Atopic Dermatitis Symptoms To Discuss Beyond Skin Changes

Atopic dermatitis may be more challenging for healthcare providers to identify because its color differs in people with darker skin than in people with lighter skin.

Atopic dermatitis, the most common type of eczema, leads to chronic (long-term) inflammation in areas of the skin. With darker skin, this skin inflammation doesn’t usually look red like in people with lighter skin. Instead, the affected skin may have a darker brown or purplish color. You may also see grayish flakes where the skin is scaling off. 

It’s important to talk with a healthcare provider about your symptoms, other than the skin color changes from inflammation, especially if you have darker skin.

Atopic dermatitis causes dry, itchy skin, a common symptom. In some people with a darker skin tone, dry skin and itchiness may be especially severe. This is an important clue that an area of skin needs treatment, even if the color changes aren’t as obvious.

If you have a darker skin tone, you might see small, hardened, very itchy bumps, known as prurigo nodularis, on areas of your skin affected by atopic dermatitis.

You may also be likely to get perifollicular accentuation, small bumps that appear around your skin’s hair follicles. These bumps look similar to goosebumps. Many people with darker skin tones won’t have any bump-like changes to their skin, and the rash appears in patches.

People with darker skin color may also develop symptoms related to long-term damage to the skin from scratching or rubbing too much. Over time, the affected skin may develop a symptom called lichenification, which is when the skin becomes extra thick, firm, and leathery.

Long-term inflammation from atopic dermatitis may also cause lasting skin pigment changes, even after the inflammation has healed and the skin has cleared.

After the inflammation has gone away, an affected area might stay a darker shade or become lighter than the surrounding skin. Healthcare providers may refer to this as hyperpigmentation (skin darkening) or hypopigmentation (skin lightening).

Atopic dermatitis can affect any area of your skin. You may be more likely to get atopic dermatitis rashes on your trunk and areas of skin covering the opposite sides of the joint, called extensor surfaces, such as the back of your elbow and the front of your knee. Atopic dermatitis can also make the lines on your palms look more obvious.

If you think you might have atopic dermatitis, share your thoughts, symptoms, and experiences with a healthcare provider. That information can help them address your concerns and focus their exam and diagnosis.

Important clues that may help your healthcare provider make an accurate diagnosis or create an appropriate treatment plan include:

• Allergies and asthma: Mention if you’ve previously had symptoms from conditions related to atopic dermatitis, even if you’ve never officially been diagnosed with them. These include food allergies, allergic rhinitis or seasonal allergies, and allergic asthma. These conditions may increase your risk.
• Family history: Share if anyone in your family has atopic dermatitis, allergies, or asthma.
• Emotional impact: Living with atopic dermatitis, especially without the right management strategies, can be stressful. Be sure to mention if your skin condition affects you mentally or emotionally.

If you think you may have atopic dermatitis or are concerned that current treatments aren’t working well enough, visit a healthcare provider. It’s important to visit a healthcare provider if your symptoms are severe or show signs of infection, such as itchy, warm, and swollen areas with oozing, bleeding, and painful skin.

Being prepared with the right information, questions, and confidence may help you make the most of your appointment. Here’s how to prepare:

• Determine who to see: In many cases, a primary care provider (PCP) can diagnose and treat atopic dermatitis. You can also request a referral to a dermatologist, a skin specialist, with experience evaluating and treating skin conditions in people with your skin type.
• Be ready to ask questions: Your appointment is an appropriate time to ask any questions about your health, symptom triggers, treatments, and more. Before your appointment, think about or jot down what you want to discuss.
• Know how to advocate for yourself: If you don’t think you’re getting the care you need, it’s important to speak up and find a healthcare provider who will take your concerns seriously.

Atopic dermatitis may be a little harder to recognize in people with darker skin tones who don’t experience redness, as it appears on lighter skin tones. You may also have other rash features, including a bump-like appearance, leathery patches, and areas of permanently darkened or lightened skin.

If you aren’t sure whether your skin condition is being properly diagnosed and treated, it may help to visit a dermatologist who has experience treating people with darker skin.