How to Advocate for Better Atopic Dermatitis Care if You Have Darker Skin

“The redness of eczema [that usually appears in fair-skinned people] is often masked in darker skin tones, appearing instead as purple, brown, or gray patches. This can lead to a delayed diagnosis and treatment,” says Alexa Steuer, MD, a dermatologist at Hackensack University Medical Center in New Jersey. “Additionally, individuals with darker skin are more prone to developing dark spots or light spots as the skin heals, which can be as distressing as the eczema itself.”

These delays can have real consequences and affect your quality of life. “Untreated eczema can interfere with sleep, work, school, and emotional well-being,” says Efe Kakpovbia, MD, a dermatologist at NYU Langone Dermatologic Associates in New York City. If symptoms aren’t improving or you feel your concerns are being overlooked, knowing how to advocate for yourself can help you get the care and support you need.

These red flags could mean your dermatologist isn’t fully addressing your concerns:

1. Your worries about atopic dermatitis are minimized. “Certain atopic dermatitis concerns in people of color are frequently overlooked,” says Dr. Steuer. Scalp eczema, for instance, can be mistaken for dandruff, but it’s actually an inflammatory condition that can cause significant itching and flaking.

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   “What is often dismissed as ashy skin is actually dry skin, a key feature of atopic dermatitis that can be more visible on darker skin,” she says. Dr. Kakpovbia says, “People may also be told that they only have postinflammatory hyperpigmentation [dark spots] and that the discoloration will fade with time, when in reality, active eczema is still present and driving ongoing inflammation.”
2. Your issues are described as ‘mild,’ but it doesn’t feel that way to you. Even if atopic dermatitis symptoms are labeled clinically “mild,” the symptom burden can still be significant. If it affects your quality of life, it deserves attention. Effective care should not only reflect visible symptoms but also consider the daily impact and your emotional well-being.
3. The treatment prescribed isn’t realistic for you. Some skin-care recommendations may be unrealistic for people with atopic dermatitis and darker skin.

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   For example, frequent (but quick) showers without proper moisturizing can strip the skin of its natural oils and worsen dryness. Or, recommended thick creams and ointments may leave a noticeable gray or white cast on darker skin. “Some treatments may not be suitable for all hair types or cultural practices,” says Steuer.
4. Your dermatologist focuses only on the rash. Dermatologists are trained to assess the visible severity of atopic dermatitis, but they should also ask about other ways the condition affects your daily life. This includes factors such as itching, sleep disruption, mental health, and changes in skin pigmentation.

To make the most of your next dermatology appointment, it helps to go in prepared. Taking these steps in advance can make it easier for your dermatologist to understand the symptoms you’re experiencing, identify patterns, and adjust your treatment plan:

1. Make a list of the treatments you’ve tried. “Before your appointment, make a list of all the treatments you have tried, including prescription medications, over-the-counter products, and home remedies,” says Kakpovbia. “This helps your dermatologist understand what has or hasn’t worked and decide on next steps.”
2. Track your triggers between appointments. Keep a log to track your flare-ups and potential triggers, such as foods, skin-care products, or stress. Note symptom severity, treatment response, and any side effects. “People with atopic dermatitis are at increased risk of developing allergic contact dermatitis, so identifying possible triggers can help your dermatologist determine whether additional testing, such as patch testing, may be appropriate,” says Kakpovbia.
3. Bring photos of flare-ups. Take clear photos during active flares to show your dermatologist. This is especially useful if you think your healthcare provider might not be familiar with how symptoms appear on darker skin tones.
4. Prepare to talk about your quality of life. “Think about any sleep disruptions or effects on your mental health, and be ready to discuss these,” says Steuer. These details help your dermatologist better understand the severity and may support more aggressive treatment decisions.
5. Flag any practical barriers to treatment. Make a list of anything that makes treatment hard to follow, from cost and side effects to routine complexity and product preferences.
6. Prepare a list of questions in advance. “Write down any questions you have about how atopic dermatitis specifically affects darker skin, including concerns about discoloration or the best skin-care products for your skin type,” says Steuer. If you’re not sure what to ask, fill out this checklist from the National Eczema Association.

Once you’re at your appointment, there are additional steps you can take to make sure your concerns are being heard and reflected in your treatment plan. “Open communication with your dermatologist is key to effective treatment,” says Steuer.

• Speak up if your treatment plan doesn’t seem compatible. “If a treatment plan feels unrealistic due to your work schedule, hair-care routine, or personal preferences, don’t hesitate to say so,” says Steuer. Adjustments are often possible, and your input helps shape a plan you can actually follow.
• Talk about your quality of life. Share how atopic dermatitis is affecting your overall well-being. “We know that eczema is associated with higher rates of anxiety and depression and reduced quality of life, so these concerns are an important part of the conversation,” says Kakpovbia.
• Ask about alternative options. If the current treatment isn’t effective or is difficult to use consistently, ask about newer treatments or other options. “Express your concerns about potential side effects like skin discoloration,” says Steuer.
• Get a second opinion if needed. If you repeatedly feel dismissed, misunderstood, or unheard, seek input from a different dermatologist — preferably one who has experience treating atopic dermatitis in darker skin. Check out the Skin of Color Society’s doctor directory or the Black Derm Directory, or ask family or friends for recommendations.
• Remember that self-advocacy is not being ‘difficult’ or ‘disrespectful.’ Self-advocacy is an essential part of managing atopic dermatitis effectively. If going to appointments on your own feels daunting, “Bringing a friend or family member for support can also be beneficial,” says Steuer.