Atopic dermatitis can affect any child. But studies show Black, Asian, and Hispanic children are at greater risk of having this condition than their White peers. It’s also more likely that their case will be severe. And depending on your child’s skin tone, it can look very different from the way it might on their classmates or friends. This can affect how quickly you can get the right diagnosis and start treatment to get your youngster feeling better again.
How Does Atopic Dermatitis Look on Different Skin Tones?
Atopic dermatitis most often shows up as a change in color on an area of the skin (erythema). This is caused by increased blood flow in certain capillaries. On whiter skin tones, atopic dermatitis may be easy to spot by patches of redness or red dots. But that’s not necessarily the case for kids with black, brown, and olive skin tones. For them, the affected skin may look ashen gray, dark brown, or purple. In the skin of some Asian people, atopic dermatitis lesions may have more well-defined borders, increased scaling, and thick, rough skin.
Small bumps, known as papules, are a symptom of atopic dermatitis that’s more common in darker skin. These bumps often show up on the chest, legs, arms, and back. Especially on kids with darker skin, this is often on the areas outside a joint, such as the elbow or knee. The bumps can grow around hair follicles and look like goosebumps.
When your child gets itchy, that leads to scratching. This can make the skin thick, rough, and leathery in a process called lichenification. Kids who have golden or dark skin tones are more likely to have this thickened skin, along with skin lesions or raised bumps called prurigo nodules.
The inflammation that comes from your child's atopic dermatitis can lead to their skin becoming discolored. It can get darker (hyperpigmentation) or lighter (hypopigmentation). Even after treatment, it can take several weeks or months for their skin to clear up. These conditions often happen after the rash has healed.
You may also see dark folds or creases called Dennie-Morgan lines under your child’s eyes. Sometimes the skin under the eye can swell and darken, similar to a black eye. Dennie-Morgan lines show up when there’s inflammation present and are more common in dark skin. They can appear in conditions other than atopic dermatitis but can help to confirm the diagnosis if your child has the other symptoms too. Your child may also have thickened skin on the soles of their feet or their palms, with more lines in the skin than normal.
Finding Atopic Dermatitis Care for Kids With Skin of Color
For a long time, dermatologists have learned what they know about atopic dermatitis and other skin conditions by studying the skin of White people. Textbooks and other educational resources still tend to show lighter skin tones, and most studies and trials for new treatments take place with White subjects. This is changing, as scientists recognize the need to learn more about skin conditions in all skin tones.
It’s important that you find a dermatologist who can recognize the different ways eczema can look in different skin tones, so you can get the right diagnosis for your child as quickly as possible. You can ask your primary care doctor for a referral or visit the “Find a Doctor” directory on the Skin of Color Society website to find a dermatologist who specializes in skin of color. By being proactive when it comes to your child's care, you can help manage their symptoms so they can live more comfortably.
Show Sources
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SOURCES:
British Association of Dermatologists: “Erythema”
Eczema in Skin of Color: “Eczema in Skin of Color: Diagnosis and treatment”
National Eczema Association: “The Science of Eczema on Brown and Black Skin.”
Mayo Clinic: “Atopic dermatitis (eczema).”
Journal of Clinical and Aesthetic Dermatology: “Dermatological Conditions in Skin of Color – Managing Atopic Dermatitis.”
Dermatologic Clinics: “Diagnosing Atopic Dermatitis in Skin of Color.”
Rady Children’s Hospital San Diego: “Atopic Dermatitis: Additional Clinical Features.”
Annals of Allergy, Asthma and Immunology: “Racial differences in atopic dermatitis.”
Asia Pacific Allergy: “A clinician's reference guide for the management of atopic dermatitis in Asians.”
