Eczema in black pores and skin: signs, prognosis, therapy

EH: Why does atopic dermatitis tend to be more severe in black patients?

MT: There are two reasons. Number one, genetic factors. A protein is expressed [produced] in every skin called ceramide, which helps retain moisture. The ceramide-to-protein ratio is lower in African Americans. So, genetically, dark-skinned people hold less moisture.

Second, there is a situational and environmental reason why African Americans have worse eczema. That’s because many African Americans in general tend to live in urban environments with lots of irritants, allergens, pollution, humidity, higher UV exposure, hard water, dust – all of these are things that can make eczema worse and impair the immune system .

EH: What is the connection between neurodermatitis and allergies?

MT: Not everyone with atopic dermatitis has allergies, but if you look at a Venn diagram, they will overlap a lot.

Why? First, with atopic dermatitis, itching and scratching causes small cracks in the skin, and allergens can penetrate more easily. Our skin should be a wall keeping everything out, but with eczema, that wall is compromised. So an allergen can get in and cause a more inflammatory response than someone with completely intact skin would.

Number two, people with atopic diathesis – people with asthma or seasonal allergies – genetically have a higher immunological response. It’s like having two kids, one gentle and the other bouncing off the walls. The second child is like the immune system of an atopic person. It’s an immunological reaction.

EH: Is atopic dermatitis difficult to diagnose in patients of color?

MT: Yes, doctors have more trouble diagnosing patients of color. Many medical textbooks often only mention Caucasians. They conducted a study in which 98 percent of photos in dermatology textbooks showed white skin. Unless you’re an expert on darker skin, sometimes you won’t be exposed to it in your workout.

Many doctors don’t realize that atopic dermatitis can appear different in color on darker skin than on Caucasian skin. Also, you may not know that while Caucasians can get flaky skin, African Americans can get bumps.

Interestingly, the localization of atopic dermatitis can be different in dark skin than in white skin. Jon Hanifin, MD, a dermatologist who practiced in Portland, Oregon and literally wrote the diagnostic criteria for eczema, said atopic dermatitis occurs on the flexors, the joints that bend at the inside of the elbows and behind the knees.

But we now know from studies that eczema in African Americans affects the extensor muscles, the front of the knees, and the back of the elbows. It’s the reverse distribution. But because criteria for black people are not inclusive, they are exclusive, and that criterion has not even been updated.

EH: Is Atopic Dermatitis in People of Color Misdiagnosed?

MT: It is often not taken seriously. I have seen many patients with atopic dermatitis who are black and whose eczema has either been swept under the rug or not recognized because it is not as red. This poor patient may be unhappy, but he is undiagnosed.

EH: Why does eczema cause skin pigment changes in darker skin?

MT: Pigment change is a protective mechanism. It’s essentially just the melanocytes [skin cells that produce the pigment melanin] trigger because they were “offended” by an inflammation.

The more pigment you have, the darker you get.

You can also get ease. Brightness can be viewed as dissolution because these melanocytes are tired – they overshot themselves during the pigment phase and are now retreating.

EH: Eczema is one of the most common skin conditions in children, especially children of color. Can you tell us about it?

MT: In America, eczema is the most common skin condition diagnosed in the first 10 years of life. We know that interest rates are rising. This can be due to pollution, living in more urban areas, and exposure to more allergens.

EH: What can parents do to take care of children with eczema?

MT: I always advise parents that when puberty comes and the hormones kick in, the kid gets a little oilier, all natural, and that moisturizes the skin. You may always have a little bit of eczema, but it won’t be as bad as it was when you were younger.

Moisturizing is also really key. They conducted a study of children in families prone to atopic dermatitis and compared intense moisturizing to less intense moisturizing. And the children who were regularly moisturized after their bath, from ages birth to six months, had less eczema as they got older. Therefore, it is really important to keep this skin barrier intact and healthy when the baby is small.

For kids with eczema, I always recommend the simplest moisturizers. Vaseline is great. Parents can even use Crisco on their babies – it’s better than nothing. Sunflower oil is really cheap. So really basic stuff.

If your child has a problem with itching, keep the skin covered. Wear the onesies with pajamas or wear the full lengths. You can be light; they can be cotton.

You should seek dermatological treatment from a provider who understands skin color to ensure the child does not have scarring or widespread hyperpigmentation. We also know that itching can lead to less sleep and cause these kids to underperform in school.

EH: Are there any foods or household products that are problematic for children with eczema?

MT: Many parents will hold back a certain food because it may have triggered a child’s eczema in the past, and then the child may actually become nutrient deficient. If you’re concerned that food is making your child’s eczema worse, you should see an allergist for a formal food test. Don’t hold back food.

Products to stay away from: Fragrance is #1 for kids. You don’t want to use a scent. You don’t want to use formaldehyde or dry-cleaned clothing.

EH: Are there any complications of eczema to look out for in children?

MT: Secondary infections are a complication of dermatitis. You see it all the time in children where scratching leads to bacteria in the skin, specifically Staphylococcus aureus. There have been some interesting studies where they actually gave kids a different type of bacteria to help regulate the bacterial load on their skin.

There’s what’s called a bleach sitz bath, where you take very diluted bleach and soak your child in a bathtub with some bleach – about half a cup of bleach in a full bathtub of water. Then rinse them off and apply a moisturizer that will help regulate the bacterial load on the skin.

EH: How are social and economic aspects included in the treatment?

MT: If you have hard water, live in a badly polluted apartment, don’t have enough money to buy moisturizer, how will your poor baby who is already genetically prone to eczema develop that skin barrier?

If you don’t have access to medical care and your pediatrician only knows white skin and doesn’t see the problems, that’s another matter.

EH: What other advice do you have? for people of color who try treat eczema?

MT: Number one, take some more vitamin D. You can talk to your doctor about it. We typically recommend between 1,000 and 4,000 international units per day. The reason is that vitamin D is an immune stabilizer. Evolutionarily, humans are said to live on the equator. We shouldn’t live in these northern climates. Our skin doesn’t produce enough vitamin D from the sun, so you need to get it in a bottle. Once you take supplemental vitamin D, it helps keep your skin from becoming less responsive.

Number two, get a humidifier. Sleeping in a bedroom with a humidifier helps maintain this skin barrier.

Number three, moisturize after the bath and don’t use soap all the time. As dermatologists, we say, “Use soap on your sweaty areas, like your armpits, under your breasts and groin when needed, and on the back of your scalp, but you don’t have to use soap all over the place all the time.”

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