Atopic dermatitis (AD) also known as eczema is a chronic inflammatory skin condition that causes itchy, dry, and discolored patches of skin. It affects both children and adults and oftentimes starts in infancy. In the US, 20% of African American children have some form of eczema usually developing during infancy and early childhood. The risk for severe atopic dermatitis (AD) may be six times higher in Black children compared to white children and is also thought to be more treatment-resistant.
Identifying AD in Babies & Young Children
Atopic dermatitis (eczema) often begins in the first months of life, and for Black children it can look different than what most parents see in online photos. On darker skin, eczema patches may appear dark brown, purple, or gray, and the skin may look dry, rough, or bumpy rather than red. Babies and young children can’t always explain what they are feeling, so knowing where eczema shows up and what it looks like can help parents catch it early.
In babies (0–2 years):
- Cheeks
- Neck
- Scalp
- Elbows and knees
- Chest or belly
In young children (2–6 years):
- Inside the elbows
- Behind the knees
- Wrists and ankles
- Hands
- Around the mouth and neck
Babies may show itchiness by rubbing their faces on blankets, becoming fussy, struggling to sleep, or scratching until the skin breaks. A doctor can diagnose AD by examining the skin, asking about family history, and sometimes ordering blood or allergy tests. Early diagnosis helps prevent infections, reduce skin damage, improve sleep, and get your child the right treatment sooner.
Signs & Symptoms on Black Skin
Atopic dermatitis can look very different on darker skin tones, which is why it’s often missed or mistaken for something else. Here are the most common signs to watch for:
- Dark brown, purple, or gray patches (instead of red)
- Intense itching, which can make the skin break or bleed
- Small, itchy bumps on the arms, legs, torso, or face
- Thick, leathery skin from repeated scratching
- Raised, firm bumps from chronic rubbing (prurigo)
- Skin color changes such as darker spots (hyperpigmentation) or lighter spots (hypopigmentation) after a flare
Because AD shows up differently on Black skin, it is often confused with dry skin, heat rash, or allergies. If you notice persistent discoloration, rough patches, or ongoing itching, it is important to talk to a healthcare provider so your child can get the right diagnosis and treatment.
Why AD Gets Missed in Black Children
Atopic dermatitis is often missed in Black children because the condition looks different and is rarely shown that way in medical textbooks or online images. Chronic itching can be common in households, so this causes parents to assume their child simply has “dry skin” rather than a medical condition. Simultaneously, many Black families face barriers to care such as short appointment times, limited access to specialists, and a long history of mistrust in the healthcare system. These challenges make it harder for parents to get clear answers, and some children are underdiagnosed or undertreated because their symptoms are not recognized. Systemic issues like cost, limited insurance coverage, and fewer culturally informed resources also contribute to delays in diagnosis and treatment. All of this means Black children often struggle longer with AD before receiving the care they need.
What “Control” Really Means
When AD is under control, itching can be manageable, the flares can become less frequent, and your child can sleep, play, and go about their day without constant discomfort. Uncontrolled AD looks very different with nonstop itching, thickened skin from scratching, and flare-ups that keep coming back. If you are unsure whether your child’s eczema is truly controlled, you can take the AD Control Tool assessment at https://www.adcontroltool.com/.
When to See a Doctor
If your child’s eczema is not improving, it may be time to see a doctor for a formal diagnosis. You should reach out to a provider if over-the-counter creams are not helping, if the rash keeps spreading, or if your child is losing sleep from constant itching. Signs like fever, yellow crusts, pus, or thickened skin from scratching also mean your child needs medical attention. A doctor will examine your child’s skin, ask about family history, and may order blood tests, allergy tests, or patch testing to rule out other conditions. In some cases, they may recommend a skin biopsy to look more closely at what is going on. Bringing photos of flare-ups and asking for a referral to a dermatologist can help your child get the right diagnosis and treatment sooner.
Managing Your Child’s AD Treatment
Modern treatments can help manage moderate to severe atopic dermatitis, and it is important to revisit your child’s treatment plan if symptoms are not improving. Doctors may recommend avoiding triggers (such as cold or dry environments, sweat, emotional stress or anxiety, rapid temperature changes, exposure to certain chemicals or cleaning solutions including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke), using fragrance-free moisturizers, or prescribing topical medications like corticosteroids or calcineurin inhibitors. For some children, options like light therapy or allergy treatments may also help. If your child’s eczema still feels out of control, ask your doctor about newer treatment options that may offer better relief.
Supported by: Sanofi Regeneron
Sources
- Atopic Dermatitis | Cleveland Clinic
- Atopic Dermatitis Control Tool
- Atopic dermatitis (eczema) | Mayo Clinic
- Atopic Dermatitis in Children | Stanford Medicine Children’s Health
- Darker Skin and Atopic Dermatitis: A Closer Look at Symptoms and Solutions | Everyday Health
- Eczema In Skin Of Color | Aveeno
- Understanding AD
- Racial Disparities in Atopic Dermatitis and Food Allergy | American College of Allergy, Asthma, and Immunology
- What exactly is eczema? | American Academy of Dermatology Association
- What is eczema? | Boston Children’s Hospital
- Eczema Visual Guide
- National Eczema Awareness Month
- The Impact of Atopic Dermatitis and Purigo Nodularis in African Americans: A Journey to Better Skin Health
- Scratch That: Understanding erstanding Atopic Dermatitis (Eczema) and Purigo Nodularis in Our Community