6 Questions to Ask Your Dermatologist About Atopic Dermatitis Treatment for Darker Skin

Everyone who has atopic dermatitis (AD) needs a good treatment plan. But if you have darker skin, you may be more likely to have skin color changes that linger after a flare, making it all the more important to prevent flare-ups in the first place, says Elizabeth Bahar Houshmand, MD, a board-certified dermatologist based in Dallas. Plus, you’ll need to consider hair care, invisible symptoms, and more.

Today, it’s easier than ever to manage atopic dermatitis and maintain your quality of life. “With the current treatments available, we can achieve much better control than was possible even a few years ago,” says Dr. Houshmand.

Asking your dermatologist the right questions can help you understand whether treatment is working, what to expect along the way, and when it may be time to adjust your treatment plan to better meet your needs.

1. How Well Will This Treatment Work for Someone With My Skin Tone?

Plus, many of the newer treatments, such as biologics and targeted oral therapies, work by targeting specific pathways in the immune system that contribute to the disease. These treatments can be effective for people of all skin tones, says Houshmand — something that both studies and real-world evidence have shown.

Finding the right approach may take time, but working closely with your dermatologist can help you gain better atopic dermatitis control and improve your quality of life. “You deserve a treatment plan tailored to your specific skin, lifestyle, and goals,” says Houshmand.

Many organizations have resources that can help you find information about treating the condition and locating a healthcare provider in your area, including:

• Skin of Color Society
• National Eczema Association
• Eczema in Skin of Color
• Dermatology Education Foundation

2. Will Treatment Help Prevent or Fade Dark or Light Spots?

Skin color changes can linger for weeks or even months, especially if you’re having back-to-back flares. “When skin heals from inflammation, it often leaves behind pigment changes, especially in skin of color,” says Houshmand.

Sometimes skin appears darker after a flare; other times skin appears lighter. Once the inflammation is under control, though, the discoloration should gradually begin to fade, says Tanya Evans, MD, a board-certified dermatologist and medical director of the skin cancer program at MemorialCare Saddleback Medical Center in Laguna Hills, California.

In this case, a good defense can be your best offense: Along with regularly moisturizing, wear sunscreen every day (UV exposure can worsen light or dark spots), and control inflammation by following your treatment routine, says Dr. Evans.

If skin discoloration lingers long after the flare, your doctor may recommend treatments such as topical retinoids, azelaic acid, niacinamide, vitamin C, or other pigment-targeting therapies, she says. “We don’t like going to those directly, though,” says Evans, “because these products may dry or irritate the skin, exacerbating inflammation.”

3. Do I Need to Avoid Certain Skin-Care Products Forever?

It’s true that using certain skin-care products can worsen eczema, “especially in people with richly pigmented skin,” says Evans. Alcohol-based products, for example, and those with strong fragrances or exfoliating properties may be too harsh on your skin.

But that doesn’t mean you’re going to be stuck using just one or two products for the rest of your life. “Having eczema doesn’t mean you have to avoid active skin-care ingredients forever,” says Houshmand. “Once your skin is stable and well controlled, you can work with your dermatologist to slowly reintroduce other ingredients.”

Just make sure you ramp up your skin-care routine one product at a time, she adds. This way, you can track any skin reactions that may occur.

4. Could My Hair-Care Routine Be Affecting Treatment?

The inflammation from atopic dermatitis can sometimes affect the scalp, causing hair breakage or temporary hair thinning, says Evans. Stick to gentle styling routines (skip tighter braids and ponytails), and wash with sulfate-free shampoos if your scalp feels sensitive, says Houshmand.

Sometimes, even “natural” hair products can be too harsh. “Botanical extracts and certain herbal ingredients can still trigger irritation or allergic reactions, due to their fragrance or chemical compounds,” says Evans.

5. Do Any Treatments Address the Invisible Toll of Atopic Dermatitis?

If your current treatment isn’t helping with these symptoms, it may be time to talk to your dermatologist about other options. “People with skin of color are sometimes undertreated, because inflammation can be underestimated on a visual exam alone,” says Houshmand. “If your disease is not well controlled, despite appropriate topical therapy, or if you’re relying on repeated courses of oral steroids, it’s worth discussing whether a more advanced treatment, such as a biologic or targeted oral medication, may be appropriate.”

6. How Will I Know If Treatment Is Working?

Well-controlled eczema can look different for everyone, says JiaDe (Jeff) Yu, MD, chair of the department of dermatology at Virginia Commonwealth University School of Medicine in Richmond and a spokesperson for the National Eczema Association. But ideally, the goal is to avoid a flare.

It doesn’t mean your skin has to be perfect, says Houshmand. “You should be comfortable, and your condition should no longer affect your activities of daily living.”

For eczema to be considered well controlled, your dermatologist will likely want to hear:

• You’re not itching anymore (or hardly ever scratch your skin).
• You can sleep well at night.
• You have little-to-no need for rescue prescription medications.
• You can exercise, socialize, and work without feeling self-conscious about your skin.
• You feel confident wearing shorts, short sleeves, or a swimsuit without worrying about your skin.