Eczema can be a lifelong condition that flares up when your skin reacts to environmental triggers or stress. For some people, flare-ups occur during stressful times, after using certain skincare products, or when the weather changes. Many families pass eczema down from generation to generation, and no two people experience it the same way.

For Black people, this condition can be especially challenging because symptoms may look different on darker skin tones. Instead of appearing bright red, patches may look dark brown, purple, gray, or ashy, which can make the condition harder to diagnose or treat early. These differences can lead to delays in getting the right treatment, something that many Black patients unfortunately experience.

What is eczema?

Eczema, formally known as atopic dermatitis, is a skin condition that causes dryness, itching, irritation and inflammation. The skin barrier weakens, allowing moisture to escape more easily, which can make the skin more sensitive to external triggers. According to the National Institute of Allergy and Infectious Diseases (NIAID), eczema often begins in childhood and can continue throughout adulthood.

Flare-ups can occur when skin comes into contact with irritating products, such as harsh soaps and fragrances, or when the body reacts to stress, heat or airborne allergens. Even excessive sweating can trigger a flare-up, either because the increased salt left on the skin or because the natural bodily fluid attracts more bacterial growth, which can inflame the skin. Research suggests that eczema is more common in people with asthma or allergies and is often defined as the atopic march according to the National Eczema Association (NEA).

Diagnosing eczema in darker skin tones can be harder, as common symptoms may appear differently. Instead of looking red, flare-ups may appear as dark patches, small bumps or thickened skin. According to the American Academy of Pediatrics (AAP), research also points to the reality that eczema tends to be more severe in Black children than in white children.

What’s happening in your body

Eczema is most commonly caused when the immune system overreacts to irritants, weakening a person’s natural skin barrier. This allows moisture to escape, which leads to dryness and inflammation. The Cleveland Clinic notes that because it’s uncomfortable, people tend to scratch the affected areas, which in turn creates more irritation and, in some cases, leads to open cuts and scabbing. This can create a vicious cycle that can spread throughout the body. 

Causes of eczema

A variety of factors can trigger eczema, and in most people, the root cause is a mix of genetic and environmental triggers. One of the most common causes is family history. If a parent has eczema, asthma, or allergies, the child has a higher chance of developing these conditions as well. The National Institutes of Health (NIH) explains that eczema is strongly linked to genetics and immune system differences.

Stress can also be a primary trigger that can lead to flare-ups, even if a person’s skin was fine before. Stress increases inflammation in the body, which can make symptoms worse. Environmental triggers such as cold weather, dry air, sweating, fragrances, and certain fabrics (like wool) can also start or worsen eczema. Additionally, exposure to common allergens like pollen, mold, dust mites, and animal dander, as well as simply recovering from an infection like the flu, can all be precursors to a flare-up. 

“Another point,” explains Dr. Diana Rangaves, PharmD, “is the sunscreen you use. Consider mineral sunscreens. These are generally well tolerated across various skin types, including sensitive skin. Chemical sunscreens can sometimes worsen irritation, particularly in people with pre-existing skin conditions like eczema or rosacea. Zinc-based formulas are less likely to clog pores and are soothing to irritated skin. So, mineral sunscreens are ideal for those looking to maintain skin health with sun protection.”

Health risks and complications

If not managed well, symptoms can grow worse over time. Constant scratching can break the skin, which increases the risk of skin infections. Likewise, research suggests that people with eczema are more likely to get secondary infections because their skin barrier is weaker.

Another complication is post-inflammatory hyperpigmentation (PIH) or dark marks left behind after a flare-up. This is especially common in darker skin tones. The discoloration can last months, even after the skin has healed. Severe or long-term symptoms may also lead to thickened skin known as lichenification from repeated scratching. Some people develop related conditions like allergic contact dermatitis, asthma or allergic rhinitis because eczema can contribute to atopic march.

What to do about eczema

Eczema is a frustrating and irritating condition, but most people can manage and minimize flare-ups by adopting smart daily skincare habits, making lifestyle changes and seeking medical treatment if at-home methods don’t improve it. Focus on keeping the skin moisturized, as this is one of the most effective ways to control eczema. Apply a thick cream or ointment at least twice a day. Fragrances and harsh soaps can irritate eczema-prone skin, so avoid using them. Switch to fragrance-free cleansers and laundry products, especially during a flare-up.

While it might feel relaxing, a steamy bath or shower could remove natural oils and dry out the skin. To avoid this, the Mayo Clinic recommends shortening bathing sessions and turning the hot water down to a warm temperature. The best time to moisturize is during a bath or immediately after. For natural heads familiar with the LOC (liquid, oil, cream) method, this is the same concept applied to skin. Water is the liquid, followed by a light oil (which can sometimes be an in-shower moisturizer). Then immediately after the shower, apply a moisturizer to lock in hydration. 

