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.
Rashes on skin
of color
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
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
- swelling
- itchiness
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
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:
Contact
dermatitis
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:
- beauticians
- healthcare
workers
- plumbers
- 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
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
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
- moisturizing
- UV light
therapy
Lichen planus
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
- antihistamines
- topical or
oral corticosteroids
- retinoids
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