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Eczema in Skin of Color: A Must-Know Resource for Dermatology Nurse Practitioners

As a Dermatology Nurse Practitioner, you will become very familiar with the challenges that come with diagnosing eczema, particularly in skin of color. While most textbooks and online references depict eczema as red, inflamed patches or red dots—these classic presentations are specific to lighter skin tones. For patients with Black and brown skin, eczema can look drastically different. Instead of the erythematous appearance we're taught about, eczema may present as dark brown, purple, or ashen gray patches, leading us to overlook or misdiagnose. The Eczema in Skin of Color website is an essential resource for our practice. I support their mission to improve diversity in dermatology education.

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Our Allergy, Asthma, and Immunology Partners

The Allergy & Asthma Network (AAN) is a leading nonprofit organization dedicated to outreach, education, advocacy, and research for individuals with asthma, allergies, and related conditions. AAN connects patients, families, healthcare providers, industry leaders, and policymakers to enhance health and quality of life. They specialize in delivering clear, medically accurate information and promoting evidence-based care. Learn more at AllergyAsthmaNetwork.org.

The American College of Allergy, Asthma & Immunology (ACAAI) is a professional organization of over 6,000 allergists, immunologists, and allied health professionals based in Arlington Heights, Illinois. The ACAAI emphasizes collaboration among its members to advance patient care, education, advocacy, and research. ACAAI allergists are board-certified specialists trained to diagnose and treat allergies and asthma, including immunotherapy, ensuring optimal patient outcomes. For more information, visit AllergyandAsthmaRelief.org. If you have the opportunity to hear an allergist or immunologist speak at a dermatology conference or vice verse, I highly recommend it. Additionally, if you're interested in public speaking, consider signing up for the AAN or ACAAI conferences and virtual events!

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What is Eczema?

Eczema (eg-zuh-MUH) is a group of inflammatory skin conditions that cause itching, dryness, rashes, and irritation. It affects over 31 million Americans and can appear at any stage of life, from infancy to adulthood. There are seven main types, including atopic dermatitis, contact dermatitis, and seborrheic dermatitis.

On lighter skin, eczema often appears red and inflamed, while on darker skin tones, it can look brown, purple, gray, or ashen. Itchiness is the most common symptom and, when severe, can lead to excessive scratching, blisters, and infections. Eczema is common in newborns, children, and adults, particularly in people in their 20s or over 50. I recently published an article on the blog titled, Empower Eczema Care with EczemaWise: A Free App for Patients and Providers where you can learn about the National Eczema Association, their EczemaWise App, and Eczema Visual Guide (a digital tool that permits the user to view eczema on different skin tones).

Eczema in Skin of Color

The Eczema in Skin of Color website is another user-friendly resources that targets patients and providers. Adult and pediatric Dermatology NPs and parents will appreciate the digital graphics used to depict the common body areas eczema can present on adults, young children, babies, and infants (up to 6 months). There is a great picture and description of the itch-scratch cycle and how the inflammatory response leads to hyperpigmentation in patients with skin of color (SOC).

Library of Clinical Images

When it comes to visual aids, the library of clinical photographic images further showcases how eczema presents in darker skin tones. These visual guides go beyond the “textbook” redness we often see and instead highlight real-world examples of eczema in melanin-rich skin. By studying these visuals, you’ll strengthen your diagnostic skills and be better prepared to identify eczema early, reducing the risk of delayed treatment or worsening symptoms like post-inflammatory hyperpigmentation (PIH).

Evidence-Based Education

There is a wealth of evidence-based resources explaining PIH, which often occurs alongside eczema and is often more bothersome than the primary disease. There are free recommendations to help you provide culturally sensitive care and tailor your treatment recommendations. For instance, we know that overly aggressive treatments like frequent steroid use can worsen PIH or cause hypopigmentation in Black and brown patients. The site provides strategies to avoid these pitfalls while still delivering effective care.

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Patient-Centered Resources

Equally impressive are the patient education materials available on the site. These resources are designed to empower patients to better understand eczema, recognize how it may look on their skin, and take an active role in managing their condition. They will find tips on everything from moisturizing routines to identifying common irritants to avoid. Special attention is given to encourage patients to avoid scratching and managing symptoms to minimize complications like infections or worsening pigmentation.

Clinical Insights and Research

Staying up to date with emerging research is crucial in our field, and the website doesn’t disappoint. It features the latest clinical findings, treatment advancements, and expert insights related to eczema in skin of color. There are resources on new approaches to managing dyspigmentation and addressing the psychosocial impact of eczema in patients with darker skin, these updates will ensure you’re delivering the most current and informed care. Ongoing education is key to improving outcomes for underserved populations. By incorporating these insights into your practice, you’ll not only sharpen your skills but also build stronger relationships with your patients.

Why This Matters

We don’t manage as many life-threatening diseases as compared to our colleagues in other specialties (unless you specialize in wound care, than you are preventing and treating conditions that may have a high risk of loss of life or limb). Nevertheless, eczema can be a life-altering condition, particularly for SOC patients at risk for delayed diagnoses and inadequate treatment due to the lack of skin of color nursing education and training. It behooves all of us to recognize these disparities and take meaningful steps to address them. By utilizing resources like Eczema in Skin of Color, we can:

• Improve diagnostic accuracy and increase our confidence as providers

• Offer tailored, evidence-based treatment.

• Provide culturally sensitive education that empowers our patients and our colleagues

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This website is more than just a resource—it’s a tool to help us deliver the equitable, high-quality care that all of our patients deserve and the education we need to improve diversity in dermatology nursing education. Take some time to explore Eczema in Skin of Color and bookmark it as part of your clinical toolkit. The knowledge you gain will not only enhance your practice but also make a lasting impact on the lives of our patients.

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Kimberly Madison, DNP, AGPCNP-BC

I am a nurse practitioner entrepreneur who specializes in dermatology nursing education and research with an emphasis on skin of color. I created this blog to share my journey as a source of motivation and as a blueprint, as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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