Managing Eczema on Black Skin
Eczema is a skin condition most of us have heard of, and experienced, but how does it impact Black skin differently? National Eczema Week is 12 – 18 September and we are taking a closer look at eczema with some of our Black Skin Directory practitioners so you know what to look for and what you should do to manage this condition.
What is Eczema?
Eczema is an umbrella term for a group of skin conditions which typically cause dry, itchy and inflamed skin. In severe cases, the skin can also bleed, become crusty and crack. It can be painful and may also impact your self-image. It is a long-term condition which can flare up and requires careful management. During flare ups it is important to take extra care as the skin can also become infected.
Typically, the symptoms of eczema are described as they appear on Caucasian skin placing the focus on inflammation and redness. However, eczema appears differently on skin of colour. Dr Ingrid Wilson of Crewe Hair and Skin Clinic notes that as redness doesn’t show on darker skin tones the skin may look ‘more reddy brown to grey’. It is important to notice changes in skin colour as this may lead to a clear diagnosis. Dr Wilson also says that there are other significant differences in the way eczema presents on skin of colour. It is usually said that eczema often occurs on the inner sides of the elbows and knees, on the other hand, in skin of colour eczema can often appear on the outer sides of the elbows and knees. This unusual presentation may make it harder to initally diagnose so it is important to be aware of these subtle differences.
How does Eczema affect Black skin differently?
Dr Wilson notes that there are specific symptoms which are more likely to occur on Black skin and skin of colour. Small, hard and lumps, lots of lines on the palms of the hands, and darkening around the eyes are all common on darker skin tones when eczema is present. Dr Wilson adds that especially with the dark circles, it is important to double check for eczema before using any skin lightening products to treat dark circles, as this may be the root cause.
Dr Mary Sommerlad, BSD Listed Consultant Dermatologist, comments that getting a specific diagnosis of eczema is ‘crucial in terms of getting the right management and getting the right referrals to a Dermatologist.’ She adds that for many people ‘management is lifelong and depends on being consistent.’ Eczema is often viewed as simply dry skin, however it is an inflammatory condition that affects the skin’s moisture barrier, the protective layer that naturally protects your skin. If your moisture barrier becomes damaged, your skin is more likely to become inflamed or to be affected by long term skin conditions such as eczema. It is important to maintain your skin’s moisture barrier to keep your skin protected. Dr Sommerlad adds that eczema is more likely to be problematic for people with Black skin as they are more prone to trans epidermal water loss (TEWL). This means the skin struggles to hold on to moisture and therefore feels drier. ‘Dry skin will be less supple and more prone to feeling itchy.’ This increases scratching which also increases the eczema symptoms. ‘There is evidence that shows that Black children with eczema are twice as likely to have severe eczema compared to their White counterparts.’ It is very important to diagnose eczema on Black skin as the discomfort is likely to be greater than on lighter skin tones. This can lead to the worsening of symptoms very quickly. Any trauma (such as inflammation or scratching) to Black skin can very easily cause both hyperpigmentation (darkening of the skin) and hypopigmentation (a loss of pigment in the skin) both of which can be cosmetically unappealing and – especially in the case of hypopigmentation - difficult to fix.
Managing and Treating Eczema
The best way to keep eczema under control and the skin comfortable is to maintain the skin consistently, even when the eczema is not active. Dr Sommerlad recommends avoiding any soaps and shower gels that foam, even if they say they are ‘soap-free’ and instead washing with moisturiser. Dr Sommerlad says that your moisturiser ‘will get you clean without stripping your skin of natural oils.’ Consistent moisturising is also key. Dr Sommerlad recommends aiming ‘to get through between 500 grams and 1kg of non-fragranced moisturiser per week.’ See our dermatologists’ recommendations for their favourite moisturisers for managing eczema prone skin below.
Eczema flare ups can be caused by a variety of triggers including changes in weather, hormonal fluctuations and stress. It is important to be able to identify your individual triggers so you can manage your eczema and anticipate if you are potentially going to experience a flare up. Dr Stephanie Williams at Eudelo says ‘Treating eczema will usually consist of a combination of anti-inflammatory prescription creams (these may be steroid based, however there are also non-steroidal anti-inflammatory prescription creams available now) … The choice of which products your doctor will recommend is individually tailored to each patient.’ Dr Sommerlad adds that steroidal and non-steroidal medication ‘is used for a short period of time and are best used under the supervision of your dermatologist.’ When a flare up occurs, it is vital to see your dermatologist quickly to get it under control to avoid any further discomfort and potential scarring or pigmentation concerns.
It is important to know the signs to look for to identify eczema on Black skin. With consistent care and maintenance, it is easily kept under control. It is important to understand your triggers and to know when you may need some extra attention from a dermatologist. Have you experienced eczema? What do you do to keep your skin in check?
Our practitoners’ favourite moisturisers for managing eczema-prone skin
Bioderma Atoderm Moisturising Cream is an all round moisturising cream containing glycerin to hydrate the skin and niacinamide to build and protect the skin barrier. It is fragrance free and suitable to be used on all skin types from birth.
La Roche Posay Lipikar Lait Urea 5+ Lotion is a lightweight but highly moisturising lotion which doesn’t feel heavy or greasy on the skin. The ingredient urea supports the skin’s moisture barrier and holds hydration into the skin.
CeraVe Moisturising Cream is formulated for dry and very dry skin. Ceramides (the powerhouse ingredient of the CeraVe range) strengthen and hydrate the skin. This is a rich cream which is perfect for the driest skin types.
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