Eczema (Atopic dermatitis)

Key Takeaways

• Eczema is a common inflammatory skin condition that causes dry skin, itching, and recurring
  rashes.

• In skin of color, eczema may not look red. It can appear purple, gray, dark brown, or as a bumpy rash around hair follicles.

• Dark spots and light spots after eczema heals are common and may last much longer than the flare itself.

• Daily moisturizing is the foundation of eczema care, but many people also need prescription treatment during flares.

• Scratching can worsen eczema, increase infection risk, and lead to pigment changes or thickened skin over time.

• If eczema is affecting sleep, mood, school, work, or leaving lasting skin changes, it is worthseeing a dermatologist.

What Is Eczema?

Eczema, also called atopic dermatitis, is a chronic inflammatory skin condition that causes itching, dryness, and recurring rashes. It is one of the most common skin conditions in the world and often begins
in childhood, although it can continue into adulthood or appear for the first time later in life.

Eczema is more than “just dry skin.” In eczema, the skin barrier does not work as well as it should. You can think of the skin barrier as the protective outer wall of your skin. When that barrier becomes weak,
moisture escapes more easily and irritants, allergens, and germs can get in. That leads to inflammation, itching, and flares.

Eczema can affect quality of life in a major way. Itching can interfere with sleep, concentration, mood, and daily comfort. In many people—especially those with deeper skin tones—the rash itself is only part of the problem. The marks left behind after eczema heals can be just as frustrating.

Fast Fact

• Who gets Eczema?

  Children and adults

• Is eczema contagious?

  No.

• Can eczema scar or discolor the skin?

  It can lead to long-lasting dark spots, light spots, and thickened skin from chronic scratching.

• Does eczema only affect children?

  No. Many adults have eczema, and some develop it for the first time as adults.

• Can eczema be treated?

  Yes. Moisturizers, trigger avoidance, topical medications, and newer prescription treatments can all help.

• Where does eczema show up?

  Common areas include the face, neck, arms, legs, hands, skin folds, and in some patients the torso or around the eyes.

A Few Important Facts

• Eczema affects up to 20% of children and up to 10% of adults in some populations.

• In the United States, eczema is more common in Black children than in White children.

• Eczema in skin of color is often underrecognized or underestimated because redness may be less

• visible.

• Many people with eczema also have a history of asthma, seasonal allergies, or food allergies.

What Does Eczema Look Like?

Eczema does not look exactly the same in every person. It can look different depending on age, skin tone, body location, and how long the eczema has been present. 

Mild Eczema- Dry irritated patches, Rough or slightly scaly skin, itching without a dramatic visible rash.

More inflamed eczema- Red, purple, gray, or dark brown patches depending on skin tone, swollen itchy plaques, areas that sting, burn, or feel very irritated.

Long-standing eczema- Thickened skin from chronic scratching, darkened or lighter patches after inflammation settles, and more noticeable scaling or skin texture changes.

Understanding How Acne Develops

A weakened skin barrier- Healthy skin helps keep moisture in and irritants out. In eczema, that barrier is “leaky.” This means: 

• skin dries out more easily 

• soaps, fragrances, sweat, and irritants can trigger inflammation more easily 

• itching becomes more likely.

An overactive immune responses- When the skin barrier is weak, the immune system becomes more reactive. That leads to inflammation, which causes:

• itching

• redness or discoloration

• swelling

• flares that keep coming back

Genetics and family history- Eczema often runs in families. People with eczema may also have a personal or family history of:

• Asthma

• Seasonal allergies

• food allergies

  This pattern is sometimes called the atopic march.

 Common Eczema Triggers: 

• fragranced soaps, lotions, and detergents

• harsh cleansers

• dry air 

• sweating or heat

• stress

• rough fabrics such as wool

• dust mites or environmental allergens

• frequent scratching
  

Skin of Color Perspective

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Skin of Color Perspective |

Why Eczema Can Feel Different in Skin of Color?

