Atopic Dermatitis in Skin of Colour: Why It Looks Different and What Actually Helps

Atopic dermatitis (eczema) is one of the most common inflammatory skin conditions worldwide, yet it is often misunderstood, particularly in people with skin of colour.

Many of the images used in textbooks, advertisements, and online resources show eczema on lighter skin tones. This can make diagnosis more challenging in darker skin tones because the condition often looks very different.

At Lafont Advanced Skin Clinic, we believe that understanding the skin is the first step towards improving it. The more accurately we identify what is happening beneath the surface, the better the outcome we can achieve.

What Is Atopic Dermatitis?

Atopic dermatitis is a chronic inflammatory skin condition caused by a combination of:

• A weakened skin barrier

• Immune system dysfunction

• Genetic predisposition

• Environmental triggers

When the skin barrier becomes compromised, it loses moisture more easily and becomes vulnerable to irritation, allergens, bacteria, and inflammation.

The result is skin that becomes:

• Dry

• Itchy

• Inflamed

• Sensitive

• More prone to infection

For many people, eczema follows a cycle of flare-ups and periods of improvement rather than being present at the same severity all the time.

Why Does Eczema Look Different in Skin of Colour?

One of the biggest challenges in diagnosing eczema in skin of colour is that redness is not always obvious.

In lighter skin tones, inflammation typically appears bright pink or red.

In deeper skin tones, inflammation may appear:

• Purple

• Grey

• Brown

• Darker than the surrounding skin

• Ashy or dull

Because the redness is less visible, eczema can sometimes be mistaken for other skin conditions or appear less severe than it actually is.

Unfortunately, this can delay treatment and prolong inflammation.

The Hidden Impact of Itching

Many people think eczema is primarily a rash.

In reality, itch is often the most significant symptom.

The itching associated with eczema can be intense and persistent, leading to:

• Sleep disruption

• Reduced concentration

• Anxiety and frustration

• Skin damage from scratching

• Increased risk of infection

Repeated scratching creates what clinicians call the "itch-scratch cycle."

The skin becomes itchy, scratching causes more inflammation, inflammation causes more itching, and the cycle continues.

Breaking this cycle is often one of the most important goals of treatment.

Post-Inflammatory Pigmentation: The Lasting Reminder

One of the biggest concerns for patients with skin of colour is the pigmentation that remains after the eczema itself has improved.

This is known as post-inflammatory hyperpigmentation (PIH).

After inflammation occurs, melanocytes can become overactive and produce excess pigment.

This may leave behind:

• Brown patches

• Grey-brown patches

• Dark marks

• Uneven skin tone

In some cases, lighter patches may also develop, known as post-inflammatory hypopigmentation.

The important thing to understand is that these colour changes are often a result of inflammation rather than a separate pigmentation disorder.

This means that controlling the eczema itself is the most important first step.

Common Triggers

Eczema triggers vary from person to person but commonly include:

Environmental Factors

• Dry air

• Cold weather

• Heat and sweating

• Seasonal changes

Skincare Products

• Fragrances

• Essential oils

• Harsh cleansers

• Over-exfoliation

Lifestyle Factors

• Stress

• Poor sleep

• Excessive scratching

• Friction from clothing

Allergens and Irritants

• Dust mites

• Pet dander

• Certain fabrics

• Household cleaning products

Identifying triggers can significantly reduce the frequency and severity of flare-ups.

Building a Stronger Skin Barrier

One of the most effective strategies for managing eczema is strengthening the skin barrier.

Think of your skin barrier as a brick wall.

The skin cells are the bricks.

Lipids, ceramides, cholesterol and fatty acids are the mortar holding everything together.

When the mortar breaks down, moisture escapes and irritants enter more easily.

A barrier-focused routine should include:

Gentle Cleansing

Avoid stripping cleansers that leave the skin feeling tight or squeaky clean.

Consistent Moisturisation

Moisturisers help restore the barrier and reduce water loss.

Look for ingredients such as:

• Ceramides

• Glycerin

• Hyaluronic acid

• Cholesterol

• Fatty acids

Reducing Inflammation

Managing inflammation early can help prevent both discomfort and long-term pigmentation changes.

Daily Sun Protection

UV exposure can worsen pigmentation and slow recovery.

Can Professional Skin Treatments Help?

During an active eczema flare, the focus should always be on calming inflammation and restoring the skin barrier.

Aggressive treatments should generally be avoided while the skin is actively inflamed.

Once the skin is stable, professional skin treatments may help address:

• Post-inflammatory pigmentation

• Uneven skin tone

• Barrier recovery

• Persistent sensitivity

Treatment selection should always be based on the individual's skin type, pigmentation risk, and current level of inflammation.

This is particularly important in skin of colour, where overly aggressive treatment can worsen pigmentation concerns.

The Bottom Line

Atopic dermatitis is much more than dry skin.

It is a chronic inflammatory condition that can affect comfort, confidence, sleep, and quality of life.

In skin of colour, eczema often presents differently, making early recognition and appropriate treatment even more important.

The good news is that with the right combination of trigger management, barrier repair, inflammation control, and professional guidance, it is possible to significantly improve symptoms and reduce the long-term impact on the skin.

If you are struggling with eczema, recurrent irritation, or pigmentation following flare-ups, a professional skin assessment can help identify what is driving the inflammation and create a treatment plan tailored specifically to your skin.