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Eczema and Ethnicity: Is Race a Risk Factor in Eczema Severity?

Posted on February 28, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Eli Sachse, RN

Eczema (also called atopic dermatitis, or AD) is a common skin condition that causes itching, discoloration, inflammation, and roughened patches of skin. AD is common worldwide. About 31 million Americans are diagnosed with the condition.

Although eczema is a common condition, some people seem to be more at risk for developing severe eczema than others. Race and ethnicity are two factors that have been studied for their impact on eczema severity.

Ethnicity, Diagnosis, and Severity

Researchers have found several associations between ethnicity and eczema, including:

  • People of African ancestry are more likely to be diagnosed with eczema compared with people of European or Hispanic ancestry.
  • Asians and Pacific Islanders are seven times more likely to be diagnosed with eczema compared with white people.
  • Black children are six times more likely to have severe AD compared with white children.
  • Black and Hispanic children are more likely to miss school due to eczema than white children.
  • People of Hispanic ancestry appear at the least risk of being diagnosed with eczema.

People with darker skin are also more likely to be diagnosed later in life than those with lighter skin. This could be due in part to the fact that doctors are more likely to be taught how to recognize eczema on lighter skin (often a reddened rash) as opposed to darker skin (often having a gray or violet appearance). It’s worth noting that among all medical specialties, dermatology is the second least diverse in terms of doctors. Dermatology training programs are trying to correct the disparity and focus teaching on learning more about different skin tones.

Atopic dermatitis can present itself differently across skin colors. (DermNet NZ)


Black people can also have eczema symptoms that are less common among white people — for example, small bumps on the skin or around hair follicles. This symptom could be caused by papular eczema or follicular accentuation.

Do Genetics Play a Role?

Research suggests a link between certain genes and eczema — such as those affecting the skin protein filaggrin and others that affect immune regulation. But the filaggrin gene mutation is relatively rare in Asian and Black populations. There is some evidence that Black skin produces fewer ceramides, another molecule that contributes to the skin barrier. More research is needed to fully understand possible genetic links between eczema and race.

The search for answers is complicated by the fact that African American and Latino populations are underrepresented in genetic research as a whole. While these populations comprise approximately 30 percent of the American population, genetic data representing Black people comprises only 2 percent of research. Data for Hispanic people reflects only 0.5 percent. The result is that for most diseases, there is not enough data to draw strong conclusions about how genetic factors affect disease.

Environmental Factors and the Risk of Severe Symptoms

In general, some factors that affect the severity of eczema symptoms include:

  • Crowded homes and communities
  • Poor air quality (affected by things like pollution, dust mites, and mold)
  • Exposure to tobacco smoke
  • Litter in the environment

Studies have shown that African American children are more likely to be exposed to these known risk factors. Evidence suggests that these environmental factors may play a role in explaining why African Americans are more likely to develop eczema — and to experience more severe symptoms.

Structural Racism as a Factor

Greater exposure to polluted environments — which can directly lead to higher rates of disease, including eczema — is an example of structural, or institutionalized, racism. Structural racism negatively affects the health of communities of color in measurable ways. For example, the fact that Black people in America have shorter life expectancies than white people is a measurable health disparity. Some aspects of structural racism that affect health outcomes can be attributed to the redlining system, which cut off minority communities from investment for decades.

Despite the fact that Black people are more likely to be diagnosed with advanced AD, studies show that they are also less likely to be receiving treatment for eczema than other racial and ethnic groups. This may explain in part why Black people experience more severe disease when compared to white people. Black people are less likely to access primary health care, less likely to have health insurance, and more likely to have lower socioeconomic status compared with other groups.

More Research Is Needed

Black Americans experience eczema at higher rates and with more severe symptoms than other groups, but there has not been enough research to fully explain why.

One area that requires more research is the effectiveness of eczema treatments among different racial and ethnic groups. Currently, we don’t know whether more severe disease may develop because eczema treatments don’t work as well for some people compared with others.

Also, the majority of medical research has historically focused on white people. More research needs to be done to understand and address the multiple disparities in the way eczema affects people of different races and ethnicities.

Efforts are underway to increase representation in studies on allergic and immunologic diseases, which include atopic dermatitis. Hopefully the future will bring a more comprehensive understanding of the ways in which race, ethnicity, genes, and environmental factors influence eczema — and greater access to timely treatment for all people.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 41,100 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Do you have questions about the impact of race and ethnicity on eczema? Share in the comments below, or start a conversation by posting on your Activities page.

References
  1. What Is Eczema? — National Eczema Association
  2. Eczema: Types and Treatment — American Academy of Dermatology Association
  3. Eczema Types: Atopic Dermatitis Overview — American Academy of Dermatology Association
  4. Eczema in Skin of Color: What You Need To Know — National Eczema Association
  5. Atopic Dermatitis in Diverse Racial and Ethnic Groups — Variations in Epidemiology, Genetics, Clinical Presentation, and Treatment — Experimental Dermatology
  6. Atopic Dermatitis, Race, and Genetics — The Journal of Allergy and Clinical Immunology
  7. Genetic Ancestry Does Not Explain Increased Atopic Dermatitis Susceptibility or Worse Disease Control Among African American Subjects in 2 Large US Cohorts — The Journal of Allergy and Clinical Immunology
  8. Racial Differences in Atopic Dermatitis — Annals of Allergy, Asthma, and Immunology
  9. Structural Racism and Its Influence on the Severity of Atopic Dermatitis in African American Children — Pediatric Dermatology
  10. Racism and Health — Centers for Disease Control and Prevention
  11. Racial and Ethnic Differences in Healthcare Utilization for Childhood Eczema: An Analysis of the 2001–2013 Medical Expenditure Panel Surveys — Journal of the American Academy of Dermatology
  12. Hispanic and Black Children More Likely To Miss School Due to Eczema Than White Children — Penn Medicine News
  13. Webinar: Eczema in Skin of Color — National Eczema Association
  14. Redlining and Neighborhood Health — National Community Reinvestment Coalition
  15. Increasing Representation of Historically Marginalized Populations in Allergy, Asthma, and Immunologic Research Studies: Challenges and Opportunities — The Journal of Allergy and Clinical Immunology: In Practice
All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Eli Sachse, RN is a registered nurse living in California. He has written about health topics for Sonoma Medicine and Microcosm Publishing. Learn more about him here.

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