Skin conditions most frequently encountered in paediatric practice include infections, infestations, atopic dermatitis, and acne. Skin of colour refers to skin with increased melanin and darker pigmentation, and reflects global racial and ethnic diversity. Managing skin conditions in skin of colour requires health equity nuance, which is rarely explicitly taught. Awareness of the demographic factors, social determinants of health, and cultural practices that affect prevalence, morphological differences, and treatment of skin conditions is imperative. In this Review, we present the burden and clinical features of the common childhood skin conditions impetigo, scabies, head lice, tinea, atopic dermatitis, and acne in skin of colour. Paediatricians play an important role in diagnosis and management of these conditions to improve quality of life and prevent downstream complications, but they require education around skin of colour. We also discuss the systemic and structural racism, and the environmental and socioeconomic disadvantage, that perpetuate skin health inequity in communities with skin of colour.