Patient & Caregiver Resources
Living with eczema (also called atopic dermatitis) can be hard. Flare-ups can happen when you least expect them. Eczema can cause inflamed, itchy, irritated, and discolored patches on your skin.
Know your treatment options. This can help you and your doctor create a plan that works best for you.
If you are a person with skin of color, it’s important to speak up about your needs. Eczema can look different on darker skin. Some doctors might not be fully trained to spot these differences. This can delay diagnosis and treatment.
Also, where you live, your financial situation and other factors can affect access to quality care. Understanding these issues can help you advocate for yourself and your loved ones.
Below are resources and information to help patients further their understanding of eczema in darker skin. In addition, there are patient handouts that can be shared with patients in the clinic.
Eczema Download Guide for Patients
About Eczema Guide (available in English and Spanish)
This guide from the American College of Allergy, Asthma & Immunology (ACAAI) covers what you need to know about eczema. It addresses common symptoms, how eczema is diagnosed, and different treatment options. It also explains how to find an allergist.
What’s the Best Treatment for My Atopic Dermatitis?
Atopic dermatitis treatment includes:
- Protecting your skin with daily moisturizers and proper eczema hygiene. This can include using a soak-and-seal routine after bathing.
- Avoiding or reducing exposure to things that irritate your skin. This may include certain allergens, soaps, chemicals, or clothing that can cause contact dermatitis.
- Creating an eczema-friendly environment. This involves being in a consistently mild temperature and a humidity level between 30-50%.
If these steps are not enough, your doctor may suggest other treatments. Topical corticosteroids and calcineurin inhibitors are common ointments for skin diseases. Systemic medications for moderate to severe eczema include biologics and JAK inhibitors. Talk with your doctor about the pros and cons of each.
Here are two charts that serve as a quick guide on eczema treatment:
Topical treatments
These are medicines (like ointments, creams, lotions, gels, or sprays) that you put directly on your skin.
| Corticosteroids | Calcineurin inhibitors | Crisaborole 2% | JAK inhibitors | |
|---|---|---|---|---|
| Use: | Controls inflammation and itching; apply 1-2X per day; approved for adults and children, including infants as young as 3 months | Controls inflammation and itching when topical corticosteroids aren’t working; apply 1-2X per day; approved for adults and children ages 2 and older | Controls inflammation, itch and rash for mild to moderate eczema; apply 2X per day; approved for adults and children 3 months of age and older | Short-term treatment of mild to moderate atopic dermatitis; apply 2X per day; approved for non-immunocompromised adults and children 12 years of age and older |
| Side effects: | Redness, stretch marks, skin thinning, spider veins; may develop dependence, leading to Topical Steroid Withdrawal Syndrome | Stinging or burning may occur upon first use; very slight risk of infection | Stinging or burning sensation may occur | Nose and throat pain or swelling; bronchitis; diarrhea; ear infection; runny nose; hives, tonsillitis |
| Cost*: | Low to moderate cost | Moderate to high cost | High cost | Moderate to high |
Systemic treatments
These are designed to treat the entire body. They are used for moderate-to-severe atopic dermatitis when topical treatments are not enough to control symptoms. They include injectable biologics, oral corticosteroids, JAK inhibitors (pills, not topicals) and phototherapy.
