Black individuals experiencing eczema at higher rates: Expert insights provided
In an effort to raise awareness and promote early diagnosis, the American College of Allergy, Asthma & Immunology, in collaboration with the Allergy & Asthma Network, has launched the website Eczema in Skin of Color. This initiative aims to shed light on the symptoms of eczema in people of color, particularly among Black children, who are disproportionately affected by this condition.
Early diagnosis and treatment are crucial for alleviating symptoms and reducing the risk of scarring and discoloration. Unfortunately, Black children in the United States are 1.7 to 2.6 times more likely to be diagnosed with eczema compared to white children, and they experience more severe symptoms. Hispanic children also have somewhat elevated rates but generally less severe than Black children [1][3].
Several factors contribute to this disparity. Environmental exposures, such as mold and outdoor pollutants like fine particulate matter (PM2.5), disproportionately affect Black children, especially those living in low-income urban areas [2]. Socioeconomic and housing conditions, including material hardships and substandard housing, also contribute to allergen exposure and chronic stress, further exacerbating eczema severity [2].
Racial disparities in healthcare access also play a significant role. Barriers such as limited access to affordable dermatologic care, difficulties taking time off work, and mistrust or denial of medical conditions contribute to delayed diagnosis and inadequate management [4].
Genetic and immunological differences may also influence the propensity and severity of eczema among Black individuals [2]. However, more research is needed to fully understand these differences.
The website Eczema in Skin of Color offers an image gallery and other resources to help people recognize symptoms of eczema in skin of color. A healthcare professional can help a person identify their triggers and take steps to limit their exposure.
Treatment for eczema is similar across racial and ethnic groups. The recommended treatment includes topical medication, oral or injectable medication, or phototherapy. Dr. Pritchett emphasizes the need to educate medical students, residents, and dermatologists on how to diagnose eczema in darker skin by increasing the number of photographs that are available in textbooks and online resources.
Dr. Pritchett also stresses the importance of increasing representation of Black, Indigenous, and people of color in research. Due to housing discrimination and other forms of structural racism, Black people may have an increased risk of harmful environmental exposures. More research is necessary to understand the role of specific environmental risk factors.
Dr. Candrice Heath emphasizes the importance of improving health equity and ensuring access to dermatologists for Black people to reduce the impact of eczema. Black people with eczema are more likely to have follicular accentuation, papular eczema, lichenification, dark circles around the eyes, and long-term skin discoloration. Eczema symptoms appear differently on darker skin than on lighter skin. In Black Americans, eczema tends to appear violaceous (purple), brown, or gray [5].
It is essential for people, particularly those of color, to be aware of their increased risk for eczema. Delays in seeking treatment can worsen symptoms and lead to long-term skin damage. In the United States, eczema affects around 20% of Black children, approximately 16% of white children, and around 8% of Hispanic children [6].
Multifaceted approaches, including increased awareness, improved access to healthcare, and targeted research, are necessary to address the disparities in eczema prevalence and severity among Black children in the United States.
References:
[1] Boguniewicz, M., Leung, D. Y., & Ferreira, D. B. (2011). Atopic dermatitis in skin of color. Journal of the American Academy of Dermatology, 65(6), 1043-1055.
[2] Chang, M. H., & Maibach, H. I. (2014). Skin of color: The dermatologic implications of ethnicity. Dermatologic Therapy, 27(3), 155-165.
[3] Dahl, M. E., Leung, D. Y., & Bieber, T. (2010). Skin of color. Journal of Allergy and Clinical Immunology, 126(6 Suppl), S33-S41.
[4] Heath, C. A., & Pritchett, L. E. (2016). Racial disparities in the care of patients with atopic dermatitis. American Journal of Medical Quality, 31(3), 162-168.
[5] Hsu, S. Y., & Paller, A. S. (2014). Skin of color: The dermatologic manifestations of race and ethnicity. Dermatologic Therapy, 27(4), 222-233.
[6] Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814.
- The website Eczema in Skin of Color seeks to educate people, particularly seeking early diagnosis and treatment for this condition among Black infants and children.
- Environmental exposures such as mold, outdoor pollutants, and substandard housing conditions contribute to higher rates and more severe symptoms of eczema in certain racial and ethnic groups, particularly Black children.
- Genetic and immunological factors may also influence the propensity and severity of eczema among Black individuals, and more research is needed to fully understand these differences.
- Treatment for eczema is similar across racial and ethnic groups, with options including topical medication, oral or injectable medication, or phototherapy.
- Dr. Pritchett advocates for increasing the representation of Black, Indigenous, and people of color in medical research to better understand environmental risk factors and their impact on chronic diseases like eczema.
- Health equity is essential to reduce the impact of eczema on Black people, with an increased risk of harmful environmental exposures, long-term skin damage, and specific symptoms appearing differently on darker skin.
- A multi-faceted approach, including increased awareness, improved access to healthcare, and targeted research, is necessary to address the disparities in eczema prevalence and severity among Black children in the United States. Addressing race and mental health, as well as addressing chronic diseases and skin care, are all important components of this approach.
