barrier function, including ceramide content and TEWL44 CERcontaining moisturizers that were found to benefit AD patients when used as mono, adjunctive, and maintenance treatment.45-48 The Canadian algorithm and US guidelines agreed that the use of moisturizers that contain humectants, lipids, and CERs (or their precursors) reduce pruritus, help control xerosis, and improve the dysfunctional skin barrier in AD patients (Table 2).19,38,39 The moisturizer should be used at least twice daily and more frequently during acute flare-ups (Box 1).19,36-39 It is important to note that there are variations in skincare norms across diverse populations. It is essential to consider these cultural variations when providing skincare recommendations to these patient populations. Integrating evidence-based recommendations for skin care in a culturally competent manner that aligns with the patient's norms/preferences is key to successful outcomes across diverse populations. More research is needed to guide culturally appropriate recommendations better.
Statement 4: To improve SOC AD patient outcomes:
• Aggressively target inflammation to prevent long-term sequelae (eg, dyspigmentation)
• Effectively manage pruritus
• Counsel on the appropriate use of potent topical corticosteroids to minimize the risk of hypopigmentation
• Consider cultural skincare practices
The published guidelines for AD are applicable to the broad and diverse spectrum of AD patients, including SOC patients. However, studies involving specific racial/ethnic groups are lacking. Racial and ethnic disparities in AD clinical trials have been reported.49,50
Two studies examined racial/ethnic differences in the safety and efficacy of approved AD therapies. Specifically, a post hoc analysis by race/ethnicity was performed for crisaborole and dupilumab in phase 3 AD trials. The crisaborole study did not demonstrate any differences in safety and efficacy between pooled (1) White versus nonwhite and (2) Hispanic versus not Hispanic/Latino groups.51
Dupilumab demonstrated significant improvement in primary week 16 outcomes versus placebo in white and Asian subpopulations. In a small black/African-American subgroup (dosing at 300 mg subcutaneous (SC) once every other week (qOW), n=25), some endpoints did not achieve statistical significance vs. placebo despite a positive trend. It is important to note that the sample size was small.52
Hyperpigmentation is a common complaint in SOC AD patients and may be particularly distressing to patients who often suffer additional psychosocial impact of their AD as a result of long lasting pigmentary changes. This is particularly challenging because many of the treatments for hyperpigmentation such as hydroquinone can be irritating in AD populations and therefore must be used with caution. A focus on pre-emptively addressing pigmentary changes through effective longitudinal control of AD itself is paramount.
One case report suggested early intervention with dupilumab may help to address hyperpigmentation in these patients. More research is needed to clarify the nuanced treatment of AD in SOC patients.53
Cultural Skincare Practices
In some people of African, Asian, and Hispanic descent, various traditional oral and topical herbal remedies may be combined with prescription therapies.15,19,54 A systematic literature review found the benefits of combining Chinese herbal medicine with
