Rashes can appear differently on different skin tones. For example, a heat rash on darker skin may look like a series of gray or white spots, while many medical sources describe them as red.
It is crucial for medical professionals to understand how health issues can present on the full range of skin tones. A lack of this understanding can lead to misdiagnoses.
It is generally advisable to contact a doctor about any rash that lasts longer than a week. The Skin of Color Society offer a database of dermatologists in the United States who have experience treating conditions in people of color.
In this article, we explore what rashes can look like on skin of color. We also describe the symptoms and treatments of specific issues.
The appearance of a rash varies with skin tone. On skin of color, a rash may be purple, gray, or white — while medical texts often simply describe these rashes as red. Some redness may appear, but typically not very much.
This is due to melanin, a molecule that gives the skin and hair their color. Generally, the more melanin a person has in their skin, the darker their skin tone. It affects how the skin reacts to sunlight, damage, and health conditions that cause rashes.
Some doctors are unaware of how skin conditions present on darker skin. A 2018 study of four major medical textbooks found that darker skin tones were underrepresented in the imagery.
The study’s authors report that while, at the time, 20.4% of the U.S. population was Black, only 4.5% of the photographs in the textbooks showed people with dark skin. They suggest that this is likely an example of racial bias in the healthcare system.
Below, we explore how various health issues can appear in skin of color.
Heat rash, sweat rash, and prickly heat are all common names for miliaria, a skin condition that occurs when the skin’s sweat ducts become blocked.
The symptoms of heat rash include:
- small, raised blisters on the skin
On darker skin, the blisters may be gray or white.
This rash often occurs due to heat and humidity, but intense exercise, nonbreathable clothing, and medical dressings can also cause it. The condition typically improves within 1–2 days.
Cooling down, wearing more breathable clothing, and changing or, if recommended, removing dressings can help.
Eczema causes patches of dry, itchy skin, and the affected area may also be flaky or scaly. If the skin is very dry, it may crack or bleed.
In darker skin tones, patches of eczema may be red, pink, magenta, or darker than surrounding skin.
Eczema is also more likely to form in specific ways in people of color. For example, there is a higher chance that the rash may be papular, characterized by a series of small bumps like goosebumps.
There are several types of eczema, including:
This occurs when the skin comes into contact with an irritant, such as poison ivy, nickel, or fragrance. The skin may itch, sting, burn, or blister.
People with certain jobs have a higher risk of contact dermatitis. These jobs may involve regular contact with chemicals, food, or water. People with a higher risk may include:
- healthcare workers
- people who work in kitchens
Avoiding contact with the trigger, such as a specific chemical, is the best approach. A dermatologist can also describe products that can help and perform skin allergy testing to identify the trigger.
Atopic dermatitis is eczema with no clear cause. The condition often begins in childhood and may not last into adulthood. In the U.S., it appears to be more common among African Americans, Asian Americans, and Pacific Islanders than other groups.
There is no cure for atopic dermatitis, but there are ways of alleviating and preventing the rash from forming.
This typically involves using a non-irritating moisturizer regularly, after bathing or showering. It is also important to avoid fragranced products, food allergens, and irritating fabrics, such as wool. In addition, a person may need a topical corticosteroid, which a doctor can recommend or prescribe.
Psoriasis is a long-term inflammatory condition that causes thickened patches of skin. On skin of color, these patches may be red or violet and have a top layer of silver or gray scales.
In the U.S., psoriasis is more common in white people than Black people. However, in Black people, it may be more likely to cover larger areas of the body.
Psoriasis can affect the nails as well as the skin, and a significant portion of people with psoriasis also have arthritis.
There is no cure, but it is possible to manage the symptoms. Among the range of options are:
- calcitriol, also called calcipotriene, a synthetic form of vitamin D
- oral or injectable biologic medications
- topical treatments, such as corticosteroid creams
- UV light therapy
Lichen planus causes a series of bumps to form on the skin. Each bump is shiny, raised, and has a flat top. On skin of color, these bumps may be gray-brown or purple.
