Patient 3: This otherwise healthy 9-year-old girl with Fitzpatrick phototype VI has had long-standing AD since she was one year old (Table 3). She had a history of seasonal allergies. She was previously treated with hydrocortisone cream 1% and skincare comprising cocoa butter and coconut oil. The patient reports being embarrassed by the dark patches on her skin and does not want to wear shorts. She received mometasone 0.1% ointment twice daily until clear, followed by crisaborole application once daily. In addition, CER-containing hydrating cleanser and moisturizer were applied twice daily. At the 8-week follow-up, her skin condition had markedly improved, with the skin of her neck cleared.
The main lessons learned: Clinically, AD may present differently in richly pigmented skin. Nuanced expression of erythema and post-inflammatory pigment alterations may be observed in richly pigmented patients with AD.12,13 Black patients may show more frequent follicular accentuation, lichenoid morphologies, and papulonodular presentations.12,13 Educating the patient and parents about maintaining a healthy skin barrier and reducing inflammation to prevent sequelae is essential. In richly pigmented skin, hyper or hypopigmentation occurs more frequently than in AD patients with white skin.12,13
The main lessons learned: Clinically, AD may present differently in richly pigmented skin. Nuanced expression of erythema and post-inflammatory pigment alterations may be observed in richly pigmented patients with AD.12,13 Black patients may show more frequent follicular accentuation, lichenoid morphologies, and papulonodular presentations.12,13 Educating the patient and parents about maintaining a healthy skin barrier and reducing inflammation to prevent sequelae is essential. In richly pigmented skin, hyper or hypopigmentation occurs more frequently than in AD patients with white skin.12,13
