Eczema and Psoriasis in Skin of Color: Challenges and Management
Bodewell Editor | September 18, 2020
Alabama-based dermatologist Dr. Tiffany Mayo spoke with Bodewell about the challenges of diagnosing, treating, and managing inflammatory skin conditions among skin of color patients.
Eczema and psoriasis are equal opportunity skin conditions: Anyone can have them regardless of age, gender, or ethnicity.
While this might provide comfort for some, helping them realize they’re not the only people in the world struggling with an inflammatory skin condition, not everyone approaches it the same way. In fact, some eczema and psoriasis sufferers are entirely unaware of their condition and how to treat it.
This trend is particularly prevalent amongst patients with skin of color, says Dr. Tiffany Mayo, a dermatologist and assistant professor at the University of Alabama at Birmingham’s Department of Dermatology. As a person of color, Dr. Mayo has empathy for this community who she says often doesn’t come in to see dermatologists because they think “it’s not for me.”
“Because of my background and experiences, I understand that there are several factors that affect patient care and, to be the most effective, you have to understand the patient as a whole. I truly want to find a way to help my patients,” she says.
Know When to Seek Help
Over the years, Dr. Mayo has noticed that skin of color patients tend to be the most reluctant to make appointments with her and that they are often the least represented amongst her patients. Though there are a number of factors that contribute to this, she has no doubts that race and ethnicity play one of the biggest roles.
“Patients don’t see doctors or other patients that look like themselves, so they are often reluctant…[or] fearful the dermatologist will not fully understand their skin type or their particular skin problem,” she says.
This reluctance, she believes, is likely deep-rooted, stemming from an underrepresentation of skin of color physicians in the medical field, as well as decreased visibility of skin of color eczema and psoriasis patients in advertisements and other media outlets. In other words, if you don’t see people who look like you that have the disease, it can be easy to assume that you can’t get it either.
More Than Just Dry Skin
Inflammatory skin conditions are actually not uncommon amongst people of color. On the contrary, research has shown that children under the age of 17 who are Black are far more likely to suffer from eczema and skin allergies when compared to white and Hispanic children.
Unfortunately, this information is not widely known and is often misconstrued. Having a high prevalence of eczema and psoriasis in one’s community can negatively downplay the seriousness of these conditions. People might be dismissive of the diseases because of a belief that “everyone” has them and it’s no big deal, or they might incorrectly assume that they don’t need treatment because it’s so widespread.
“Eczema is so common that it is often ignored until it is severe,” explains Dr. Mayo. “For psoriasis, patients are often misdiagnosed initially due to different presentations of clinical signs in skin of color. Unfortunately, this all leads to more severe disease.”
Educate Yourself...And Others
Chiquanna “Chi” Villines, a skin of color patient and eczema sufferer since she was 8 months old, is no stranger to having to explain the seriousness of her condition to others. Growing up, she saw myriad dermatologists — none of whom were Black, she notes — and yet there are people in her life who still don’t comprehend the degree to which her eczema has affected her.
“I feel like [my eczema] was just kind of brushed under the rug, that it wasn’t treated like a big deal. There was no empathy,” she says. “Even now some of my aunts are like, Well how’s your skin? And I don't think they realize how bad it was. It’s just so hard to explain the whole situation to people sometimes.”
Such a lack of knowledge about skin conditions not only affects how sufferers are treated, but it can also lead them to ignore or downplay their symptoms. Sometimes patients come in to see Dr. Mayo to address what they believe are minor issues — such as skin dryness, dandruff, or discoloration — only to leave with the knowledge that they actually have eczema or psoriasis.
Identifying Your Triggers
One of Dr. Mayo’s favorite questions to ask patients is what products they use on their bodies already. Doing so often helps her identify sources that might be aggravating the patient’s skin — and oftentimes the patients are surprised to learn that what they thought was helpful was actually making the problem worse. For example, if a skin of color patient is exhibiting seborrheic dermatitis — a form of eczema caused by yeast — Dr. Mayo will usually inquire if they’re applying certain oils to their skin.
“As a Black female, I know to ask this because I also grew up ‘greasing’ my scalp. It is so ingrained in the hair care routine of Black women that it is almost therapeutic on an emotional level,” she says, and yet people don’t normally assume it could be exacerbating their condition.
Better Late Than Never
As a result, dermatologists often don’t see skin of color patients until later in the progression of their disease, which is the opposite of what they’d recommend. Delaying treatment of eczema or psoriasis not only extends the duration and depths of one’s symptoms, but it can also lead to irreversible skin damage and permanent scarring in the form of hyperpigmentation or hypopigmentation. These dark or light patches often show up in places where inflammation is the worst, but certain treatments, such as topical steroid use, can also thin the skin and permanently change its color.
Chi, who used topical steroids for more than a decade before switching to more natural solutions, has a combination of “white spots and dark spots” on her body.
“They’re in the creases where my eczema flared up the most,” she says, listing her inner elbows, behind her knees, and the bottoms of her ankles as key areas.
Fortunately, with proper treatment and maintenance, most symptoms caused by eczema and psoriasis can be managed, if not erased entirely.
“These skin changes are mostly reversible,” Dr. Mayo says, “however, dyspigmentation can be permanent in severe disease.”
By identifying and treating one’s skin early, patients can avoid developing extreme cases and permanent scarring. On the whole, Dr. Mayo believes it is more important to be preventative than reactive with one’s treatment plan. Even when she sees patients who believe they just have “sensitive skin,” she’ll likely air on the side of caution and recommend they use eczema products, just to be safe.
Products For Skin of Color Patients
When it comes to recommending treatments, Dr. Mayo prefers over-the-counter and non-steroid options, regardless of her patient’s skin color. For a thick, non-reactive moisturizer, she might suggest Vanicream to soothe and hydrate the skin.
As an early treatment regimen, or even as a long term maintenance therapy, Dr. Mayo also recommends Bodewell. She says both the Super Cream and Light Serum “feel great on the skin” and can help calm inflammation and irritation before it advances.
“They actually have active ingredients that help inflammation. Even low-grade inflammation can lead to hyperpigmentation in skin of color patients, so a product like Bodewell’s can be helpful in preventing flares and post inflammatory hyperpigmentation.”
Prevent Scarring With SPF
Last on Dr. Mayo’s list of effective skincare management for skin of color patients is wearing sunscreen. Even though skin cancer rates are lower amongst people of color, Dr. Mayo encourages using SPF, particularly during the summer, to prevent scarring on the skin.
The challenge is finding a sunscreen that doesn’t sting and that blends well with the tone of one’s skin color. Dr. Mayo recommends patients seek out mineral-based SPFs that don’t leave a white cast.
In the end, there is no one-size-fits-all solution for treating eczema and psoriasis, but that doesn’t mean one should lose hope. By practicing preventive and proactive care, and not ignoring the problem, patients of all skin colors have the ability to monitor and control their conditions. It’s just a matter of educating oneself and taking that first step...into a dermatologist’s office.