Insights in Skin of Color Patients With Atopic Dermatitis and the Role of Skincare in Improving Outcomes
May 2022 | Volume 21 | Issue 5 | 462 | Copyright © May 2022
Published online April 28, 2022
Andrew F. Alexis MD MPH FAADa, Heather Woolery-Lloyd MD FAADb, Anneke Andriessen PhDc, Valerie D. Callender MD FAADd, Mercedes E. Gonzalez MD FAADc, Candrice Heath MD FAAD FAAPe, George Han MD PhD FAADf
aWeill Cornell Medical College, New York, NY
bSkin of Color Division Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami; Miami, FL
cRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
dHoward University College of Medicine, Washington DC; Callender Dermatology & Cosmetic Center, Glenn Dale, MD
eDermatology Lewis Katz School of Medicine; Pediatric Dermatology, Philadelphia, PA
fDermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
Abstract
Background: Research on the role of race and ethnicity in the pathophysiology of atopic dermatitis (AD) is limited. Variations in the epidemiology, clinical presentation, and disease course in skin of color SOC AD patients have been reported. This manuscript seeks to offer insights into distinct features of AD in populations with (SOC) and provide recommendations on the role of skincare in treating AD amongst diverse populations. Methods: A literature review followed by panel discussions and an online review process explored best clinical practices in treating AD patients with SOC and providing expert guidance for skincare use, including gentle cleansers and moisturizers.
Results: Some studies have identified differences in skin barrier properties in racial/ethnic groups affected by AD that may have implications for barrier function. Variations in the clinical presentation – including morphology, severity, and distribution – of AD in populations with SOC have been reported. Epidemiologic studies suggest a higher prevalence among self-identified Blacks/African Americans and greater health care utilization for AD among both Blacks/African Americans and Asian/Pacific Islanders. Pigmentary sequelae, including hyper- hypo- and depigmentation is a distinct feature of AD in patients with SOC that may contribute to the quality of life impact of the disorder. Xerosis may be more stigmatizing in SOC due to greater visibility of scale and dryness in the context of melanin-rich skin. Racial/ethnic variations in the prevalence of pruritus have also been reported, which may in turn have implications for AD in SOC. 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. Further research will help to tailor patient education and foster individualized approaches to treatment, prevention, and adjunctive skin care across the diverse spectrum of patient populations.
J Drugs Dermatol. 2022;21(5):462-470. doi:10.36849/JDD.6609
INTRODUCTION
Atopic dermatitis (AD) is a highly prevalent chronic immune-mediated disorder of the skin that affects populations globally. Although the role of race and ethnicity in the pathophysiology of AD remains unclear, variations in the epidemiology, clinical presentation, disease course, and impact on quality of life have been reported in different racial/ethnic populations. Data from the US has identified higher prevalence and persistence in African American children as well as racial/ethnic disparities in health care utilization and access to therapies.1-8
Genetic and immunophenotypic differences between racial/ethnic populations have also been reported. Most notably, lower rates of filaggrin gene mutations have been described among Black populations. In addition, studies involving small populations of East Asian and African American patients have identified differences in cytokine expression when compared to European-American patients.9-11
Variations in morphology and clinical presentation include nuanced expressions of erythema (due to background melanin)
