5 Things People of Color Need to Know About Eczema

Amrita Marino

As a child, Lauren Du Pree didn’t spend a lot of time thinking about the fact that she had eczema. “It wasn’t like I got bullied. It was just this thing I had to put cream on,” Du Pree, now 35, tells SELF. But after years of living with the itchy, inflammatory condition, things changed. “I started getting more severe flares in college and especially after I graduated,” says Du Pree, who is a singer, writer, and filmmaker in Los Angeles. Her flare ups were causing extremely dry, rough skin; light patches all over her face; and even eye swelling, and she “started to realize this is a serious chronic condition.”

More than 31 million Americans have eczema, which is typically caused by an overactive immune system that results in skin inflammation in response to allergens and/or irritants. Black people in the US are not only more likely than other folks to get eczema in childhood, but may have harder-to-treat or severe symptoms in adulthood and certain subtypes that could be trickier to diagnose. (Why? The reasons are a bit complicated and still being studied—more on that in a moment.)

While the chronic skin disease can show up in infancy—about 10% to 20% babies will have it—many little kids grow out of it. However, more than half, like Du Pree, will not. The good news is that there are treatments, like topical steroids that help, as well as newer biologics that help quash the underlying immune response that generates so many of the symptoms. Here’s what dermatologists want people with darker skin to know about eczema.

1. Your symptoms could be misdiagnosed.

Anyone can feel the itchy, dry sensations of eczema, but what the condition looks like can vary depending on your skin tone. You may have heard that eczema can cause “red patches,” but people of color tend to have brown, purple, gray, or ashen areas of skin. As a result, docs may be more likely to misdiagnose your eczema. Derms usually have some training about all the different ways a condition can manifest, but other health care providers may not know what skin problems look like on diverse skin tones. Tiffany Mayo, MD, an associate professor and director of clinical research in dermatology at the University of Alabama at Birmingham, tells SELF that she probably sees at least one patient of color with eczema in her office every week who was previously misdiagnosed.

The condition can be overdiagnosed, as well. “There’s a tendency to diagnose all itchy rashes as eczema, especially in people with dark skin, instead of really exploring all of the different possibilities,” Oma N. Agbai, MD, founding director of multicultural dermatology and hair loss disorders at the University of California, Davis School of Medicine, tells SELF. “This is particularly important in adult patients who have never had sensitive skin in the past and never had eczema as a child.”

If you think you might have eczema and are looking for a qualified derm to treat you, consider asking your friends for recs. You might also search for a Black dermatologist via the Skin of Color Society or Black Derm Directory. You can also ask health care providers if they regularly treat patients with darker skin. “It’s not just about the ethnicity of the dermatologist,” says Dr. Agbai. “There are more dermatologists of all skin types who are more and more dedicated to diagnosing and treating people of color with unique conditions that have special presentations.”

2. Your eczema may be more severe or difficult to treat.

As we mentioned, Black people may experience more severe or persistent symptoms, potentially due to genetic or environmental factors. That may include certain variations in a gene for filaggrin, a structural protein that's important for skin hydration and barrier function, says Dr. Agbai, who is prone to eczema herself. “There's also a theory that pollutants or irritants in urban areas might be more prevalent and might cause more skin irritation in certain populations,” she says.

However, another cause of disparity is that people of color are statistically less likely to have access to quality health care. Because treatment is important, anything that blocks it—like being under- or uninsured, which is more common for people of color—can affect a condition like eczema.

Physicians may also think you won’t be interested in certain treatment options if they assume you’ll have issues with the cost. Dr. Mayo suggests getting ahead of that by asking your dermatologist: “Are there more advanced treatment options that I might consider?” You can also ask about more thorough testing, including a skin biopsy or patch test, to rule out other conditions besides eczema.

3. You may be more likely to have certain kinds of eczema.

Eczema is often called atopic dermatitis, but there are several types, which means your symptoms can look a little different depending on what you have. For example: Black people are more likely to have papular eczema, which causes very itchy, tiny raised bumps—known as papules—rather than flakey patches.

“It's not the classic eczema that you see in a textbook. It is very common, or way more common, in patients of color,” says Dr. Mayo. “We actually talk about it as a subtype in patients of color, and it's misdiagnosed all the time as something else, ringworm, you name it.”

And some complications of eczema, like having lighter or darker areas of skin known as post inflammatory hypo- or hyperpigmentation, are also more common in people of color.

To get an accurate take on what’s causing your skin problems, it helps to see a specialist early. You “should not be shy” about asking for a referral to a dermatologist, says Dr. Agbai. “There might be some hesitation, but usually you'll know if treatments are working, if you feel like things are starting to get under control, or if you feel like maybe things are worsening,” she says. “It's very important to follow your gut and to seek more answers and more specialized care based on how your treatments are going.”

4. Household and personal products may cause flare-ups.

You may know things like perfumes, fragrant soaps and detergents, makeup, and skin care products can be eczema triggers, but there are products you might not even consider that could cause a flare-up as well.

You can think of your skin as a brick house that has mortar in between the bricks, says Dr. Mayo. In patients with eczema, the mortar isn’t sealed tight. So internal elements—like moisture—get out easily and external elements—like allergens—get inside easily. And when irritants come in, the “immune system is right there, ready to act,” she says.

Dryer sheets, hair care products, and even some natural or essential oils can be aggravating your symptoms without you even knowing it. “Just because it’s natural doesn’t mean you won’t be sensitive to it,” says Dr. Mayo. “Poison ivy is natural.”

If you have scalp eczema, hair oil, as well as styles that pull at the scalp and cause tension—like braids, cornrows, crochet braids, locs, and weaves—may also make your symptoms worse.

5. Eczema can do a number on your mental health.

One of the most important things docs want you to know is the serious impact that this inflammatory skin condition can have on your emotional wellbeing. People with eczema are more likely to feel anxious or depressed than those who don’t have it. A recent study from the UK suggests that folks of color experience more mental distress related to eczema compared to other people.

“The itch is a horrible symptom and it keeps you up at night,” says Dr. Mayo. “When you're up at night, you’re not getting sleep. When you’re not getting sleep, it’s really difficult to concentrate or be productive at school or at your job.”

If eczema is having an impact on other aspects of your life, it’s all the more important for you to advocate for yourself to get the best possible outcome at the doctor’s office. Don’t just tell your doctor about your symptoms; talk to them about what's happening because of them. “If it’s waking you up at night or you are withdrawing from social situations because of anxiety about scratching, that's not normal and we need to do something about it, even if the clinical appearance doesn’t [seem] severe,” says Dr. Mayo. And if you’re not seeing progress with your current physician, you may need to pursue a second opinion or new doctor. Finding the right health care provider and speaking up during appointments are two important steps in the right direction for your health. But you may also need to be a fierce advocate for yourself outside of the doctor’s office as well.

“There have been so many times I’ve been going through it with my skin and I booked a job anyway,” says Du Pree. When she has acting gigs, she asks for accommodations so her eczema symptoms won’t flare, like wearing makeup only during performances and skipping it at dress rehearsals. “You have to advocate for yourself,” she says.

Related:

• I’m a Black Dermatologist With Eczema—Here’s How I Manage My Painfully Dry Skin

• 5 Things People of Color Should Know About Taking Care of Their Skin

• What ‘Skin of Color Dermatology’ Is Doing to Make Health Care More Inclusive

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Originally Appeared on Self