The most commonly affected areas are the back, neck, lower legs, ankles, and the insides of the wrists. In 20% of cases, lichen planus causes no symptoms beyond the bumps, but in others, it causes intense itching.
Lichen planus can last for months or years, and there is no known cure. Treatments that can relieve the symptoms include:
- wet dressings
- colloidal oatmeal
- topical or oral corticosteroids
Vitiligo is a condition that causes patches of skin to lose its color, or become depigmented. If the condition affects areas with hair, the hair may turn white, too.
The condition occurs when the immune system attacks melanocytes, the cells that produce melanin. Scientists are not sure why this happens, but they believe that it could stem from an autoimmune response.
Areas commonly affected by vitiligo include:
- the eye area
- the mouth area
- the fingers and toes
- the elbows
- the knees
- the lower back
- the genitals
- sites of injury or sunburn
Vitiligo can affect anyone, but it is more noticeable in people with darker skin. People with vitiligo are more likely to have a family history of autoimmune disorders.
The depigmentation often stops or slows over time. Treatments focus on reducing the spread of depigmentation and restoring color to the skin. This may include the use of medicated creams or light therapy.
The symptoms of shingles are:
- pain or a burning or tingling sensation in an area where a rash will develop 1–2 days later
- the blistering rash, which may be painful and often forms on the torso, but can form anywhere
- cracking, bleeding, or scabbing as the rash heals
On highly pigmented skin, a shingles rash may be red, the same color as the skin, or slightly darker. The scabs may be grey.
While the rash often heals within 2–4 weeks, it is important for anyone with shingles symptoms to see a doctor for treatment within 2–3 days. This is because shingles can cause long-term complications.
The doctor can prescribe antiviral medication, which can reduce the risk of complications and shorten the healing time.
Ringworm is a fungal infection of the skin. It often causes a round or ring-shaped rash with a raised border, though the rash may be shaped differently on certain areas, such as the feet or hands.
On darker skin, the ringworm rash is often gray or brown.
Ringworm is contagious, so it is important to seek treatment right away and avoid touching the rash, even if it is itchy.
Other names for this infection include:
- jock itch, which affects the groin
- athlete’s foot, which affects the feet
- barber itch, which affects the beard area
Treatment may involve antifungal cream or, if the rash covers a large area, oral medication.
The best approach to treatment at home depends on the cause of the rash. But there are some general strategies for preventing further irritation, such as:
- washing with cool or lukewarm, rather than hot or cold, water
- using a mild, fragrance-free cleanser and avoiding harsh soaps
- using a moisturizer to hydrate dry skin
- wearing loose clothing to avoid chafing
- wearing soft natural fibers, such as cotton or linen
- changing out of wet or sweaty clothes as soon as possible
- avoiding touching or scratching any rash, especially with unwashed hands
- regularly using clean dressings for rashes that bleed or weep
It is also important to protect the skin from sun damage with a product that contains SPF 30 or higher. UV light can also worsen skin irritation for people with certain conditions.
In some cases, a rash signals a medical emergency. Seek urgent medical attention if a rash:
- forms suddenly and spreads quickly
- is very painful or blisters
- covers most or all of the body
- shows signs of an infection, such as swelling or pus
- accompanies a fever
Anyone who may have shingles or ringworm should see a doctor promptly to prevent transmission. For shingles, a person should wait no more than 2–3 days.
Otherwise, it is generally a good idea to contact a doctor if any rash lasts longer than a week.
The Skin of Color Society provide a database of dermatologists in the U.S. who have experience treating conditions in people of color.
In skin of color, a rash may be red, brown, purple, or gray.
Some doctors may misdiagnose skin issues in people of color due to a lack of awareness. Skin of color is often underrepresented in medical texts.
A dermatologist who understands how rashes present in the full range of skin tones is best prepared to provide the right treatment.