331: Eczema Symptoms-Skin Color Connection: Why Skin Tone May Make Certain Symptoms WORSE w/ Dr. Shawn Kwatr

The Healthy Skin Show

Did you know that the severity of eczema symptoms + skin color have a unique relationship? That certain eczema symptoms can be WORSE for skin of color versus white or lighter skin tones?

While practitioners are typically taught about the “classic eczema patient” who has itchy eczema, there is huge variation in how atopic dermatitis (eczema) manifests on different skin tones.

Eczema on black skin, for instance, often presents as itchy skin bumps in areas not usually associated with atopic dermatitis.

One main metric used to diagnose eczema is redness. But inflammation and eczema on dark skin often show up purple or grey, which makes it tough for practitioners to diagnose — especially if they were only taught to look for redness.

So today, let’s dive into the complex topic of eczema symptoms + skin color thanks to NEW RESEARCH from returning guest – Dr. Shawn Kwatra!

We talk about why people of color so often struggle to get a correct skin rash diagnosis (black skin versus asian skin versus white skin), different ways chronic skin rashes manifest in different races, and much more!

This topic is of particular importance because rashes (depending on race) can present looking more like psoriasis when it’s actually eczema – thus leading to misdiagnosis. Plus we’re discussing how to measure how itchy you are (no matter your skin tone) so you can convey it accurately to your doctor.

Shawn Kwatra, MD, is a Director of the Johns Hopkins Itch Center and an Associate Professor of Dermatology at the Johns Hopkins University School of Medicine in Baltimore, MD, USA.

He specializes in medical dermatology areas of clinical expertise, including atopic dermatitis, psoriasis, chronic itch of unknown origin and dermatology for ethnic skin. Dr. Kwatra also runs a basic science laboratory and clinical trials unit and is funded by the National Institutes of Health and multiple foundations.

Dr. Kwatra has been an author or co-author on over 200 publications and author of the book Living with Itch.

This was such a fascinating conversation and I am so excited to share it with you!

In This Episode:

• Eczema symptoms-skin tone connection: How rashes look different based on skin color
• Why eczema symptoms can be mistaken for psoriasis
• Importance of serum IgE lab test for eczema
• Who is MOST affected by Prurigo Nodularis?
• Why topical steroids create eczema white patches on skin
• Non-steroidal medication options for eczema symptoms
• How skin of color patients lose out on getting better treatment options
• BEST way to show your dermatologist how itchy you are

Quotes

“If you have atopic dermatitis and you are a skin of color patient, and particularly an African American patient, you're more likely to develop these small bumps for your eczema or prurigo nodules.”

“If you apply a topical steroid for a long time, your skin actually gets lighter. And sometimes it takes many months to years to go back, and sometimes it can actually even be permanent. So we have to be really careful in skin of color patients when we're giving topical steroids, of the potency, and the duration of use, even on the scalp.”

Links

Find Dr. Shawn Kwatra online here and here | Twitter

Get Dr. Kwatra's book Living with Itch: A Patient's Guide

Diagnosing Atopic Dermatitis in Skin of Color (Dr. Kwatra’s paper)

Luvut

1. Introduction (00:00:00)

2. How rashes look different based on skin color (00:01:20)

3. Eczema symptoms show up differently on different skin tones (00:05:49)

4. Importance of serum IgE lab test for eczema (00:10:00)

5. Who does prurigo nodularis affect? (00:13:37)

6. Do topical steroids cause white patches on skin? (00:16:08)

7. Itch in skin of color (00:21:30)

8. Non-steroid medication options for eczema symptoms (00:27:54)

9. Final thoughts (00:30:18)