Eczema in skin of colour

This clinic is listed on the Black Skin Directory website, and so some clients approach this clinic for help with managing their skin. Eczema affects skin of colour differently to Caucasian skin

• Higher incidences of eczema have been reported in Black and Asian populations
  • Asian skin is more likely to get eczema because it has the thinnest stratum corneum and reduced barrier function. African descent skin is the most likely to have the driest skin. (This was found in the UK by Schofield et al.)
  • Children of African heritage are twice as likely to experience severe disease than children of European heritage.
• Despite these differences, for many years it has been taught that the classical presentations do not vary fundamentally.
  • However some researchers have found that eczema may affect the extensor surfaces rather than the flexor surfaces of black children. (This means that eczema would affect the  backs of the elbow and front of the knees in black children, whereas in other races it would more commonly affect the backs of the knees and the front of the elbows).
  • A systematic review and meta analysis in 2019 found that people of African descent experienced more papular lichenoid (hard small and lumpy) lesions, palmar hyperlinearity (lots of lines on the palms of the hands), ichthyosis (a condition with dry, scaly and thickened skin) and darkening around the eyes. ( So the initial approach  for someone who has darkening around the eyes where eczema is present should incorporate eczema management rather than going straight for skin lightening products)
  • Other signs seen more commonly in darker skin are:
    • pityriasis alba (a  common, benign skin disorder consisting of characteristic round or oval hypopigmented lesions with fine scales and occurring predominantly in children and adolescents)
    • Denny Morgan lines ( extra creases or folds just below the lower eyelid ) and
    • perifollicular accentuation (these are small bumps on the skin centred on the hair follicles).
• In pink/white Caucasian skin the redness of eczema is seen more easily than on darker skin.   In darker skin, the changes are subtle yet significant and may look more reddy brown to grey in colour. This may mask the severity of the eczema and could lead to under treatment

The importance of getting a proper diagnosis

• It is important to get a diagnosis to be able to access the correct treatment early, and to avoid complications such as loss of pigmentation (hypopigmentation) and excess pigmentation (hyperpigmentation)
• There can also be conditions that may look like eczema which aren’t such as psoriasis which should be managed differently, or other skin conditions that would need to be managed by a dermatologist
• There are a wide variety of  creams, lotions and ointments available from General Practice. It is really important to  find a formulation that the patient is comfortable using because you have to use far more than you would expect.
• Don’t be afraid to ask for a referral to dermatologist because  they have access to some medications which GPs don’t have access to which can be transformative.  Most GPs will likely to have had just one week of training in dermatology before they qualify,  but have the opportunity to learn about dermatology from a range of resources.
• There are some cosmetic procedures where caution is advised with eczema such as some skin peels or treatments like the Cleopatra facial (similar in principle to the Hydrafacial)

The best ways of treating eczema effectively and preventing flare ups

• Don’t suffer in silence.  See your GP early. They have access to medications that can treat a flareup which is likely to include topical steroids
• If you can’t get in to see a GP speak with a Pharmacist.  Some of the products that can be prescribed are also available to buy in Pharmacies
• Maintaining a good emollient skin care regime is important, and ideally maintained without steroids to prevent flare ups.
• Emollients and steroids are extremely important, but steroids can be overused in skin of colour which risks hypopigmentation (loss of pigment).  There can be hidden steroids in treatments bought online including skin lightening treatments. Long term cumulative steroid toxicity is a real thing that can lead to complications in the eye  like cataract and glaucoma or brittle bones  (osteoporosis fracture)
• If you are not happy with your progress ask for a referral to a dermatologist who will have access to a range of alternative treatments to steroids.
• Waiting times to see a dermatologist in the NHS are very long at the moment.  There are also great medical grade products which are available from good aesthetics/skin care clinics which may be more expensive but can have other properties such as anti-ageing.
  • Zo Skin health range: hydrating cleanser and hydrating cream have been the mainstay. In 2023 a new product the Balancing Cleansing Emulsion a conditioning gel to milk cleanser that supports the skin’s barrier leaving skin soothed, supple and strong.
  • Neostrata range: Bionic lotion
• Near Infrared light such as from the Dermalux LED (which is available at this clinic) can be used on dry skin, but should not be used in photosensitive eczema