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Darker Skin and Atopic Dermatitis: A Closer Look at Symptoms and Solutions

On Darker Skin, Atopic Dermatitis Symptoms Don't Fit the Textbook Definition

Key differences in symptoms can lead to delayed diagnosis and treatment — but finding culturally competent care makes all the difference.
On Darker Skin, Atopic Dermatitis Symptoms Don't Fit the Textbook Definition

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How Inclusive Is Atopic Dermatitis Treatment, Really?

How Inclusive Is Atopic Dermatitis Treatment, Really?

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How Inclusive Is Atopic Dermatitis Treatment, Really?

How Inclusive Is Atopic Dermatitis Treatment, Really?00:06:08

Being Black With Atopic Dermatitis: Feeling Judged By Your Skin

Being Black With Atopic Dermatitis: Feeling Judged By Your Skin00:05:10
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Published on May 7, 2025
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Atopic dermatitis, one of the most common types of eczema, is typically described as patches of red, inflamed skin, but that’s not the case for everyone. Symptoms can appear differently on darker skin — and in some cases, more severe. This can make getting the right care a challenge.

Not all doctors have experience diagnosing and treating atopic dermatitis in darker skin, says Nada Elbuluk, MD, a clinical assistant professor of dermatology at Keck Medicine of the University of Southern California in Los Angeles and the founder and director of the USC Skin of Color and Pigmentary Disorders Program. “This can lead to a delayed diagnosis, and disease severity can sometimes be underestimated, which can lead to undertreatment.”

This is why it’s critical for ongoing dermatology research to explore how atopic dermatitis affects people of color, says Caroline Opene, MD, a dermatologist at UCLA Health in Santa Monica, California. And it’s equally important that people with darker skin know what symptoms to look for and how to advocate for their care.

What Atopic Dermatitis Looks Like on Darker Skin Tones

Atopic dermatitis in darker skin can appear as itchy, bumpy, rough, dry patches that are darker than your normal skin color.

Illustrative graphic titled Atopic Dermatitis in Lighter VS Darker Skin Tones shows In white skin, atopic dermatitis (AD) is usually red or pink. In skin of color, AD can appear dark brown, purple, or ashen gray. Everyday Health logo.
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Symptoms may show up as:

Dark Brown, Purple, or Gray Patches While pink and red areas may still show up, they’re usually not as visible in darker skin tones, says Dr. Elbuluk. Instead, flare-ups on darker skin tend to be more purple, ash gray, or dark brown.

Thick, Leathery Skin This is known as lichenification and can make your skin itchy, thick, and leathery. It’s common in people of color with atopic dermatitis.

Small Bumps Small bumps, which are known as papular eczema, may appear on your arms, legs, and torso. Goosebump-like areas may also show up around your hair follicles, which is known as follicular accentuation.

Thick, Raised Bumps Known as prurigo, this condition causes skin thickening and firm, raised bumps. It’s commonly caused by excessive rubbing and scratching of eczema-prone areas.

Changes in Pigment Areas affected by atopic dermatitis may be a different color than the surrounding skin. When the affected skin becomes darker, it’s known as hyperpigmentation; when it gets lighter, it’s known as hypopigmentation. In some (but not all) cases, the skin returns to its normal color over time.

Intense Itchiness This is common with atopic dermatitis in darker skin tones. Unfortunately, repeated scratching and rubbing can make the condition worse.

Is Atopic Dermatitis More Severe in People of Color?

Generally speaking, atopic dermatitis tends to be more severe in people of color.

Research shows that Black and Latino Americans who have atopic dermatitis tend to have a greater disease burden than white people living with the condition. And Black people in particular tend to have more persistent, severe cases of atopic dermatitis than white people.

These discrepancies may be due to many contributing factors:

Delays in Seeking Care “Many times, people wait too long to seek medical care and try to treat it themselves with over-the-counter products, which are typically not sufficient,” says Elbuluk.

Underdiagnosis or Misdiagnosis Even when people seek care, symptom discrepancies in darker skin can make the condition difficult to diagnose. “Signs of active disease can be different in darker skin,” says Elbuluk. As a result, it’s not uncommon for atopic dermatitis to be misdiagnosed or underdiagnosed in people of color. You may seek medical care but be undertreated if your doctor isn’t used to treating atopic dermatitis in darker skin, Elbuluk notes.

Socioeconomic Status Research has also found that systemic issues related to socioeconomic status, such as racism, can limit access to quality medical care for people of color. This can contribute to more severe cases of atopic dermatitis.

Environmental Triggers Environmental exposure to air pollution, allergens, and chemicals can also increase the severity of atopic dermatitis. And because of systemic racism — specifically, housing discrimination — Black and Latino Americans are more likely than white Americans to live in areas with harmful environmental exposure.

