What Does Atopic Dermatitis Look Like on Darker Skin?

Atopic dermatitis, the most common form of eczema, can lead to dry, itchy, and inflamed skin. It often comes and goes in flares.

Atopic dermatitis affects people of all skin tones, but it doesn’t always look like the red, itchy rash you might expect. 

Atopic dermatitis can look different on darker skin, making it difficult to diagnose. Knowing how atopic dermatitis looks on darker skin can help you get the care and relief you need.

Atopic dermatitis on people with darker skin may look ashen gray, purple, violet, or a darker shade of brown than they’re used to. These color differences can make it harder to recognize the condition, even for medical professionals. As a result, healthcare providers can sometimes miss or mistake atopic dermatitis on darker skin for something else.

Another common issue is changes in skin color that happen after an atopic dermatitis flare. These areas may heal with lighter or darker patches.

People with darker skin often experience more noticeable and widespread dryness with atopic dermatitis. The skin may look dull, ashy, flaky, or have a sandpaper-like texture. 

This dryness can spread across the arms, legs, or upper body. In some people with dark skin, atopic dermatitis can occur on the outer parts of the limbs, like the back of the arms, rather than inside the elbows or behind the knees. The skin may also be more likely to crack, especially on the hands, feet, and joints.

Dry areas might feel rough or bumpy, though they may not be noticeably inflamed. With time and scratching, lichenification can occur, which causes the skin to become thick and leathery.

Unlike the flat patches often seen in lighter skin, atopic dermatitis in darker skin might cause small, raised bumps called papular eczema. These bumps may look like tiny pimples or rough patches and can be scattered or grouped. You might see papular eczema on the chest, back, arms, or legs, and it’s often very itchy.

You might also notice tiny bumps, similar to goosebumps, forming around hair follicles, called follicular accentuation. Some people develop firm bumps from repeated scratching. These bumps can be mistaken for other skin conditions, so it’s important to see a healthcare provider with experience treating darker skin.

After an atopic dermatitis flare heals, it can cause hyperpigmentation (darker skin) or hypopigmentation (lighter skin) on the area affected. These color changes are especially noticeable in darker skin tones and can sometimes be more bothersome than the eczema itself.

Hyperpigmentation occurs when inflammation triggers the skin to produce more melanin, the pigment that gives skin its color. This creates darker patches where the eczema was active. Hypopigmentation occurs when inflammation damages the melanin-producing cells, causing lighter patches. 

Most pigment changes disappear, and the skin color usually returns to normal. However, it can take several months or even longer.

Swelling and itching are common symptoms of atopic dermatitis and might be more intense in people with darker skin. The skin may appear puffy or swollen, sometimes making it difficult to see in darker skin. However, it can be felt when you touch the affected areas. 

Itching in darker skin tones is often severe and can lead to scratching that damages the skin, causing thickened areas, scarring, or dark marks. Over time, scratching can change how the skin looks and feels.

Some additional skin changes can also appear more often in certain groups with atopic dermatitis.

People with darker skin, especially those of African descent, may have more noticeable hyperlinearity, which occurs when the skin on the palms and soles becomes thicker, making the lines on the skin more visible

Other signs include dark circles around the eyes, medically known as periorbital dark circles, and extra skin folds below the eyes.

People of Asian backgrounds may have patches with more flaking skin and thickened areas. This type of eczema can sometimes look similar to psoriasis, a different skin condition.

In the United States, eczema is more common in Black, Hispanic, Asian, and Pacific Islander children than in white children. About 1 in 5 Black children has eczema, compared to 1 in 6 white children and 1 in 12 Hispanic children. Symptoms also tend to be more severe for these groups.

Children with darker skin are also more likely to see a healthcare provider or get a prescription for their eczema. However, despite more medical visits, many face challenges in getting consistent care and treatment, leading to worse flare-ups and long-term issues.

Genetics isn’t the only reason for these differences. The following can also affect your chances of developing atopic dermatitis:

• Environmental factors: You may be at a higher risk of atopic dermatitis if you live in a city rather than a rural area, live in dry climates or cooler regions, or breathe in more air pollution, common in crowded or industrial areas.
• Access to care: Some families have difficulty finding a nearby clinic, affording treatment, or taking time off work. These challenges can delay care and worsen symptoms over time. 
• Structural racism: Black and Hispanic people often have less access to good housing, education, and healthcare. This can lead to delayed diagnosis and fewer treatment options for managing atopic dermatitis.

Atopic dermatitis treatment is generally the same for all skin tones, though people with darker skin may need extra care to prevent dryness, irritation, and pigment changes.

Some tips for managing atopic dermatitis in darker skin include:

• Moisturize daily: Use thick creams or ointments, not lotions, at least daily, ideally right after a bath or shower. Natural options like shea butter can also help keep the skin moisturized and soft.
• Avoid harsh products: Soaps, lotions, and products with fragrance, alcohol, or dyes can dry out the skin and worsen atopic dermatitis. Use mild, fragrance-free cleansers designed for sensitive skin.
• Take short, warm showers: Keep baths or showers under 10 minutes and use warm (not hot) water to prevent the skin from drying out and itching.
• Try prescription creams: Topical steroid creams are often the first choice for flares. Talk to your healthcare provider about prescription nonsteroid options like Elidel (pimecrolimus), Protopic (tacrolimus), or Eucrisa (crisaborole). These medications work well for all skin types.
• Consider advanced treatments if needed: Light therapy or immune-targeting medications may be needed for severe cases.
• Be cautious with herbal remedies: Some natural products can worsen atopic dermatitis. Since many haven’t been well studied, it’s best to check with a dermatologist (a doctor who specializes in skin conditions) before trying them.
• Treat pigment changes: Once eczema is under control, hyperpigmentation can be treated with products containing ingredients like topical retinoids and hydroquinone.

Daily sun protection is important, especially if you use treatments that can make your skin more sensitive. Use a broad-spectrum sunscreen with SPF 30 or higher and reapply it every two hours. Wear wide-brimmed hats and sun-protective clothing outdoors, and stay out of the sun during peak hours (mid-morning to mid-afternoon).

Atopic dermatitis often looks different on darker skin, appearing gray, purple, or dark brown. Small, itchy bumps, rough patches, thickened skin, and extensive dryness are common.

After a flare, the skin may also heal with lighter or darker spots that can take time to fade.

Because these signs can be mistaken for other conditions, it is important to work with a dermatologist familiar with your skin type.