What Does Eczema Look Like On Black Skin – Julie Van Onselen, Dermatology Nurse Advisor at NES, explains how problems with changes in skin pigmentation arise when normal skin color is disrupted. These pigmentary skin problems are more noticeable in darker skin, but can occur in all skin tones. This article was published by
Skin type is described by the Fitzpatrick classification (1), which determines skin color by phototype, which depends on the amount of melanin pigment in the skin.
What Does Eczema Look Like On Black Skin
Skin changes are caused by active or itchy scratching. These changes can cause two types of pigmentary skin changes:
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Hypo- and hyper-pigmentation are more visible in darker skin types, but can occur in any skin type and can be worrying and distressing for those with it.
The main way to improve pigmentation changes in the skin is to treat the underlying condition and inflammation. But even after treatment, the discoloration can last for months or years.
In light skin, the typical pattern may be red or dark pink spots, dry, itchy skin, and small vesicles (blisters) in severe burns.
In darker skin, inflammation is more difficult to detect, as it appears as various stages of hyper-pigmentation, more subtle, and therefore redness is often not seen. As a result, its severity may be underestimated.
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Post-inflammatory hypo- and hyper-pigmentation is a much bigger concern in people with darker skin because it takes months to resolve and can sometimes be a bigger concern than the discoloration itself.
Another common feature of black skin is follicular prominence. This is where small, itchy bumps or ‘papules’ appear on the skin – mainly on the trunk and wrists. Dry skin and scale are more prominent because its white or gray color is very noticeable.
A UK longitudinal study of ethnic variations in atopic reported that dark-skinned children (of African-Caribbean ethnicity) were more likely to develop atopic than their white counterparts and six times more likely to develop severe atopic dermatitis. (2)
Dark patches of skin (hyper-pigmentation) are caused by inflammation, which stimulates melanocytes – the skin cells that give the skin its color – to increase melanin synthesis (the process by which the skin makes pigment). An increase in this synthesis causes the pigment to be transferred to the epidermis (top layer of the skin).
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When the skin is injured by scratching or rubbing the melanin, the pigment is released. This explains why people with darker skin types tend to have hyper-pigmented areas during flare-ups.
Another cause of darkening is post-inflammatory pigmentation, which can occur after the flare has settled and appears as a dark patch where the lesion has healed. This skin change is frustrating because the dark patch may not return to the body site but may last for months. It occurs in all skin types, but is more pronounced in darker skin. A common pigmentary feature of severe atopic in all skin types is wrinkles under the eyes, known as Denny-Morgan folds, with dark circles.
Post-inflammatory pigmentation is stimulated by sunlight, so sun protection is important for people of all skin types because it can prevent it from happening and help it recover. Gradually, the post-inflammatory pigmentation fades.
Chronic scratching and rubbing results in visible scratch marks and increased skin markings on thickened areas of the skin, called lichenification. These areas of skin are always hyper-pigmented – in light skin it is dark pink, while in dark skin it is slate gray – but always dry, scaly and scaly.
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Lichenification caused by constant rubbing occurs on all skin types – sometimes as a single patch, usually on the dominant side of the person, the elbow crease of the right arm, or a specific body part. However, a person may develop a lichenified area of skin on the front of their feet due to a nightly habit of rubbing their feet together while sleeping.
Scratching and rubbing is often unconscious and can become a habit even when it doesn’t flare up. Body areas where lichenification is common include the back of the skull or neck, wrists, forearms, lower legs, and genitalia (such as the scrotum or vulva).
Pale patches of skin (hypo-pigmentation) appear when a flare resolves through the sub-acute phase and returns to dry skin without inflammation.
People who often worry that hypo-pigmentation is caused by the side effects of topical steroids – especially topical treatments. It is true that topical steroids cause the small blood vessels in the skin to dilate. But this is temporary and does not damage the skin. Hypo-pigmentation itself is not treatable.
Eczema On Dark Skin
Another cause of pale patches is pityriasis alba – low grade, mainly seen in children or teenagers. The name means ‘fine scale’ (pityriasis), pale color (alba) – so their patches are hypo-pigmented, sometimes pink, and dry.
Pityriasis alba is more common in dark skin than white skin. It often appears after sun exposure as the hypo-pigmented areas do not turn brown and become more prominent.
The characteristics and progression of pityriasis alba are slightly different from atopic. It usually consists of anywhere to 20 round or oval patches, mainly on the face but also on the neck, shoulders and upper body. It is unlikely to affect other parts of the body. The associated dryness and scaling is more pronounced in the winter months, but true hypo-pigmentation is most evident in the summer.
The main difference between pityriasis alba is that it is mild or itchy. However, the two conditions often appear together, in which case the typical spots will be itchy. Pityriasis alba patches resolve gradually. First, the scale disappears, then the normal skin tone is restored. Again, it can sometimes take months for the skin to return to its original color.
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There is no specific treatment for pigmentary skin changes, but it is important to recognize and treat it in people of all skin types. Prompt treatment can help reduce long-term post-inflammatory pigmentation.
Over time, the hyper- and hypo-pigmentation will eventually resolve. However, it should be remembered that pigmentary changes may persist even after successful treatment. If this occurs, topical steroids should not be continued in these areas for long periods of time, as this may lead to permanent hypo-pigmentation.
It’s not the only condition that causes pigmentary changes: they can be caused by many other skin conditions that someone may have with them. Melasma and vitiligo are two other common pigmentary skin conditions, but there are rarer conditions as well. Therefore, any unexplained pigmentary skin problems should be evaluated and investigated.
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Hyperpigmentation on the face – and occasionally the forearms – can be caused by melasma, which is an overproduction of melanin that causes flat, dark spots or patches of skin – usually on the cheeks and around the eyes. The exact cause is unknown, but it may be genetic and is thought to be hormonal, as it is seen in women who are pregnant or taking oral contraceptives. It only affects adults – usually women – and is made worse by sun exposure.
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The condition causes the skin to lose color in patches – usually permanently. Discolored areas usually develop over time. This condition can affect the skin on any part of the body. It can affect the hair and the inside of the mouth. Treatment is aimed at restoring skin color, but not at preventing persistent skin discoloration or recurrence.
Skin Deep is a website that features images of people with different skin tones to help patients and doctors better understand and explain the symptoms of different skin conditions: https://dftbskindeep.com/.
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Eczema usually appears red on white skin; On dark skin it can be purple or ash gray or dark brown.© 2021 VisualDx; Canva
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