Finding Culturally Competent Care for Atopic Dermatitis

“Working with a dermatologist who understands atopic dermatitis on people of color can lead to receiving an earlier diagnosis and faster, more effective treatment,” says Dr. Opene. “This can dramatically improve the outcome of treatment and reduce the occurrence of future flare-ups.”

Research has found that Black people seen by dermatologists with experience treating people of color reported increased satisfaction with their care, compared with prior experiences. More specifically, these people were pleased with their dermatologist’s knowledge about Black skin and hair and felt their provider was sensitive to their culturally unique needs.

But finding a culturally competent dermatologist can be difficult.

For one, there’s a small number of people of color who work in dermatology. Although a doctor of any background may be able to provide quality care, “In some cases, dermatologists who have darker skin themselves have a greater interest in specializing their work and knowledge toward patients with darker skin,” says Opene.

Finding culturally competent care may also be challenging if you don’t know where to look.

4 Ways to Find the Right Atopic Dermatitis Provider for You

If you’re not sure where to get started when searching for culturally competent atopic dermatitis care, Opene offers these tips:

  1. Contact your insurance provider. Reach out to your health insurance company to ask them to help you find an in-network provider who has the experience you’re seeking.
  2. Consult your family doctor. Your primary care provider undoubtedly makes referrals daily and may be familiar with dermatologists who would best meet your needs.
  3. Connect with the American Academy of Dermatology Association (AAD). The organization has an easy-to-use directory of dermatologists. Use the filter option to help find a dermatologist with the specific experience and characteristics you want. This may be especially helpful if you live in a rural or remote area.
  4. Do your research. When all else fails, you can search the Internet for providers who have experience treating atopic dermatitis in people of color. You may find websites, forums, chat rooms, and even information about specific doctors who meet your needs. As with the AAD directory, this may be great for people who live in a rural or remote area.

Once you find a dermatologist, Opene recommends writing down some questions to cover during your consultation, such as:

  • Have you had any specific training or education in cultural differences in atopic dermatitis?
  • How would you include aspects of my cultural identity in my care?
  • Can you share examples of how you’ve worked with people from different cultural backgrounds? Has treatment been successful with those patients?

Finding the right doctor can be daunting, but remember: Receiving culturally competent, effective, and timely care can significantly improve your treatment outcome and give you the tools you need to reduce future flare-ups.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Eczema in Skin of Color: What You Need to Know. National Eczema Association. September 22, 2023.
  2. Sangha AM. Dermatological Conditions in Skin of Color-: Managing Atopic Dermatitis. Journal of Clinical and Aesthetic Dermatology. March 2021.
  3. Croce EA et al. Reframing Racial and Ethnic Disparities in Atopic Dermatitis in Black and Latinx Populations. The Journal of Allergy and Clinical Immunology. November 2021.
  4. Gorbatenko-Roth K et al. Assessment of Black Patients’ Perception of Their Dermatology Care. JAMA Dermatology. October 1, 2019.
Additional Sources
  • Alexis A et al. 594 - United States Prevalence of Atopic Dermatitis in Adults and Pediatrics by Race and Ethnicity. British Journal of Dermatology. August 2024.
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Lydia-J-Johnson-bio

Lydia J. Johnson, MD

Medical Reviewer
Member of American College of Lifestyle Medicine
Lydia Johnson, MD, is a board-certified dermatologist. Her medical career of more than 20 years has included work in private practice and in an academic medical center, as well as various medical leadership positions, including department chair. In 2020, Dr. Johnson embarked upon a passionate journey to utilize her medical knowledge and experience to help create a more widespread and lasting impact on the individual and collective health of our community. She is doing this as a board-certified lifestyle medicine physician, board-certified dermatologist, and certified health coach.

Johnson envisions a future of healthcare that prioritizes and values maintenance of health, holistic well-being, and disease prevention. Through lifestyle medicine certification, she is committed to being a part of that transformation. As a coach, she empowers others to enjoy lives of optimal well-being and identify the ways to do so through lifestyle behaviors that are accessible to all. Her purpose is to help others thrive in all aspects of their lives, with a foundation of optimal health.
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Maia Niguel Hoskin, PhD

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Maia Niguel Hoskin, PhD, is a graduate assistant professor of counseling who earned her doctorate in counselor education and clinical supervision at Southern Illinois University. She is also a Forbes contributor, consultant, and therapist. She writes about topics related to structural racism and oppression, women’s issues, and mental health in both scholarly and non-scholarly publications. Her research also explores how social media and mediated images of Blacks impact behavior and mental health conditions, such as anxiety, depression, and racial trauma. Dr. Maia has a catalog of published, peer-reviewed journal articles and book chapters, and her editorial work has appeared in outlets such as Zora, Momentum, Vox, Healthline, What to Expect, The Healthy, and MadameNoire. She is a staunch activist of racial and gender equity who has lectured at more than 20 speaking engagements and facilitated dozens of workshops on cultural consciousness and mental health for various businesses, organizations, schools, colleges, and universities.

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