Scaly patches of skin that can arise on any area of the body during infancy, although eczema frequently prefers the inner wrists and elbows, behind the knees, and neck in children and adults. These patches can seem hyperpigmented and brown in persons with deeper skin tones, or pink or red in people with lighter skin tones.

Source: Asian Women Festival

Skin problems are difficult to manage. They might be issues you've been addressing for a long time, but they can also emerge on the skin apparently out of nowhere. It's easy to misdiagnose oneself since diverse rashes and discolorations might appear identical to the untrained eye. Some symptoms may overlap with others, further complicating matters.

What is Eczema?

"Eczema" comes from the Greek word "ekzein," which means to "boil over" or "burst out." "Dermatitis" means "inflammation of the skin."

Eczema is characterized by dry, itchy, and red skin (atopic dermatitis). It's a common, non-contagious skin ailment. If you have asthma or allergies, you are at a higher risk. There are treatments to alleviate symptoms, but no cure. Eczema or another kind of dermatitis affects up to 15% to 20% of the population at some time.

Eczema (also known as atopic dermatitis) is a skin ailment that produces dry, red, itchy, and rough skin. It is one of several kinds of dermatitis. Eczema compromises the skin's barrier function (the "glue" of your skin). Because of the lack of barrier function, your skin becomes more sensitive and prone to infection and dryness.

Eczema is not harmful to your health. It does not imply that your skin is contaminated or sick, and it is not communicable. There are therapies available to assist you manage your symptoms.

Up to 15 million Americans suffer from eczema. Eczema is common in infants, with 10% to 20% developing it. However, over half of those who get the illness outgrow it or see considerable improvement as they become older.

Eczema affects both men and women equally and is more prevalent in persons with a personal or family history of asthma, environmental allergies, and/or food allergies.

Causes of Eczema

Eczema is caused by a mix of immune system activity, genetics, environmental factors, and stress.

Immune system	Your immune system overreacts to minor irritants or allergens if you have eczema. This response may cause skin irritation.
Genetics	If your family has a history of dermatitis, you are more likely to get eczema. You're also more vulnerable if you have a history of asthma, hay fever, or allergies. Allergens are substances that cause an allergic reaction, such as pollen, pet hair, or foods. There may also be a change in your genes that affect a protein that aids your body in maintaining healthy skin. Your skin will not be totally healthy until it has appropriate quantities of that protein.
Environment	There are several things in your environment that might irritate your skin. Tobacco smoke, air pollution, harsh soaps, wool textiles, and various skin creams are among examples. Dry and itchy skin can result from low humidity (dry air). Heat and extreme humidity can promote perspiration, which can aggravate the irritation.
Stress	Your stress levels might either cause or aggravate your eczema. There are both mental/emotional and physical manifestations of stress. Mental/emotional signs: Depression. Difficulty relaxing. Use of alcohol, tobacco, or illegal drugs to relax. A negative opinion of yourself (low self-esteem). Anxiety, constant worry. Feeling overwhelmed. Difficulty with concentration. Irritability, mood swings, or a short temper Physical signs: Nausea and dizziness. Not wanting to have sex. Sleeping too much. Sleeping too little. Diarrhea. Constipation. Muscle tension. Aches and pains.

Eczema is not caused by an allergic response. Nonetheless, many children with eczema also have food sensitivities. This is not to say that particular foods, such as dairy, eggs, and nuts, which are major food allergy triggers in children with eczema, cause or worsen the condition. Before eliminating certain items from your child's diet, consult with your doctor to ensure that your child's nutritional needs are addressed.

Triggers of Eczema

A trigger is anything that does not cause eczema. However, it can cause it to flare or aggravate an existing flare.

irritants to the skin

The most typical causes are irritants to the skin. Wool or man-made fibers that come into touch with the skin, for example, might cause a flare-up in many people with eczema.

Other factors that might irritate the skin include:

• Cleansers and soaps
• Perfume
• Makeup
• Sand and dust
• Chlorine
• Solvents
• Environmental irritants
• Tobacco smoke
• Allergies or infections

Certain disorders that have an influence on the immune system can also cause flares. For example, the following factors might cause or intensify a flare:

• Flu or cold
• Bacterial contamination
• Allergic response to mold, pollen, or other allergens

Eczema in Different Skin Types

Skin changes are produced by either active eczema or scratching in response to eczema itch. These alterations can cause two types of pigmentary skin changes in eczema patients:

HYPO-PIGMENTATION Skin pigment or color loss, commonly seen as lighter areas of skin than the overall skin tone.

HYPER-PIGMENTATION Darker patches of skin than the typical skin tone.

Hypo- and hyperpigmentation are more noticeable in darker skin types, but they can develop in any skin type and can be alarming and unpleasant for anybody suffering from eczema.

Skin Type	Characteristic
I	White Skin, Freckles
II	Pale Skin, freckles rare
III	Light/light brown skin, no freckles
IV	Light brown/olive skin, no freckles
V	Skin brown
VI	Skin Black

Skin types: Fitzpatrick classification, adapted from: https://dermnetnz.org/topics/skin-phototype/

Eczema symptoms differ depending on the person's skin type.

Inflammation is more difficult to detect on darker skin since it shows as distinct phases of hyperpigmentation and is more moderate, therefore redness is frequently overlooked. As a result, the seriousness of eczema may be underestimated.

The typical pattern on lighter skin is inflamed, red or dark pink regions with dry itchy skin, which may leak with small vesicles in severe flares (blisters).

