Eczema and Darker Skin: Treating Babies and Children

As parents know, caring for babies is a full-time job. Eczema is one additional challenge families can face in those early months and years. It affects children physically and can be emotionally stressful for parents.

Eczema, also known as atopic dermatitis, is an itchy, chronic skin condition that is sporadic and is often associated with asthma and allergies. It is a breakdown in the skin barrier leading to compromised function. It most commonly affects children, with most cases appearing by age 5. In infants, it often affects the scalp, face, torso, and outer portion of the arms and legs. In children, the inner parts of the arms and legs are most commonly affected.

October is Eczema Awareness Month, and one in 10 people in the U.S. have the condition. While any baby or child can get eczema, it often looks different on different skin colors. It may be harder to diagnose when parents and caregivers aren't sure what to look for. When parents of dark-skinned babies face barriers in accessing care for their children’s skin, this can exacerbate an already stressful situation.

Why Are Certain Ethnic Groups at Higher Risk for Eczema?

In the United States, Black children have been found to have a higher risk for eczema (19.3%) than White (16.1%) and Asian (7.8%) children. Black children are 1.7 times more likely to develop atopic dermatitis, the most common form of eczema, than White children.

“In the United States, eczema is more common and oftentimes more severe in Black Americans as compared to White Americans," says Mona Amin, DO, FAAP, a board-certified pediatrician. "The increase in severity could oftentimes be that eczema is missed in darker skin tones so skincare management isn’t done as soon as it should be."

Eczema can be caused by several things. “Primarily, eczema is influenced by genetic and environmental factors, and likely may explain the difference in eczema among various ethnic and racial groups," says Tiffany Jow Libby, MD a board-certified dermatologist, and director of Mohs Micrographic and Dermatologic Surgery.

The reason why Black Americans may have a higher incidence of eczema is still being studied. "This condition impacts the quality of life of not only the kids, but the parents as well. The [cause] is not completely understood,” adds Naana Boakye, MD, MPH, a board-certified dermatologist and co-founder of Bergen Dermatology. 

When it comes to the environment, certain exposures to chemicals, pollutants, and allergens may increase the risk of eczema. Children in urban areas tend to have more exposure to allergens like dust, mold, and pollution which could also increase the risk of eczema.

How Are Eczema Symptoms Different for Babies With Darker Skin?

The appearance of the lesions is different depending on skin tone. They can be bright red, gray, brown, or purple.

Alexis Stephens, DO, FAOCD, FAAD, a board-certified dermatologist in Florida, explains the difference between skin types. “In deeper skin tones affected areas may appear hyperpigmented or darker than the surrounding skin whereas in fair skin tones the affected area may appear red in color," she says.

“Eczema often presents differently in darker-skinned babies, as the background of melanin confounds the way pink and red may appear in the skin,” says Dr. Libby. She goes on to say that because of these differences, eczema may be missed as a diagnosis or it may take longer to diagnose for dark-skinned babies and children.

Dr. Boakye agrees. “If a practitioner is not aware of the nuances, the diagnosis can be missed or be thought of as something completely different."

Representation in Online Eczema Research

Statistics show babies with darker skin may be more likely to have eczema, yet when parents search online, almost all of the images that come up are of light-skinned babies. The popular skincare brand Aveeno took note of this and launched a campaign called "Eczema Equality" aimed at making sure every skin tone is represented. The company's goal was to photograph babies of all skin colors as a resource for parents.

Dr. Amin believes that racial disparities can come from both patients' lack of awareness about eczema and their inability to access care as well as clinicians' lack of understanding of how to diagnose eczema on darker skin tones. It's part of why she partnered with Aveeno Baby.

It's not just a lack of representation online. Dr. Amin says images in most textbooks do not show darker skin children and rashes, including eczema. In fact, a 2018 study showed less than 5% of images in textbooks showed children with darker skin tones.

Racial inequity that creates barriers to accessing quality healthcare is another reason eczema in darker-skinned babies is missed. A 2021 study found Black people in the U.S. were more likely to lack health insurance, have no usual source of medical care, or face more financial barriers to accessing medical care and paying for treatments than White Americans.

