In babies with darker skin tones, eczema is more challenging to see and may appear purple or gray, and areas may start to thicken where they have scratched skin.

Eczema or atopic dermatitis usually begins in infancy, with 60% of cases starting by 1 year of age. It affects people of all skin colors, races, and ethnicities.

This article explores what eczema looks like in babies with darker skin color. It also discusses its causes, triggers, and how to manage the condition at home.

According to a 2021 study, Black children in the United States tend to have greater prevalence, persistence, and severity of eczema than people with lighter skin tones.

Its prevalence among African American children is 19.3% compared with 16.1% among European American children. They are also 1.7 times more likely to get eczema.

Eczema is a skin condition that causes the skin to become dry, itchy, and easily irritated. It can cause the following symptoms in babies:

  • itching
  • oozing
  • skin color changes on eczema patches
  • swelling, or edema
  • skin thickening, or lichenification
  • marks from scratching

Symptoms in darker-skinned babies

While every baby can have similar symptoms, they make not look the same on all skin tones.

Eczema patches on babies with darker skin tones may be more difficult to see. The patches may appear darker, which is known as hyperpigmentation, and look purple, dark brown, or ashen gray.

The thickening of the skin due to frequent scratching, which doctors call lichenification, often appears hyperpigmented in children with darker skin.

There are also symptoms that more commonly appear in skin of color. These include:

  • dry, scaly, and itchy skin, known as xerosis
  • extra creases below the lower eyelids, which doctors call Dennie-Morgan lines
  • increased lines in the palms
  • hard and extremely itchy nodules, which healthcare professionals call prurigo nodularis

Read more about eczema in darker skin.

Where it occurs

The location and appearance of eczema also change as the child grows.

In the first 6 months, infants typically develop eczema on the face, chin, forehead, scalp, and cheeks. By 6–12 months, when babies begin to crawl, they may develop eczema on their elbows and knees.

Children aged 2 years up to puberty commonly get thickened rashes that may bleed or ooze on the following areas:

  • ankles
  • neck
  • folds of elbows and knees

Experts do not know the exact cause of eczema, but they believe that a combination of genetics and environmental factors can cause abnormalities in the immune system and the epidermis. This is the outermost layer of the skin.

An overactive immune system responds to environmental irritants and triggers, causing inflammation. Common triggers include:

  • irritants such as soaps and detergents
  • environmental allergens such as dust mites and pollen
  • cold and dry weather
  • food allergies
  • textures such as wool and other fabrics
  • skin infections
  • sweat
  • saliva
  • scratching

Dermatologists recommend the following tips to reduce flare-ups and manage eczema symptoms in babies:

  • follow the dermatologist’s directions for the duration, frequency, and amount of topical corticosteroids to apply on the child to avoid side effects
  • identify and eliminate triggers that cause the baby’s eczema to appear or worsen
  • use diluted bleach bath therapy for difficult-to-control eczema while being sure to follow the dermatologist’s instructions to avoid irritating the baby’s already sensitive skin
  • treat eczema symptoms as soon as they appear to prevent them from worsening

Read more about different home treatments for eczema.

Bathing helps remove irritants and dirt from the baby’s skin and repair the skin barrier. Daily bathing of the baby and emollient application can help soothe symptoms and reduce itching and dryness.

Below are some important things to remember when bathing a baby with eczema:

  • bathe with lukewarm water for 5–20 minutes
  • use a mild fragrance-free cleanser
  • apply cleanser on eczema-free skin and avoid washing any skin with eczema
  • do not use bath oils or bubble baths, as this may cause flares
  • limit the use of cleansers during severe flares
  • use moisturizers with high oil content twice a day to protect the skin barrier and keep the skin hydrated

Read more about bathing and eczema.

Parents or caregivers should inform their doctors if avoiding allergens and applying moisturizers and creams do not improve the baby’s eczema. It is also essential to tell their doctor if they notice the symptoms worsening.

Children with eczema are prone to skin infections. Parents should bring their child to a doctor if they see early signs of skin infection, which include:

  • fever
  • warmth around affected areas
  • pus-filled bumps on or around the eczema patches
  • cold sores or fever blisters on the skin

The outlook of eczema depends on many factors. Many children with eczema improve over time, but those with atopies, such as asthma and allergic rhinitis, may have more persistent symptoms.

Eczema comes and goes, and relapses often require individuals to use medications. Parents and caregivers should know their child’s eczema triggers since continuous exposure can cause persistent symptoms.

Below are some frequently asked questions about managing eczema.

Can eczema go away by itself?

Most children outgrow their eczema and have their symptoms resolved by adulthood. However, children with persistent, late onset, and severe eczema may have long lasting symptoms.

What can cure eczema?

There is no cure for eczema, but avoiding triggers, bathing daily, using gentle moisturizers, and applying topical medications can help manage eczema.

What to do about eczema itching?

A person should not scratch itchy eczema patches since this can lead to bleeding, skin thickening, and infections.

Anecdotal evidence suggests the following can help relieve itching:

  • apply a cool compress to the itchy skin using a clean washcloth
  • have a colloidal oatmeal bath
  • moisturize with a thick ointment
  • distract the child
  • pinch or touch skin near the itchy eczema patch
  • reduce stress since this can cause eczema to flare

Eczema affects all children, but studies show that the condition is prevalent among African American children and other ethnicities.

Itchy eczema patches may be difficult to see in children with darker skin tones and appear more purple, brown, or ashen gray.

Parents or caregivers should work with the doctor to find a treatment plan for their baby. This could include avoiding triggers, using moisturizers, and applying topical medications as a doctor prescribes.