For many people with deeper skin tones, eczema is not just about the itch. It is also about how the rash looks, how long pigment changes last, and how easily the condition can be underestimated. Textbook descriptions of eczema are often based on lighter skin, where inflamed skin looks obviously red, but in skin of color, eczema may look very different.

Eczema may not look red

On deeper skin tones, eczema may appear: 

• purple or violaceous

•  Dark brown

• Gray, purple, or ashy

• less visibly inflamed than it actually is

That matters because if redness is harder to see, eczema may look “milder” than it really is—even when the itching, inflammation, and sleep disruption are significant.

A bumpy or follicular pattern is common

Some patients with skin of color develop a follicular pattern, meaning the eczema looks like many small bumps around the hair follicles. This can be especially common on the arms, legs, and torso.

Eczema may show up in different body areas

Although eczema often affects the inner elbows and behind the knees, patients with skin of color may also have eczema involving:

• the outer surfaces of the arms and legs

• the torso

• the around the eyes

• the around the belly button

• the hands

Additional Concerns

Dark spots and light spots can last after the flare improves

One of the biggest frustrations in skin of color is what happens after the eczema flare goes away.

1. Post-inflammatory hyperpigmentation- This refers to dark spots or dark patches left behind after inflammation heals.

2. Post-inflammatory hypopigmentation- This refers to lighter patches that can remain after a flare.

These pigment changes are common in eczema and may last months after the itch and active rash improve. In some cases, they can be more upsetting than the flare itself.

Why this matters

If you have skin of color, eczema treatment is not just about calming the current flare. It is also about:

• reducing scratching

• controlling inflammation early

• preventing infection

• limiting long-term pigment changes

• choosing treatments that control eczema without creating unnecessary lightening or irritation

Why Eczema Matters

Itching can be exhausting. Persistent itching can disrupt sleep, school performance, work concentration, mood, exercise and daily comfort. Some people scratch in their sleep without realizing it, which can worsen the skin barrier and keep the itch-scratch cycle going.

Scratching can damage the skin. Repeated scratching can lead to bleeding, open areas in the skin, thickened skin, more inflammation, bacterial or viral skin infections.

Pigment changes can linger. In skin of color, eczema often leaves behind dark spots, light spots, uneven skin tone, these marks may take much longer to fade than the flare itself.

It can affect confidence and mental health. Eczema can be visible, uncomfortable, and frustrating. When it is severe or persistent, it can affect self-esteem, confidence, social comfort, and overall quality of life. That is especially true when eczema affects the face, hands, or other highly visible areas.

Treatment Options - Depends on acne severity

• Mild Eczema

  • daily moisturizer

  • trigger avoidance

  • short courses of over-the-counter hydrocortisone 1% on appropriate body areas

  • gentle skin care habits

  If you are using hydrocortisone on the face, groin, or underarms, it is best to be cautious and get medical guidance, since these areas are more sensitive.

• Moderate Eczema

  • Moderate eczema often requires prescription treatment, such as:

  • prescription-strength topical steroids

  • topical calcineurin inhibitors such as tacrolimus or pimecrolimus

  • non-steroidal topical medications such as crisaborole or topical ruxolitinib in appropriate patients

  These treatments help calm inflammation more effectively than moisturizer alone.

  A note for skin of color

  When eczema affects the face, eyelids, neck, or skin folds, steroid-sparing treatments such as tacrolimus or pimecrolimus can be especially helpful because they avoid some of the long-term side effects associated with repeated steroid use in delicate areas.

• Moderate-to-Severe Acne

  If eczema is widespread, frequent, severe, or not responding well to topical treatment, a dermatologist may recommend stronger options such as:

  • phototherapy

  • biologic medications such as dupilumab and other newer targeted treatments

  • oral medications, including selected JAK inhibitors in appropriate patients

  These treatments are usually considered when eczema is affecting daily life in a major way or when repeated flares continue despite a good skincare routine and prescription topicals.

