INDIVIDUAL ARTICLE: An Algorithm for the Management of Atopic Dermatitis in People With Skin of Color

August 2023 | Volume 22 | Issue 8 | SF386361s3 | Copyright © August 2023


Published online July 22, 2023

Andrew F. Alexis MD MPH FAADa, Heather Woolery-Lloyd MD FAADb, Anneke Andriessen PhDc, Candrice Heath MD FAAD FAAPd, George Han MD PhD FAADe

aWeill Cornell Medical Medicine, New York, NY
bSkin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine Miami, FL
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, NL
dLewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA
eDepartment of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY

Abstract
Background: Variations in the epidemiology, clinical presentation, and disease course in skin of color (SOC) atopic dermatitis (AD) patients have been reported that may impact treatment approach and skincare recommendations.
Methods: The project used a modified Delphi hybrid process comprising face-to-face discussions and an online review process. A panel of physicians (advisors) who treat SOC patients with AD used information from literature searches, expert opinions, and their experience to develop a practical algorithm to improve outcomes for SOC patients with AD.
Results: The algorithm for SOC patients with AD aims to inform dermatologists and other healthcare professionals caring for these patients. The first section of the algorithm addresses education and behavioral measures. Treatment adherence is a considerable challenge in chronic inflammatory conditions such as AD, making education essential. The second section discusses the assessment of the skin condition. The third section informs on treatment and maintenance measures for AD. Treatment and maintenance of AD in patients with SOC should be proactive, effectively control inflammation longitudinally, include effective skin barrier protective strategies, and consider cultural practices.
Conclusion: Robust comparative studies are needed to better understand racial/ethnic variations in AD. The algorithm supports educating healthcare professionals and patients to foster individualized treatment, prevention, and adjunctive skincare approaches across diverse patient populations.

J Drugs Dermatol. 2023;22:8(Suppl 2):s3-10.

INTRODUCTION

Variations in the epidemiology, clinical presentation, disease course, and impact on quality of life have been reported in SOC populations.1 Epidemiologic studies focused on atopic dermatitis (AD) suggest a higher prevalence among self-identified African Americans and greater health care utilization for AD among African Americans and Asian/Pacific Islanders.2 Data from the US has also identified a higher prevalence and persistence of AD in African-American children. In addition, racial/ethnic disparities in health care utilization and access to therapies have been identified in some SOC populations.2-6

Clinically, AD can present differently in some SOC populations. Evidence suggests investigators may under-score skin signs in patients with SOC in clinical trials.1 Nuanced expression of erythema and post-inflammatory pigmentary alteration may be observed in SOC patients with AD.1,7-10 Black patients may show more frequent follicular accentuation, lichenoid morphologies, and papulonodular presentations.1,7-10 Recognizing morpho-logical variations and differing clinical presentations in SOC AD patients is important for an accurate diagnosis, while early treatment to reduce inflammation and pigmentary sequela may