inhibitors is associated with adverse effects and hypopigmentation in patients with SOC.7,28 Early intervention of pigmentary changes, plus topical alternatives with anti-inflammatory and skin barrier repair properties that allow routine long-term use without risk can be effective in reducing AD severity, and related symptoms for patients of color.26,29-31
The skin microbiome plays an important role in AD pathophysiology.32-34 Several studies have evaluated the role of the microbiome in skin barrier function, and the efficacy of prebiotic emollients to target Staphylococcus aureus for AD management.35-38 More recently, a prebiotic emollient, containing shea butter, canola oil, niacinamide and Aqua posae filiformis (a lysate of Vf grown in La Roche-Posay thermal spring water), was shown to significantly decrease the usage frequency of topical corticosteroid after 28 days in AD patients, compared to control group who used their usual classical emollient.39 Similarly, the same prebiotic emollient provided significant greater reduction pruritus in AD patients under systemic therapy (cyclosporin A, dupilumab or a Janus kinase inhibitor).40 Additionally, emollients 'plus', which correspond to prebiotic emollients have recently been recommended in European AD guidelines.41,42 Altogether, these results highlight the benefits of prebiotic skincare in AD treatment and the role of microbiome for healthy skin barrier.
Though a plethora of AD moisturizers are available, the lack of robust comparative studies with ethnically diverse populations poses a challenge. Racial/ethnic variations in AD clinical presentation, as well as a greater burden of pruritus and xerosis among patients with SOC may require different approaches to AD management and treatment. US guidelines strongly recommend moisturizers and gentle cleansers as an integral part of AD management to reduce disease severity and the need for pharmacological intervention.26 Therefore, clinicians should integrate QoL assessments, skincare, and prescription therapies with patient perspectives on cultural norms and treatment priorities.
CONCLUSION
In populations with SOC, AD is more prevalent and is associated with a variety of physical and mental QoL impacts. In addition, healthcare and socioeconomic disparities affect the access to AD specialty care and dermatologic clinical trials for patients with SOC. Increased clinician awareness of AD presentation, associated symptoms and comorbidities, plus impact on patients of color will improve treatment outcomes. Further research is needed on the benefits of adjunctive emollients, moisturizers, and cleansers in the management of AD and their impact on QoL in diverse ethnic populations.
DISCLOSURES
HD is an employee of La Roche-Posay Laboratoire Dermatologique, L'Oreal USA. CK has served as on the advisory board and speaker for Lilly, UCB, Aerolase, Sun Pharmaceuticals, Regeneron; a speaker for Nutrafol, Norvatis; consultant for Abbvie, Pfizer; and Janssen steering committee, SOC advisory board. CNF has served as an advisor and consultant for L'Oreal. ZDD has served as an researcher and consultant for L'Oreal.
ACKNOWLEDGMENT
We thank RBC Consultants for their contribution to manuscript.
REFERENCES
- Lopez Carrera YI, Al Hammadi A, Huang YH, et al. Epidemiology, diagnosis, and treatment of atopic dermatitis in the developing countries of Asia, Africa, Latin America, and the Middle East: a review. Dermatol Ther (Heidelb). 2019;9(4):685-705.
- Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-1534.
- Kim Y, Blomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139(4):827-834.