Post-inflammatory hypo- and hyperpigmentation are far more worrying in individuals with darker skin, as it can take months for this to cure and can occasionally be worse than the eczema itself.

Follicular prominence is another sign of eczema that is more frequent in darker skin. This is when eczema manifests itself as little, irritating bumps or 'papules' on the skin, most commonly on the trunk and forearms. Dry skin and scale can also be more visible, as their white or grey color stands out the most.

Eczema in Dark Skin 

A UK longitudinal study of ethnic differences in atopic eczema found that children with darker skin (African-Caribbean ethnicity) were more likely than white children to have atopic eczema, and were six times more likely to develop severe eczema.

Source: Medical News Today

Children of African American and Hispanic descent are more prone to have severe or chronic eczema. While genetics have a role in the development of eczema, environmental factors also play a role.

Because of structural racial inequalities, indigenous and Latinx children may be at a higher risk of getting severe or recurring eczema. Researchers discovered that because of socioeconomic inequities, these youngsters are more likely to originate from low-income families and reside in locations with greater pollution levels. These are variables that increase the likelihood of getting severe atopic dermatitis. Racial disparities in healthcare are also a role.

Since eczema may be more difficult for certain doctors to identify in persons with darker skin, some clinicians may underestimate the severity of eczema in people of color.

Eczema can develop deeper brown, purple, or gray spots on darker skin. Swollen, heated, itchy, dry, or scaly regions are possible. The damaged skin may seem darker or lighter than the surrounding skin after a flare-up.

Eczema may manifest itself anywhere on the body. However, Black people are more likely to develop papular lesions, which appear as little pimples on the torso, arms, and legs.

This is papular eczema, which can seem like persistent goosebumps. Black folks are also more prone to acquire extensor surface lesions.

The skin patches on and surrounding a person's joints are referred to as extension surfaces. These lumps can form around hair follicles, a condition known as follicular accentuation.

Symptoms of Eczema on Black Skin

On darker skin tones, redness might be harder to notice, making diagnosis more complicated. Patches of skin that are darker than the rest of the skin may seem purple, ashen grey, or dark brown.

Eczema can cause changes in skin color in black skin, however the specific hue may vary. Affected locations may appear as follows:

• lighter than the skin around it
• whitish
• grayish
• brown
• purple
• darker than the skin around it

Eczema, as well as itch scratching and skin thickening (called lichenification), can produce color changes. You may observe hyperpigmentation, in which the afflicted region appears darker, or hypopigmentation, in which the affected area seems lighter than the surrounding skin.

Remedies

Medications

People suffering with eczema may be prescribed a variety of drugs, including:

• Medications available over-the-counter. Topical anti-itch creams containing hydrocortisone (use with care) or oral antihistamines (Benadryl, Zyrtec, Allegra) may be helpful in relieving symptoms.
• Topical treatments on prescription. These topical remedies aid in the relief of irritation and inflammation. Topical corticosteroids and calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus are examples (Elidel). Follow your doctor's instructions when using a corticosteroid cream, ointment, or lotion to your skin. Excessive usage may result in hypopigmentation, or skin whitening in that region.
• Oral corticosteroids, such as prednisone, may be administered on a short-term basis for severe flare-ups.
• Biologics: The FDA recently authorized dupilumab (Dupixent), an injectable biologic, to treat severe eczema.
• Antibiotics: Scratching eczema-affected skin might result in a bacterial skin infection. Antibiotics, either topical or oral, can be used to treat these conditions.

Other treatments

• Aside from drugs, there are various different methods of therapy available to treat eczema.
• Therapy using light. If your eczema is chronic or does not react well to treatments, light therapy may be an alternative. It entails exposing the skin to modest quantities of UV radiation under controlled conditions. If hyperpigmentation is an issue, it may not be suggested for dark skin tones.
• Dressings that are wet. When eczema is prevalent, this therapy may be beneficial. It entails covering the afflicted region with damp bandages and applying topical corticosteroids.
• Techniques for reducing stress. Eczema flare-ups can occasionally be triggered by stress. As a result, stress-relief strategies such as yoga or meditation may be effective

Eczema is a term used to describe a set of common skin disorders that manifest differently in persons with varying skin tones. Eczema areas on darker skin may seem dark brown, purple, or gray. In certain situations, the disease is characterized by tiny, hard, raised bumps.

The disease is especially prevalent in Africa and Oceania. Eczema is more common in African American youngsters in the United States. Because of socioeconomic risk factors, African, Hispanic, and Indigenous Americans are more likely to develop undiagnosed, severe, or chronic eczema.

All skin tones require the same treatment and maintenance. Anyone having eczema symptoms should consult a doctor for a diagnosis and treatment.Eczema treatment seeks to encourage gentle skin care while avoiding factors that might cause flare-ups. When a flare-up occurs, medicines and other therapy can help alleviate symptoms.

Eczema is more severe in individuals of race, perhaps resulting in permanent pigmentation changes or skin thickness. As a result, taking efforts to control the disease and seek treatment is critical.

References:

https://eczema.org/information-and-advice/living-with-eczema/skin-pigmentation/

https://my.clevelandclinic.org/health/diseases/9998-eczema#

https://www.medicalnewstoday.com/articles/325066

https://www.henryford.com/blog/2020/09/is-it-eczema-or-something-else

https://www.healthline.com/health/eczema/eczema-on-black-skin#outlook

https://www.aveeno.com