Sometimes, certain foods or substances can irritate, leading to contact dermatitis. Keep track of products, foods or environments that cause flare-ups and then avoid those triggers as much as possible. However, in some situations, simply avoiding triggers may not be enough.

When to see a doctor

When at-home methods aren’t doing the trick, it’s time to see a dermatologist who might prescribe hydrocortisone or stronger steroids to calm inflammation. The AAD explains that topical steroids help reduce itching and redness when used correctly. If traditional steroids aren’t doing the trick, talk with a dermatologist about creams like calcineurin inhibitors (e.g., tacrolimus). 

However, don’t forget that mental and physical health often go hand in hand. When left unchecked, stress can manifest as physical ailments, including breakouts, rashes, and eczema. Techniques such as breathing exercises, journaling or counseling can reduce stress-related flare-ups. In severe cases, dermatologists may use controlled UV light therapy to calm inflammation. The AAD supports this option for patients who do not respond to creams.

Overall, if an eczema flare-up is painful, prevents sleep or doesn’t improve with over-the-counter treatments, it’s time to see a doctor who can prescribe stronger medications or check for an infection. Also see a dermatologist if flare-ups leave dark marks or discoloration, which is especially common in Black skin. Dermatologists trained to work with darker skin tones can help prevent long-term changes and create a treatment plan that fits your needs.

Is eczema bacterial or fungal?

Eczema is neither a bacterial nor a fungal infection; rather, it is a chronic inflammatory skin condition rooted in a compromised skin barrier and an overactive immune system. While it isn’t caused by germs, there is a complex relationship between eczema and the “skin microbiome.”

On healthy skin, a diverse community of microorganisms coexists peacefully. However, for those with eczema, the skin barrier is often “leaky,” which allows moisture to escape and irritants to enter, as explained by the AAAAI. This imbalance frequently leads to a bacterial overgrowth, specifically of Staphylococcus aureus (Staph). This isn’t the cause of the eczema, but it can trigger flares and lead to secondary infections that require antibiotics. Similarly, certain fungal organisms, such as Malassezia, can aggravate eczema, particularly on the scalp or neck (often referred to as seborrheic dermatitis).

How do you get rid of eczema on Black skin?

Managing eczema on Black skin requires a specialized approach that prioritizes skin barrier repair and the prevention of post-inflammatory hyperpigmentation (PIH), as noted by Skin Friend. Because melanin-rich skin is more prone to transepidermal water loss, the “soak and seal” method is the gold standard: immediately after a lukewarm shower, apply a thick, fragrance-free emollient or ointment (such as raw shea butter or ceramide-rich cream) to damp skin to lock in moisture.

To treat active inflammation, dermatologists often prescribe topical corticosteroids or non-steroidal calcineurin inhibitors. However, it is vital to use these under professional guidance; overuse on darker skin can lead to temporary skin thinning or hypopigmentation (light spots).

Bottom line

Eczema can be frustrating, especially when symptoms look different or harder to treat on darker skin tones. But with the right care and awareness of triggers, most people can manage their symptoms well. Early treatment, medical interventions as needed and consistent skincare can make a big difference.

Frequently Asked Questions

Does caffeine make eczema worse?

There is no strong evidence that caffeine directly triggers eczema, but it may worsen symptoms for some people if it affects sleep or increases stress.

What is the three-minute rule for eczema?

The three-minute rule is to apply moisturizer within three minutes after bathing to seal moisture into the skin.

What cream is best for eczema?

Dermatologists recommend thick, fragrance-free creams or ointments, such as petroleum jelly or ceramide-based moisturizers, for eczema.

Citations

National Institute of Allergy and Infectious Diseases Staff. Eczema (Atopic Dermatitis). National Institute of Allergy and Infectious Diseases. August 2024. https://www.niaid.nih.gov/diseases-conditions/eczema-atopic-dermatitis

Jodi L. Johnson, PhD. The Atopic March: How Eczema Can Lead to Allergies and Asthma. National Eczema Association. April 2022. https://nationaleczema.org/blog/science-atopic-march/

Jennifer J. Schoch, MD, FAAD, FAAP, Katelyn R. Anderson, MD, FAAP, FAAD, Amie E. Jones, MD, FAAP, Megha M. Tollefson, MD, FAAP, FAAD. Atopic Dermatitis: Update on Skin-Directed Management. Pediatrics. May 2025. https://publications.aap.org/pediatrics/article/155/6/e2025071812/201952/

Cleveland Clinic Staff. Eczema: What It Is, Symptoms, Causes, Types & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9998-eczema

National Institute of Allergy and Infectious Diseases Staff. Eczema Causes & Triggers Research. National Institute of Allergy and Infectious Diseases. November 2024. https://www.niaid.nih.gov/diseases-conditions/eczema-causes-and-triggers

American Academy of Dermatology Association Staff. Atopic Dermatitis: Self-Care. American Academy of Dermatitis Association. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/self-care

Mayo Clinic Staff. Atopic Dermatitis (Eczema) – Symptoms and Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273