Eczema On the Rise In the African American Community—Along With Unequal Care
Given current events—a powerful movement against racial injustice on top of a life-changing pandemic—it’s clear to me that we can no longer be complacent. Inequality is being called out everywhere, including in medicine. Luckily, within the eczema community, trailblazers have set out to disrupt our customary ways of thinking—not only to shed light on the skin condition itself but also to highlight the significant racial disparities when it comes to diagnosing and treating African Americans with eczema. As an African American woman, there are times where I’ve been misunderstood or frustrated with the lack of diversity in eczema representation.
Researchers have found African American children are almost twice as likely as their white counterparts to have eczema–but Black people are much less likely to receive a proper diagnosis or adequate treatment. So why are eczema rates so high in this community? And why aren’t Black people of all ages getting the care they need? There are several factors contributing to these problems, and the more we learn about these issues, the more we can do to make sure everyone receives quality care.
Why do African American kids have higher rates of eczema?
Although African American adults are slightly less likely to have eczema compared to people of other races, 20% of Black children have eczema, which is almost double the rate found in white, Asian, Native American, and Hispanic children.
Experts are still determining the exact factors that contribute to these numbers, and they’re learning more all the time. Recent studies have shown exposure to irritants, both indoor and outdoor, can lead to higher cases of eczema. African Americans tend to live in heavily urban settings with irritants and allergens such as pollution, humidity, ultraviolet radiation, harsh water, dust, mold, and more. These triggers can leave one with a compromised immune system and make people susceptible to eczema—and often, more severe cases of it.
Additionally, new research analyzing genetic factors of eczema is finding certain mutations affecting the skin barrier cells and skin immune cells can be passed down through families, and these mutations are more common in some ethnic groups, like people of African descent, compared to others.
Why is it harder for African Americans to get diagnosed and effectively treated for eczema?
A lack of diverse representation in medical education and research creates a blind spot for doctors treating African Americans with eczema. Studies show that when it comes to medical school training, dermatologists aren’t often taught about eczema in those with darker skin tones, nor are they given many opportunities to treat eczema in these individuals. Due to the lack of visual representation, many doctors place all skin types into one group. This is usually based on lighter or white skin tones. Since skin is not a monolith, this “one size fits all” strategy is problematic.
On darker skin tones, eczema looks different from the prescribed red, raised bumps doctors are used to seeing in training and textbooks. Instead, eczema patches in these skin tones are comprised of multicolored pigmentation and maybe dark brown, purple, and ashen grey. Additionally, African Americans tend to have drier skin, which is prone to hardening, leading to thickened skin. This may cause doctors to misdiagnose eczema or downplay its severity.
Once eczema is diagnosed and the focus turns to treatment, there are more racial disparities. The vast majority of clinical trials researching eczema medications look at people of European descent—in fact, a 2019 review of eczema studies found people of African descent made up only 0.7% of all trial participants. But eczema manifests differently for African Americans than white people, due to different genetic variables. Therapies that work well for white skin might not be as effective for Black skin, which is why more studies are needed that focus on more diverse populations.
Medical insurance adds another complication.
Black people also face disparities in eczema treatment due to challenges with health insurance coverage. Eczema can manifest differently in African Americans, and common eczema symptoms like hyperpigmentation, scarring, extremely dry skin, and thickened skin are also experienced by Black people without the condition. Therefore, insurance companies can sometimes deny coverage for eczema doctors or medication because they consider those problems to be cosmetic rather than medical. This causes increased out-of-pocket costs for African Americans with eczema, making it hard for those who struggle financially to afford necessary medication.
While there can seem to be a heaping mound of obstacles when it comes to unfair practices for African Americans concerning eczema, I see a light at the end of the tunnel. Vibrant eczema advocates have been very proactive in incorporating equality movements. #POCSKINMATTERS started by Briana Banos is holding skincare companies accountable to establish educational awareness, research accountability, and equal representation. I’ve personally been behind the scenes on calls discussing ways to gain funding and health equality for African Americans and people of color.
I feel confident that, as a strong community, African Americans are on the fast track to redesigning inclusivity for all. We have new companies emerging onto the scene such as Topicals, catering to skin flare-ups, co-founded by 23-year-old Olamide Olowe. Additionally, the National Eczema Association and Allergy & Asthma Network are informational hubs where African Americans can go to gain resources.
I’m dedicated to working with my community to provide equality for all, and I won’t stop until we’ve received it.