel) or tacrolimus (Protopic). Your doctor can also talk to you about more advanced treatments like biologics. If cost is a factor, your provider can help connect you to the drug company’s financial assistance programs. You can also look on your own via a site such as NeedyMeds.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Journal of Allergy and Clinical Immunology: “Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations.”
CDC: “Socioeconomic Factors.”
Eczema in Skin of Color: “Social and Economic Factors,” “Eczema in Skin of Color: Diagnosis and Treatment.”
National Eczema Association: “Eczema on black skin: pictures, symptoms and treatment,” “Telemedicine for eczema: tapping into the virtual wellness trend,” “Science of eczema on skin of color.”
Journal of Allergy and Immunology Clinical Practice: “Racial and Ethnic Disparities in the Treatment of Patients with Atopic Dermatitis in the United States: A Retrospective Matched Cohort Study.”
UpToDate: “Treatment of atopic dermatitis (eczema),” “Patient education: Eczema (atopic dermatitis) (Beyond the Basics).”
JAMA Network: “Racial and Ethnic Differences in Atopic Dermatitis-Related School Absences Among U.S. Children.”
Social Science & Medicine: “Representations of race and skin tone in medical textbook imagery.”
Journal of Cutaneous Medicine & Surgery: “Teledermatology in Atopic Dermatitis: A Systematic Review.”
