We tend to think of hair and skin as two separate concerns. But the place they meet, at the hair follicle, is precisely where a common and often overlooked type of eczema can show up.
Follicular eczema is a subtype of atopic dermatitis, the most common type of eczema. It forms around individual hair follicles on the body and scalp and occurs more frequently in darker skin tones. Though it is often waved off as goosebumps or just dry skin, dermatologists say the bumpy texture is a documented condition that’s treatable once it’s correctly identified.
“Many of my patients have spent months or even years trying different drugstore products like scrubs and shampoos without knowing there was a diagnosable condition that explains their symptoms,” says Neha Chandan, MD, a double board-certified dermatologist and Mohs surgeon in St. Petersburg, Florida. “Follicular eczema is one of the most common ways eczema presents in skin of color, and yet most patients have never heard the term before they come to see me.”
To help demystify the condition, we asked dermatologists to break down what Black patients should know about follicular eczema. Here are the key things they shared, from getting a correct diagnosis to managing flares and protecting your skin from future irritation.
Meet the Experts
- Neha Chandan, MD, is a double board-certified dermatologist and Mohs surgeon in St. Petersburg, Florida.
- Viktoryia Kazlouskaya, MD, is a double board-certified cosmetic and medical dermatologist in New York City.
Follicular eczema is easy to mistake for something else
“Follicular eczema is seen more commonly in patients with darker skin tones,” says Viktoryia Kazlouskaya, MD, a double board-certified cosmetic and medical dermatologist in New York City. Instead of the typical scaly patches you get with other types of eczema, “it presents as tiny rough bumps centered around the hair follicles,” Dr. Kazlouskaya explains. It can often resemble other conditions, such as keratosis pilaris (KP), which is caused by the buildup of the protein keratin around hair follicles, resulting in small, rough bumps. (As an aside, KP and follicular eczema can look very similar at first glance, but Dr. Kazlouskaya says the distribution of the bumps is one key tell, with KP favoring the backs of the arms, thighs, and cheeks and follicular eczema involving much larger areas of the body.) That kind of resemblance is exactly why it gets missed so often by patients—and sometimes doctors too.
Medical training plays a big role in this. “Historically, most dermatology textbooks and teaching materials contained predominantly images of lighter skin, and many physicians had limited exposure to how common skin diseases appear in patients with darker skin tones,” says Dr. Kazlouskaya. But, she notes, this is shifting, with medical schools, dermatology residency programs, and groups like the American Academy of Dermatology starting to invest more in skin-of-color education.
You can help your dermatologist make the correct diagnosis
Luckily, follicular eczema doesn’t usually require invasive testing to diagnose. “A biopsy is usually not necessary but can be helpful when the diagnosis remains uncertain or when another skin condition needs to be excluded,” Dr. Kazlouskaya says. In most cases, she adds, a medical provider can make their diagnosis through a skin examination alongside a review of the patient’s medical history.
According to Dr. Chandan, you can play an important role in getting correctly diagnosed by coming prepared with detailed information about your symptoms, including itchiness, which can be a meaningful clue even if other indicators of eczema aren’t present, along with anything that seems to make flares worse. Most importantly, don’t be afraid to advocate for a thorough skin exam. She suggests asking your doctor to check the areas most affected section by section, whether that’s your chest, back, arms, or scalp, since a quick glance may not be enough to spot the signs of follicular eczema.