What to Expect

Most acne treatments require patience. Many people begin noticing improvement after 6–8 weeks, while some treatments require several months to reach their full effect. Stopping treatment too early is one of the most common reasons people fail to see results.

Building a Simple Acne Routine

Daily routine for eczema-prone skin

1.  Bathe or shower in lukewarm water. 

   Keep showers or baths relatively short. Hot water can worsen dryness and itching.

2. Use a gentle cleanser only where needed. 

   Choose a fragrance-free, gentle cleanser. Avoid harsh soaps and heavily scented body washes.

3. Pat the skin dry. Do not scrub the skin with a towel. 

   Do not scrub the skin with a towel. 

4. Moisturize right away

    Apply moisturizer within a few minutes of bathing while the skin is still slightly damp. This helps lock in moisture.

5.  Reapply moisturizer to dry areas during the day

   Hands, arms, and legs often need extra attention.

During a Flare

During an active flare, many people need to do all of the basics above plus an anti-inflammatory treatment.

That may include:

• hydrocortisone or another topical steroid

• a prescription anti-inflammatory cream or ointment

• cool compresses for itch

• extra moisturizer

• avoiding scratching as much as possible

Common Acne Mistakes to Avoid

• Using moisturizer only when skin looks dry

  • Moisturizer works best when used every day, not just during flares.

• Take very hot showers

  • Hot water can strip moisture from the skin and worsen itching.

• Using fragranced products

  • Fragranced soaps, detergents, and lotions are common irritants.

• Scratching through the itch

  • Scratching can temporarily feel relieving, but it often worsens inflammation, increases infection risk, and

    leads to thickened skin and pigment changes.

• Stopping treatment to early

  • Many flares improve gradually. If treatment is stopped too soon, the rash may rebound quickly.

• Assuming every itchy rash is “just dry skin”

  • If moisturizer alone is not controlling symptoms, it may be time to treat it as eczema rather than simple

    dryness.

When Should You See a Dermatologist?

Consider seeing a dermatologist if:

• eczema is not improving with consistent moisturizing and over-the-counter treatment

• flares are frequent or severe

• the skin is oozing, crusting, painful, or showing signs of infection

• eczema is disrupting sleep, school, work, or quality of life

• you are developing persistent dark spots or light spots

• the rash is affecting the face, eyelids, hands, or large areas of the body

• you think you may need a prescription treatment

• you are not sure whether the rash is eczema or something else

For patients with skin of color, early treatment can be especially helpful because it may reduce the risk of long-lasting pigment changes.

FAQ

• Is eczema just dry skin?

  No. Dry skin is a major part of eczema, but eczema is also an inflammatory skin condition. Many people need more than moisturizer alone to control flares.

• IIf my rash is not red, can it still be eczema?

  Yes. In deeper skin tones, eczema may look purple, gray, dark brown, or ashy instead of bright red.

• Can eczema leave dark spots?

  Yes. Eczema can lead to post-inflammatory hyperpigmentation, which means dark spots left behind after inflammation heals. It can also leave lighter patches.

• Do children always outgrow eczema?

  Some do, but not all. Eczema can continue into adulthood, and some adults develop eczema for the first time later in life.

• Are steroid creams dangerous?

  When used appropriately, steroid creams can be very helpful and safe. Problems are more likely when they are used too often, too long, or on sensitive areas without guidance. If you need frequent steroid use, it is worth talking with a dermatologist about a longer-term plan.

• What type of moisturizer is best for eczema?

  In general, thick fragrance-free creams or ointments work better than thin lotions. Products with ceramides or petrolatum can be especially helpful.

References

1. American Academy of Dermatology

2. National Eczema Association

3. DermNet

4. Recent review articles and guidelines on atopic dermatitis, skin of color, and eczema treatment

5. Literature on racial and ethnic disparities in atopic dermatitis and pigmentary change after
   inflammation

Medical Disclaimer

This article is intended for educational purposes only and should not replace professional medical advice. Always consult a qualified healthcare professional regarding diagnosis or treatment of a medical condition.