| Biologics | Oral or injectable corticosteroids | Phototherapy (light therapy) | JAK inhibitors | |
|---|---|---|---|---|
| Use: | Injected under the skin every 2 weeks; tralokinumab approved for adults, dupilumab approved for adults and children 6 months of age and older | Daily pill or long-acting injection given at doctor’s office – should not be used long-term due to side effects; approved for children | Exposure to ultraviolet (UV) light to reduce inflammation and itch and boost the body’s ability to fight bacteria; can be applied to specific areas or entire body; approved for children ages 6 and older | A pill taken 1X daily for moderate to severe atopic dermatitis for adults and children 12 years of age or older whose disease is not well controlled by other systemic treatments |
| Side effects: | Redness or itching at injection site; eye or eyelid inflammation; allergic reaction; cold sores; joint pain; mouth and throat pain; difficulty sleeping | Weakened muscles, bone thinning, eye problems, diabetes, weight gain, sleep problems, mood swings or behavior changes, Cushing syndrome, slowed growth in children; symptoms may worsen after treatment | Sunburn; skin aging; risk of skin cancer | Shortness of breath; chest pain or pressure; nausea; vomiting; cold sweat; lightheadedness; slurred speech; weakness on one side of your body |
| Cost*: | High cost | Low cost | Moderate to high cost | Moderate to high |
*May depend on your health insurance coverage
Note on listed side effects: this is not a complete list of all side effects of these medications. Consult with your doctor such as a board-certified allergist to discuss potential side effects of your medication.
Eczema management is different for everyone
When coming to a decision about your care and what resources to use, remember that each person’s eczema can look and feel different. Talk with your doctor about personalized care. Although there’s no cure for eczema, it can be managed with the right treatment plan and support. Ask about medication side effects, costs, or how to make daily treatment routines easier. Your voice matters in your care.
If you feel stressed, anxious or depressed because of your skin condition, talk with your healthcare provider. Seek a referral to a mental health specialist. Find a support group or reach out to the online eczema community.
Shared decision-making for your eczema care
Work with your doctor to choose the right treatment plan. You can use tools like the Shared Decision Making Tool, developed in partnership with the American Academy of Allergy, Asthma & Immunology (AAAAI). Share your results with your doctor as a discussion guide to help you create a plan that fits your needs.
Eczema caused by Type 2 inflammation
Your body has an immune system that defends itself against germs and bacteria. In some people, the immune system is overactive and causes excess inflammation. This is called Type 2 inflammation. It can lead to severe symptoms. For people with eczema, this means the skin is more inflamed, irritated and itchy. It may involve more severe patches of dry, bumpy and/or crusty skin.
Finding out if your eczema is caused by too much Type 2 inflammation helps you and your doctor decide on the best treatment plan. Some resources:
- Allergy & Asthma Network provides a Type 2 inflammation Toolkit to help explain this immune system response.
- ACAAI offers an informational webpage for Type 2 inflammation: Understanding the Type 2 Inflammation Connection.
- The National Eczema Association also has a page on Type 2 inflammation and eczema.
Common barriers to patient care and ways to overcome them
Where you live. Living far from health clinics or in areas with poor transportation can make doctor visits hard.
Try This: Ask about telehealth or local pop-up community clinics.
Home or neighborhood. Your environment may have triggers like pollution, dust, mold, or cockroaches, which can worsen eczema.
Try This: Talk to your physician about how to reduce these triggers at home. Seek local resources for home interventions, pest control or mold cleanup. Adding air purifiers or dehumidifiers may also help.
Access to healthy and safe food. If your eczema is worsened by food allergies, living in a place without easy access to safe foods can be a problem.
Try This: Look for online delivery programs that specialize in providing affordable specialty foods.
Language and cultural gaps. Many people are unable to find providers who are culturally in tune with their own experience. They may not be able to find providers who speak their language.
Try This: Look for healthcare centers that specialize in skin of color or have bilingual staff. You can also ask about online consultations or referrals. Check doctor profiles and photos to help you find a more relatable provider.
Financial strain. Without insurance or enough money, it can be hard to see a specialist or afford treatments for eczema.
Try This: Ask about generic drugs or patient assistance programs that might help cover costs. Re-examine your insurance plan to ensure your coverage fits your needs.
Lack of diversity in medical training. Doctors may have limited experience treating eczema in skin of color.
Try This: If you feel your concerns are not taken seriously, seek a second opinion or a specialist. Patient advocacy groups can also help.
Patient education. You may feel overwhelmed by your diagnosis and not have the support you need to follow your treatment plan.
Try This: Look for patient education resources from advocacy groups that use simple language and videos to help you learn more.
For evaluation and treatment of eczema, consult with your doctor, preferably a skin specialist such as a board-certified allergist.
