Dr. Marissa Joseph
Pediatrician, Dermatologist & Assistant Professor, Department of Medicine, University of Toronto
Tanya Mohan
Eczema Patient & Peer Support Volunteer, Eczema Society of Canada
Signs and symptoms of eczema vary across a diversity of skin tones and pigmentations. Recognizing them is important to ensure proper treatment.1
Eczema is a chronic inflammatory skin condition2 believed to be caused by a combination of environmental, genetic, and immunological factors. “The skin inflammation that results, causes patients to experience a range of symptoms, the most disruptive one being the itch,”2 says Dr. Marissa Joseph, a pediatrician and dermatologist practicing in Toronto and Assistant Professor in the Department of Medicine at the University of Toronto. Other symptoms of eczema include dry, cracked skin, patches, flaking, oozing, and in severe cases, infection.3
Eczema affects quality of life
The physical and emotional challenges of living with eczema make it hard to feel good in one’s skin.4 “The burden of itch can just take over your life,” says Tanya Mohan, an eczema patient and peer support volunteer with the Eczema Society of Canada. The relentless itch can cause severe sleep deprivation, leading to other problems.5 “The lack of good, restorative sleep can affect people’s mental well-being. And in children, it can impact their development and concentration and affect the entire family because if the child isn’t sleeping, the parents may not be sleeping either,” says Dr. Joseph.
The effect on a patient’s self-esteem can also be profound.6 “Even when it’s not visible, patients are scratching and feel very stigmatized, alone, and self-conscious,” says Dr. Joseph. “They may wear bulky clothing to hide the affected areas and fear that people seeing them might think it’s contagious,” she says.
Mohan can relate. “Around junior high, I became more concerned with my appearance and would try to hide it from everyone, wearing long sleeves and long skirts in the summer,” says Mohan. She recalls one traumatizing incident while riding the streetcar at age 16. “I was going to Caribana and was wearing a skirt slightly above the knee, and an elderly person loudly commented on my skin, asking if it was contagious and moving away from me on a very crowded streetcar. It was mortifying.”
I’ve seen quite an improvement in understanding how eczema presents in different skin tones, and it’s wonderful to see this transition because you feel identified and heard.
Differences in symptom presentation important in ensuring suitable treatment7
In terms of severity, “some patients are only mildly affected with intermittent flares or bouts of inflammation, while others are severely debilitated by the condition,” says Dr. Joseph. Similarly, eczema also presents differently across different skin types. “Typically, when we describe a flare as red and inflamed, it’s related to patients with less pigment in their skin or white skin.8 While those descriptions are important for helping health-care providers educate their patients on their condition and when to use their medicines, they’re not really applicable to patients with brown or black skin because their eczema may present as brown, grey, or purple,” says Dr. Joseph.
Additionally, “some patients are labelled with having brown discoloration as an after-effect. This is a type of scarring that disproportionately affects patients with pigmented skin, but it can also be a sign of very active eczema that needs to be treated,”9 says Dr. Joseph. “Not recognizing such differences could lead to under-treatment, under-prescribing, or even the severity of the condition, meaning the patient doesn’t get access to the appropriate treatment they need.”
Fortunately, this is an area of dermatology that’s getting more attention. “We still have a lot of work to do both in teaching about skin disease so that it represents everyone across all skin types and in research to understand these differences in presentation and mechanisms because these might vary by ethnicity,” says Dr. Joseph.
When Mohan was diagnosed in the early eighties, skin diversity was not a consideration. But things have come a long way. “I’ve seen quite an improvement in understanding how eczema presents in different skin tones, and it’s wonderful to see this transition because you feel identified and heard,” says Mohan.
Treatment options to help manage eczema symptoms10
While there’s no cure for eczema, there are many effective treatments.11 “This is a condition that can be managed well, so it’s important to see one’s health-care provider to make sure that treatment is optimized. We have many patients in our care that have very good control of their symptoms,” says Dr. Joseph.
Mohan is one of them. “After having my daughter, I went back to my dermatologist and finally got on a treatment plan that has helped with the itch, and that has helped me get my quality of life back. It’s amazing to be able to sleep, function, and have a conversation at work or on Microsoft Teams without feeling constantly itchy, and the level of focus I have now is fantastic,” she says.
With current diagnostic knowledge and treatment options, people with eczema of all skin types can feel good in their skin — both physically and emotionally.
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References
1 “Eczema and Skin of Colour.” The Eczema Society of Canada, 24 Feb. 2022, https://www.eczemahelp.ca/about-eczema/eczema-and-skin-of-colour/. p.1
2, 3 Quality of Life Report – Altogethereczema. https://www.altogethereczema.org/images/files/esc_quality_of_life_report_2017.pdf. p.2
4, 5 “Eczema and Mental Health.” The Eczema Society of Canada, 10 Jan. 2022, https://www.eczemahelp.ca/mental-health/. p.2
6 “Eczema and Mental Health.” The Eczema Society of Canada, 10 Jan. 2022, https://www.eczemahelp.ca/mental-health/. p.1
7,8,9 “Eczema and Skin of Colour.” The Eczema Society of Canada, 24 Feb. 2022, https://www.eczemahelp.ca/about-eczema/eczema-and-skin-of-colour/. p.1
10 Eczema Society of Canada the Atopic Dermatitis Patient Journey. https://eczemahelp.ca/wp-content/uploads/2020/09/esc-atopic-dermatitis-patient-journey-report-2020.pdf. p.11
11 Eczema Society of Canada the Atopic Dermatitis Patient Journey. https://eczemahelp.ca/wp-content/uploads/2020/09/esc-atopic-dermatitis-patient-journey-report-2020.pdf. p.13