Treatment for Eczema on Babies with Dark Skin

Your baby has been diagnosed with eczema—now what? No matter their skin color, treatment is similar for all races and ethnicities.

“I think the key is to work with a pediatrician and a dermatologist to ensure that everyone is involved in the care of the child to treat the acute condition,” says Dr. Boakye. “However, more importantly, to ensure how to control the condition, cultural differences should be considered when determining treatment.”

Around the world, there are different guidelines for treating eczema. For example, for atopic dermatitis in Asian-Pacific areas, doctors recommend moisturizers that contain specific ingredients like coconut oil, ceramides, and shea butter. When it comes to bathing, South Africans are advised to avoid soap for atopic dermatitis, whereas in Latin America it states to avoid irritating cleansers.

Here in the U.S., gentle soaps, cleansers, and good moisturizers are usually recommended. But for some babies, a doctor may prescribe topical medications. In extreme cases, light therapy may be the best course of treatment.

“Strengthening the skin barrier helps combat eczema on all skin tones. Maintaining the skin barrier starts with using a well-rounded nourishing moisturizer," says Dr. Stephens. One suggestion she makes is a moisturizer with colloidal oatmeal in it. Colloidal oatmeal delivers a variety of skin health benefits such as moisturization, barrier protection, anti-inflammatory properties, and antioxidant properties.

How Can I Prevent My Baby From Getting Eczema?

Using an emollient balm on a regular basis may help prevent eczema before parents see any external symptoms. An emollient balm helps the skin maintain its moisture which contributes to overall skin barrier function and health. Two popular brands are Mustela Stelatopia Emollient Balm and Aveeno Baby Eczema Therapy Nighttime Balm.

Dr. Libby advises parents and caregivers “recognize and try to avoid common triggers that include certain types of soap, shampoo, body wash and cleansers, laundry detergents and fabric softeners with chemical additives, certain fabrics like wool or polyester in clothing and bedding, fragrances, and extended exposure to dry air, extreme heat or cold.”

Sometimes these items can cause what's known as contact dermatitis, which is a particular form of eczema. That's when a baby or child has a reaction after coming into contact with an allergen or another irritant such as a chemical in a soap or detergent.

Parents should also pay attention to the baby's fingernails. Keep them short to avoid them scratching the skin while itching and potentially causing an infection. The aim is to avoid further irritation to the skin.

Karrie Locher, RN, BSN CLC, a postpartum and neonatal nurse and lactation counselor, shares some other tips for preventing and managing eczema.

Work Bathing and Moisturizing Into Your Routine

Bathing and moisturizing babies is an important part of caring for eczema. Not only does bathing wash off potential irritants from the day, but it also helps restore moisture to the skin barrier. Use warm (not hot!) water for your baby.

It's also important to moisturize after the bath to help introduce and seal in moisture. We tend to moisturize after baths, however, we can also work moisturizing into our routine at other parts of the day. One way to do that is to incorporate moisturizing at the same time as two separate diaper changes during the day.

In Black families, there is a greater awareness and effort towards moisturizing children so their skin doesn't appear "ashy." Sometimes excessive dry skin can appear white or grey. In dark skin tones, it can look "ashy." This habit of moisturizing is one that may help prevent eczema flare-ups in Black babies and children.

Pat, Don't Rub!

After bathing, dry off the skin gently with a towel by patting. Don't rub your baby dry, as this method can further irritate already sensitive skin.

Opt for a Humidifier at Night

Humidifiers are incredible at bringing moisture into the air, especially if you live in an area with a harsh climate. Turn one on in the baby's room before they go to bed. This helps combat dry air associated with some of the harsh colder months to keep babies comfortable and their skin at less risk for drying out. 

How You Dress Your Baby Matters

Dressing your baby in lightweight, temperature-regulating, non-scratchy materials is important, especially in children with eczema. Materials like 100% cotton or bamboo allow their skin to breathe and not "hold on" to heat. We want to prevent babies from overheating and sweating, as this can cause a loss of moisture and further irritation, leading to an "itch-scratch-itch" cycle.