Eczema

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition that causes the skin’s protective barrier to break down, leading to dryness, intense itching, rash, and inflammation. It is not contagious, not caused by poor hygiene, and not simply dry skin. Eczema is an immune-mediated condition with strong genetic and environmental components — and without proper treatment, it tends to persist and worsen over time.

How eczema looks different in skin of color

One of the most significant gaps in dermatology training is how eczema is taught. Medical textbooks have historically shown eczema almost exclusively on lighter skin tones, where it appears as a clearly red, inflamed rash. In patients with darker skin, eczema looks fundamentally different — and this difference has led to decades of underdiagnosis and undertreatment in Black and brown patients.

In melanin-rich skin, eczema may appear grayish, ashen, dark brown, or violaceous rather than red. The inflammatory areas often look more muted, less dramatic — and are consequently dismissed or missed entirely by providers who weren’t trained to recognize it. By the time many patients with darker skin tones receive an accurate diagnosis, their eczema has already left significant post-inflammatory hyperpigmentation: the dark patches that remain long after the active inflammation resolves.

Dr. Marcelus evaluates eczema with full understanding of these presentation differences and treats both the active inflammation and its aftermath, including the hyperpigmentation that can persist for months to years.

What triggers eczema flares?

Eczema flares are driven by a combination of immune dysfunction, skin barrier disruption, and environmental triggers. Common triggers include: irritating soaps, detergents, or fabric softeners; synthetic fabrics; heat and sweating; dry air and cold weather; stress; dust mites, pet dander, and mold; and topical products with fragrances or alcohol. Identifying your personal triggers is a key part of long-term management at Cutis MD.

Frequently asked questions

Why does eczema look different on my skin?

In patients with melanin-rich skin, eczema appears gray, ashen, or dark purple rather than red — because darker skin tones have more melanin that mutes the visible redness of inflammation. This is why eczema is so commonly missed or misdiagnosed in Black patients. At Cutis MD, Dr. Marcelus evaluates eczema with full understanding of how it presents across all skin tones.

Can eczema cause permanent dark spots?

The eczema itself does not cause permanent discoloration, but the post-inflammatory hyperpigmentation it leaves behind can take months or even years to fade without targeted treatment. Dr. Marcelus addresses this directly as part of eczema management — not as a separate concern.

Is eczema related to allergies?

Many patients with eczema also have allergic conditions like hay fever or asthma — a connection called the atopic triad. However, eczema is primarily a dysfunction of the skin barrier and immune system, not purely an allergic condition.