Eczema on the Skin of Black People: A Guide to Symptoms and Treatment

Eczema is a chronic skin rash that can affect anyone. But certain people have a higher risk of getting it. In fact, studies show that people with darker skin tend to have more eczema. While the treatments are the same for everyone, eczema can look different in Black people and those with darker skin tones. 

Recognizing what eczema looks like on Black people may help you figure out if eczema is the cause of your rash. And it can help you know when you need to get treatment. 

Social factors that make Black people more prone to eczema

Research shows that eczema is more common in Black children as compared with Hispanic and non-Hispanic white children. In fact, one study found that Black children were more than twice as likely to have eczema compared with white children. Not only do Black people tend to have more eczema, it also tends to be more severe. Experts aren’t sure why this is. Some possible factors include:

• Socioeconomic factors: For example, studies found that households with higher education levels had more eczema. People who live in larger metropolitan towns also have a higher risk of eczema.

• Structural racism: Studies show that structural racism may factor into the eczema disparity. The consequences of racism for people of color may contribute to an altered immune response and higher rates of eczema.

Ultimately, more studies are needed to understand why eczema is more common and more severe in people with darker skin tones.

What does eczema look like on the skin of Black people?

People often think of eczema as an inflamed, red rash on dry skin. This is probably because  most images show eczema on people with lighter skin tones. But this presents a problem, because eczema may have a different appearance on people with darker skin tones. 

Typically, darker skin won’t show the tones of red the way that lighter skin does. For this reason, inflammation doesn’t look red on the skin of Black people, but the rash may appear:

• Darker brown

• Purple

• Gray 

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The level of inflammation in the skin is often underestimated in people with darker skin tones. That’s why it’s important for a healthcare professional to know what to look for in your skin. Eczema flares can also cause skin to feel warm and look dry or ashy. There can be open sores or oozing as well. 

Pictures of eczema on Black skin

Here are some pictures of eczema on the skin of Black people on different body parts. 

A man with darker skin tone has facial eczema.

The eczema rash on the face can appear in a gray, darker brown, or purple color in people with darker skin tones.

An eczema rash develops on the hand of a person with darker skin tone.

An eczema rash on the leg appears in a purplish color in people with darker skin.

An eczema rash develops on the arm.

Eczema can cause postinflammatory hyperpigmentation.

What are the symptoms of eczema?

The hallmark symptom of eczema is itching. The itch of eczema can be very intense. It can be so itchy that it affects your daily life and your sleep. Inflamed skin and cracked skin can also be painful and uncomfortable. 

Eczema can occur anywhere on the skin, but the rash typically has a characteristic location and quality. The scaly, dry rash will commonly occur:

• In the creases of the elbows

• Behind the knees

• Around the neck

• On the eyelids 

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Nummular eczema is a type of eczema that’s more common in adults. This rash will usually show up as round circles on the lower legs. 

Eczema symptoms more common in the skin of Black people

One type of eczema, called papular eczema, causes small, itchy bumps on the torso or arms. This can make the hair follicle stand out. This type of eczema can be more common in Black people. 

What are the complications of eczema on darker skin?

When eczema is severe or left untreated, there’s a risk of changes to the texture or color of the skin. These changes can be especially noticeable in darker skin: 

• The skin can go through a process of thickening (lichenification) in areas of repeated scratching or rubbing. It’s common if you have chronic eczema flares.

• Inflamed skin from eczema often changes color. The skin may either get darker in the area of inflammation (called postinflammatory hyperpigmentation) or develop light spots (called hypopigmentation). Usually this color change isn’t permanent and will go away after a few months. These skin color changes after an eczema flare are more common if you have darker skin.

Regardless of skin tone, infection can also be a complication of eczema. If you have broken skin from inflammation and scratching, your natural protective barrier is no longer intact. This makes it more likely for bacteria, fungi, and viruses to enter and cause infection. Common infections with eczema include: 

• Methicillin-resistant Staphylococcus aureus (MRSA)  

• Molluscum contagiosum

• Herpes simplex (called eczema herpeticum) 

What can trigger eczema?

There are many triggers for eczema. While triggers will vary from person to person, they aren’t usually dependent on skin type or tone. Common eczema triggers include:

• Dry skin: Dry skin is more prone to irritation and inflammation. Well-moisturized skin can prevent eczema flares.  

• Weather changes: Some people are sensitive to weather extremes, either extreme heat and humidity or cold. Protecting and moisturizing your skin during extreme weather can be helpful. 

• Excessive water: Washing the skin too much can cause dryness and eczema flares. Consider limiting your shower times and using lukewarm water instead of hot water. 

• Harsh soaps and irritants: People with eczema are more sensitive to harsh products. Avoiding harsh soaps or detergents may decrease flare-ups. 

• Stress: Emotional or physical stress can often lead to flares. Managing your stress can help manage your eczema. 

• Sweat: Sweat can be irritating to skin with eczema and cause more itchiness. Consider clothing that helps wick away moisture, or change your clothing often if you sweat a lot.

What are the risk factors for eczema?

Experts don’t fully understand eczema. And they aren’t totally sure why eczema is more common in people with darker skin. There are many factors that may contribute to the development of eczema. Risk factors for eczema include:

• Your genetics (eczema runs in families)

• Stress

• Having very dry skin

• Living in cold and/or damp places

• Having certain food allergies or hay fever

What is the treatment for eczema on the skin of Black people?

The treatment of eczema is similar for anyone with the condition. It’s not dependent on your skin type. The treatment a healthcare professional recommends is usually based on the severity of your eczema. We’ll review the three most common types of eczema treatment.

1. Topicals

Topical medications come in different formulations, like creams and lotions. They come in over-the-counter (OTC) and prescription strengths. Common ones include:

• Topical corticosteroids reduce inflammation and can provide quick relief from itching. But they aren’t for long-term use. They risk thinning the skin and losing effectiveness over time.

• Nonsteroidal topical creams (like pimecrolimus and tacrolimus) are helpful in sensitive areas such as the face, neck, and genitals. They don’t have the same risk of steroid creams and are safe for long-term use.

• Topical janus kinase (JAK) inhibitors, like Opzelura, which target a specific part of the immune system.

• Topical antibiotics (like mupirocin) are useful when you have broken skin. They help to reduce the risk of complications from infection.

• OTC lotions and moisturizers (like Aquaphor and Vaseline) are an important part of treatment. They help to combat dryness and keep the skin flexible. Keeping the skin moisturized can help prevent eczema flares.

2. Systemic medication

Sometimes healthcare professionals recommend oral and injectable steroids if you have severe eczema flare-ups. These medications work throughout the body and target the immune system. As a result, they can have more serious side effects, including a risk of infection. Common systemic medications include: 

• Steroids, like prednisone and dexamethasone 

• Older immunosuppressants, like methotrexate

• Newer medications, like Dupixent, Adbry, and Rinvoq, which target specific parts of the immune system

3. Phototherapy

Light therapy with ultraviolet light can be helpful in reducing skin inflammation. A healthcare professional administers this treatment in the office, 3 times a week. Each session takes a few minutes. Treatment with phototherapy usually lasts 1 to 3 months, depending on how well your skin responds. 

Phototherapy is generally safe, and usually there aren’t any major side effects. It can cause skin darkening, especially in Black people and those with darker skin tones, so special consideration should be given in these groups.  

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Written by:

Alina Goldenberg, MD, MAS, FAAD

Alina Goldenberg, MD, MAS, FAAD, is a board-certified dermatologist in private practice in San Diego. She is also an assistant clinical professor in the Department of Internal Medicine at the University of California, Riverside School of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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