If you have atopic dermatitis (AD), it’s important to know that flare-ups don’t look the same for everyone. “In people with lighter skin, inflammation often appears bright red,” 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 darker skin, however, redness may be much less obvious.”
This difference can make atopic dermatitis more difficult to recognize — not just for you, but for healthcare providers, too. Research suggests the severity of atopic dermatitis may be underestimated in people with darker skin, which can delay proper diagnosis and treatment and lead to more skin discoloration after a flare.
Knowing what an atopic dermatitis flare looks and feels like — both before and after — can help you recognize symptoms sooner, start treatment earlier, and reduce the risk of long-term skin changes.
1. Skin Color Changes
Redness isn’t the only sign of a flare-up. “In darker skin, inflammation often presents as purple, gray, deep brown, or violet tones, rather than bright red,” says Elizabeth Bahar Houshmand, MD, a board-certified dermatologist based in Dallas.
“Pigment changes can persist long after inflammation has resolved, so people with darker skin may underestimate how active their disease has been,” says Dr. Evans. Following your treatment regimen consistently and moisturizing daily, she adds, can help rebuild the skin barrier, which can help reduce the risk of future flares.
2. Skin Discoloration After a Flare
Even after a flare subsides, changes in skin color can linger for weeks or months, says Evans. “In people with darker skin tones, these changes are often more noticeable than the eczema itself,” she says.
Dark spots tend to develop after the inflammation fades, while lighter patches may occur because inflammation temporarily reduces pigment production, says Evans. “The most important step is controlling the inflammation early and preventing recurrent flares, because every flare increases the risk of long-lasting pigment changes,” she says.
To help your skin recover, moisturize regularly and wear sunscreen every day. “UV exposure can make dark spots persist longer and can make light spots appear more pronounced,” says Evans.
3. Persistent Itching
Your skin doesn’t have to look inflamed to be inflamed. A persistent itch can sometimes begin long before any visible changes appear on your skin, says Evans.
As tempting as it may be, try to avoid scratching or rubbing the area as much as possible, since this can worsen the discoloration, she adds.
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