7 Atopic Dermatitis Symptoms More Likely Seen on Dark Skin

Atopic dermatitis (AD), a common form of eczema, is a chronic (long-term) skin condition that causes inflammation, itching, irritation, and drying of the skin. People of color are about 1.5 times as likely to have AD compared to white people.

Atopic dermatitis may appear differently on dark skin tones, and understanding these differences can aid in early diagnosis and proper management.

Follicular accentuation refers to the inflammation of the hair follicles in your skin, making them more visible. This symptom is more common in people with darker skin types. It may present as a rash resembling goosebumps on the chest, abdomen, back, arms, or legs.

Your healthcare provider may recommend corticosteroid medications and creams to help decrease the inflammation. It may also help to hydrate your skin with the right moisturizers for atopic dermatitis.

A papule is a small raised bump on the skin, less than a centimeter wide. In individuals with a lighter skin tone, papules can appear red, but those with a darker skin tone may exhibit them in shades of brown, purple, or gray.

Your healthcare provider may recommend a similar treatment, such as a topical steroid cream, for papules.

Individuals with darker skin tend to experience a higher rate of skin color changes, particularly after an eczema flare. Atopic dermatitis can cause some areas of the skin to appear darker, especially after healing, a condition known as hyperpigmentation.

In people with darker skin tones, these patches can appear ashen grey, darker brown, or a violet hue, which may sometimes blend with the surrounding skin.

Treating hyperpigmentation involves treating the underlying inflammation that causes it. This symptom may take months to go away.

Some people notice that the skin affected by atopic dermatitis may appear lighter than usual, a condition known as hypopigmentation. 

To manage hypopigmentation, your dermatologist may recommend topical steroids or topical calcineurin inhibitors such as Protopic (tacrolimus) and Elidel (pimecrolimus). It is important to apply sunscreen to the affected areas.

Itching is common with atopic dermatitis, regardless of skin color, but Black people tend to experience more severe itching. Due to scratching those itches, people with darker skin tones are more likely to develop firm, itchy bumps on their skin, known as prurigo nodularis.

To help, avoid using hot water or fragranced products, as these may dry out the skin and trigger itching.

Excessive scratching or rubbing can also lead to lichenification, a condition in which the skin becomes thickened and discolored. To manage lichenification, scratch your skin less as you treat the underlying atopic dermatitis.

You may notice a thickening in the skin of your palms with more prominent lines. Researchers have found that these lines are more likely in people with darker skin tones.

Atopic dermatitis is often studied in individuals with white skin. It may sometimes be more challenging to detect and treat early in people with darker skin, as it is less likely to cause noticeable redness. Some healthcare providers may have knowledge gaps about AD on darker skin.

When atopic dermatitis is treated late, it can lead to more severe symptoms, more changes in skin color, or scarring, which can also cause anxiety and distress.

Structural racial inequality, such as where you live and your access to care, may make getting a diagnosis and care more difficult. It’s important to seek care if you think you have atopic dermatitis. Symptoms require the expertise of a dermatologist, a medical doctor specializing in diagnosing and treating skin conditions.

If you notice two or more of these symptoms, it’s important to see a dermatologist:

• Itching, which can be severe
• Skin patches that look darker brown, purple, or ashen grey
• Areas of inflammation that feel warm to the touch
• Dryness or scaling
• Thickening and hardening of the skin
• Rashes that may ooze or bleed when you scratch them
• Firm, raised bumps on your skin

Certain steps can help you make the most of a dermatology appointment. Here’s how to prepare:

• Take a picture of your flare to help your dermatologist understand what it looks like.
• Identify your main concerns: Is the itching, rashes, or discoloration?
• Write down any over-the-counter (OTC) and prescription medications you take to manage your flares.
• Write down any other medications or supplements you take. 
• Identify what things seem to improve or worsen your flares. 
• Note the areas of your body where you typically experience symptoms.
• Write down when you started noticing changes to your skin.
• Come prepared with any questions you would like to ask.

If you have darker skin, you may notice darker brown, ashen grey, or violet patches on your skin instead of redness. You may also experience changes in skin pigmentation. More severe itching is common, along with symptoms such as lichenification (thick, leathery skin) and prurigo nodularis (firm bumps).