In the US, 19.3% of Black children have some form of eczema usually developing during infancy and early childhood1. The risk for severe atopic dermatitis (AD) may be 6 times higher in black children compared to white children2 and is also thought to be more treatment-resistant3. AD prevalence is 12.94% in Chinese children, very close to that of Japan and Korea4. Eczema can look very different on darker skin tones. Eczema is commonly thought of a red, dry, and itchy rash – how it appears on lighter skin tones. But redness can be a challenge to detect on darker skin tones which may make diagnosis more difficult. On darker skin, patches may appear darker than the rest of the skin, looking purple, ashen grey, or dark brown1,5,6. Studies have shown that melanin-rich skin does not retain as much water as white skin7, which means that in general, black people are more likely to have dry skin. Although eczema can be found anywhere on the body, eczema on black skin is often found on extensor surfaces – like the fronts of the arms and legs3. Other signs to look for1: Very dry or scaly skin Intense itching Skin thickening (lichenification) Dark circles under the eyes Small bumps on torso, arms, or legs (called papular eczema) Bumps that develop around hair follicles and resemble goosebumps (called follicular accentuation) Although eczema severity improves for some patients in adolescence, it can be a lifelong issue affecting performance in school. One US study found that Hispanic children were 3.4 times more likely to be chronically absent from school due to AD than non-Hispanic white children, and non-Hispanic black children were 1.5 times more likely to be absent due to AD compared to non-Hispanic white children8. References: Eczema on black skin - National Eczema Association. Eczema on black skin: pictures, symptoms and treatment (nationaleczema.org) Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. Br J Dermatol. 2002;147:920-925. Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122:449-455. Guo Y, Li P, Tang J, Han X, Zou X, Xu G, Xu Z, Wei F, Liu Q, Wang M, Xiao F, Zong W, Shen C, Li J, Liu J, Luo Y, Chang J, Sheng N, Dong C, Zhang D, Dai X, Zhou J, Meng C, Niu H, Shi X, Zhang X, Xiang J, Xu H, Ran Q, Zhou Y, Li M, Zhang H, Cheng R, Gao X, Wang H, Gu H, Ma L, Yao Z. Prevalence of Atopic Dermatitis in Chinese Children aged 1-7 ys. Sci Rep. 2016 Jul 19;6:29751. doi: 10.1038/srep29751. PMID: 27432148; PMCID: PMC4949439. American College of Allergy, Asthma and Immunology. New Website Spotlights Unique Differences of Eczema In People of Color - ACAAI Public Website Atopic Dermatitis (AD) in Brown Skin - Eczema in Skin of Color.org Atopic Dermatitis (AD) in Brown Skin | Eczema in Skin of Color Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. J Clin Aesthet Dermatol. 2014;7(6):25-32. Wan J, Margolis DJ, Mitra N, Hoffstad OJ, Takeshita J. Racial and Ethnic Differences in Atopic Dermatitis–Related School Absences Among US Children. JAMA Dermatol. 2019;155(8):973–975. doi:10.1001/jamadermatol.2019.0597