Studies and Research on Eczema in Black and Brown Skin
Research shows that people with skin of color have more severe eczema and share a larger burden related to the disease.
Understanding Eczema Terms
Besides the 7 Types of Eczema, there are other terms associated with eczema that are good to know.
Atopic dermatitis
A chronic inflammatory skin disease caused by a skin barrier defect and an immune system reaction. It’s the most common form of eczema. Common triggers include infections, irritants, dust mites, pet dander, pollen, foods and stress.
Atrophy
A decrease in size of a body part; for eczema, it is a thinning of the upper layers of skin ( epidermis and dermis). The thinning makes the skin more fragile and prone to tearing. Atrophy is more common as people age. It can also be caused by use of topical corticosteroid medications.
Contact dermatitis
A type of eczema that occurs when an allergen (allergic contact dermatitis) or irritant (irritant contact dermatitis) comes in contact with your skin. Common irritants include detergents and bleach, soaps, shampoos, solvents, alcohol, fertilizers and pesticides and common allergens are nickel, fragrances and preservatives.
Dyshidrotic eczema
Fluid-filled blisters that are very itchy and appear mostly on hands and feet, usually caused by sweat, water or exposure to nickel or other allergens; it is more common among women and rarely appears in children under 10.
Eczema
An inflammatory skin conditions in which the skin develops a red, itchy and irritated rash. The word itself has Greek origins – it means “to boil over.” The most common cause of eczema is atopic dermatitis.
Emollient
A product that softens and moisturizes the skin.
Erythema
A reddening of the skin. However, in people with darker skin pigmentation, the redness may be less obvious. It may appear as darker, ashen gray, brownish or purplish skin.
Filaggrin
A skin protein that binds to keratin fibers in epithelial cells. Studies show nearly one-half of people with atopic dermatitis have a genetic condition associated with filaggrin mutation that causes the skin to lose moisture and allow allergens, irritants and bacteria to enter the skin more easily.
Follicular accentuation
Inflammation of the hair follicles. This may present as a rash that looks like goosebumps.
Humectant
A product that helps retain moisture in the skin.
Hydration
A process of absorbing water or moisture.
Hyperpigmentation
Patches of skin that are darker in color than the surrounding skin.
Hypopigmentation
Patches of skin that are lighter in color than the surrounding skin.
Lichenification
Thickening and hardening of skin patches that gives it a leathery appearance. It is usually caused by chronic scratching. Lichenified skin may appear red or darker than surrounding skin.
Melanin
Pigment produced by skin cells called melanocytes. The amount of melanin is what determines skin color.
Moisturizer
A product that makes the skin softer by increasing its hydration.
Neurodermatitis
Patches of itchy skin that are dry, thick, scaly, leathery or of or different color. It’s normally confined to one or two areas of the body that are easily accessible to scratching. The most common areas affected are arms, shoulders, elbows, legs, ankles, wrists, hands, back of the neck or scalp. Stress is believed to be a driving factor.
Nummular eczema
Itchy, coin-shaped spots or lesions that appear on the hands, arms, chest or legs.
Seborrheic dermatitis
Red, greasy skin with yellowish-white crusty flakes that occur in areas of the body that tend to be oily. In infants, this is usually found on the scalp or the folds of the skin. In older children and adults, it can be found in the sides of the nose (nasolabial fold), in between the eyebrows, on the scalp (known as dandruff), and on the upper chest.
Stasis dermatitis
Pressure build-up in blood veins, often in the lower legs, forcing fluid to leak out of the veins and into the skin; it can cause redness, discolored skin, oozing, infection, ankle swelling and scaly, dry, itchy skin.
Striae
Indented band or streaks of darker or different colored skin, commonly referred to as “stretch marks.” Striae can also result from the overuse of topical corticosteroid medications.
Telangiectasia
Dilated or broken blood vessels on the surface of the skin.
Topical
A medication applied to the surface of the skin.
Xerosis
Excessively dry skin. This may cause itching, skin flaking or cracking.
