Eczema is a common skin problem seen all over the world, including the United States. It usually presents as dry, itchy, red or darker areas of skin. Another word for eczema is  dermatitis (which literally means inflammation of the skin) and sometimes it is referred to as “the itch that rashes”.  In people with skin of color, eczema can appear “ashen”, brown, or grayish in color. Eczema is the second most common skin problem in Black individuals and is one of the most common skin issues seen in babies and kids. 

There are several types of eczema or dermatitis, some of which are discussed below:

Atopic Dermatitis:
Also known as atopic eczema, atopic dermatitis is a skin problem with an unknown cause. It usually starts in babies (or infants) and is described as itchy, scaly or dry skin. In severe cases, the skin can become more thick and dark with repeated rubbing or scratching (or lichenified). Atopic dermatitis can be  associated with other conditions such as asthma or allergies.  It appears to be more common among Blacks, Asians, and Pacific Islander communities.

Nummular Dermatitis:
Also known as nummular eczema. This appears as itchy “coin-shaped” areas of inflammation and can be crusty or scaly.

Xerotic (asteatotic) Eczema:
Also known as asteatotic eczema. In this type of eczema, extremely dry skin becomes inflamed and may require treatment beyond moisturizers.

Contact Dermatitis:
In this form of eczema, skin irritation can arise from repeated  contact with irritants (like soap, detergents, harsh chemicals) and allergens (like poison ivy, nickel, fragrances, etc.)

Eczema can also look different in patients with darker skin. In some cases, it may appear as small bumps  (papular eczema) or scale around the hair follicles (eczema with follicular prominence).

A major concern for people of color is the skin discoloration associated with eczema. Rubbing or scratching secondary to the itch of eczema can lead to darkening (hyperpigmentation) or lightening (hypopigmentation) of the skin. This discoloration can last for months to years, even after the eczema is treated.  Darkening of the skin is especially visible in children with skin of color.  If the patient’s underlying eczema and inflammation is treated, however, the changes in skin color can be improved over time. 

What is the cause of Eczema?
The cause of atopic dermatitis is unknown but doctors think it may have to do with a protein called filaggrin that keeps the skin strong by building a protective barrier on the surface.  It is also thought to be related to genes inherited within families and issues that arise from the immune system. Things in the environment can also make it worse.  Atopic dermatitis seems to happen more in places with lots of factories and big cities. 

How do I know if I have Eczema?
The diagnosis is primarily based on the appearance of the skin and on personal and family history of allergies and asthma.

How is Eczema treated?
There are many ways to treat eczema. The first step is to avoid things that can irritate your skin or allergens to which your body may react. Gentle skin care is also recommended:

• Avoid really hot or cold showers/baths
• Bathe or shower for 5-10 minutes with a gentle cleanser no more than once daily followed by patting skin dry and immediately moisturizing the skin
• Avoid scented products (including perfumes or colognes, cleansers, detergent, etc.)
• If you have food allergies, avoiding those foods may help improve your eczema symptoms.
• Use bland, unscented creams or ointments daily. 
• Avoid using other kinds of treatments like herbal supplements or vitamins because they may have allergens or irritants that can make your eczema worse.
• A dermatologist may also prescribe a topical corticosteroid to  help reduce inflammation in the skin. 
• Eczema can sometimes get infected, and your dermatologist may  prescribe antibiotics or antibacterial cleansers to treat an infection. 
• In severe cases, eczema is treated with medications that help your immune system.