Dermatology: how to manage atopic dermatitis in patients with skin of colour

Sachdeva, Muskaan; Joseph, Marissa

doi:10.7573/dic.2021-12-1

Cited by 10 publications

(8 citation statements)

References 62 publications

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“…Interestingly, some differences in the clinical manifestations of AD exist among ethnic groups, which may pose diagnostic challenges. The clinical heterogeneity of AD is oftentimes the result of differences in the distribution and pigmentation of the lesions [ 8 ]. Asian individuals typically present lesions with more defined borders, sometimes closely resembling psoriasis plaques, as well as more scaling and lichenification, in comparison to white AD patients [ 9 , 10 ].…”

Section: Clinical Featuresmentioning

confidence: 99%

Overview of Atopic Dermatitis in Different Ethnic Groups

Chiricozzi

Maurelli

Calabrese

et al. 2023

JCM

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Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a high prevalence worldwide, including countries from Asia, Africa, and Latin America, and in different ethnic groups. In recent years, more attention has been placed on the heterogeneity of AD associated with multiple factors, including a patient’s ethnic background, resulting in an increasing body of clinical, genetic, epidemiologic, and immune-phenotypic evidence that delineates differences in AD among racial groups. Filaggrin (FLG) mutations, the strongest genetic risk factor for the development of AD, are detected in up to 50% of European and 27% of Asian AD patients, but very rarely in Africans. Th2 hyperactivation is a common attribute of all ethnic groups, though the Asian endotype of AD is also characterized by an increased Th17-mediated signal, whereas African Americans show a strong Th2/Th22 signature and an absence of Th1/Th17 skewing. In addition, the ethnic heterogeneity of AD may hold important therapeutic implications as a patient’s genetic predisposition may affect treatment response and, thereby, a tailored strategy that better targets the dominant immunologic pathways in each ethnic subgroup may be envisaged. Nevertheless, white patients with AD represent the largest ethnicity enrolled and tested in clinical trials and the most treated in a real-world setting, limiting investigations about safety and efficacy across different ethnicities. The purpose of this review is to describe the heterogeneity in the pathophysiology of AD across ethnicities and its potential therapeutic implications.

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Section: Clinical Featuresmentioning

confidence: 99%

Overview of Atopic Dermatitis in Different Ethnic Groups

Chiricozzi

Maurelli

Calabrese

et al. 2023

JCM

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“…As a consequence, the use of standardised scoring systems that rely on skin erythema, including SCORing Atopic Dermatitis and Eczema Area and Severity Index, may result in less experienced physicians significantly underappreciating the severity of AD in darker skin [4,39.40]. Other classic findings that are more commonly reported in skin of colour include Dennie-Morgan lines, diffuse xerosis, and hyperlinearity of the palms [11,47].…”

Section: Differences In Clinical Phenotype Of Ad In Australian Skinmentioning

confidence: 99%

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Diverse Skin Types in Australia

Courtney

Lopez

Lowe

et al. 2023

JCM

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Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease affecting Australians of all ages, races, ethnicities, and social classes. Significant physical, psychosocial, and financial burdens to both individuals and Australian communities have been demonstrated. This narrative review highlights knowledge gaps for AD in Australian skin of colour. We searched PubMed, Wiley Online Library, and Cochrane Library databases for review articles, systematic reviews, and cross-sectional and observational studies relating to AD in Australia for skin of colour and for different ethnicities. Statistical data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics was collected. In recent years, there has been substantially increased awareness of and research into skin infections, such as scabies and impetigo, among various Australian subpopulations. Many such infections disproportionately affect First Nations Peoples. However, data for AD itself in these groups are limited. There is also little written regarding AD in recent, racially diverse immigrants with skin of colour. Areas for future research include AD epidemiology and AD phenotypes for First Nations Peoples and AD trajectories for non-Caucasian immigrants. We also note the evident disparity in both the level of understanding and the management standards of AD between urban and remote communities in Australia. This discrepancy relates to a relative lack of healthcare resources in marginalised communities. First Nations Peoples in particular experience socioeconomic disadvantage, have worse health outcomes, and experience healthcare inequality in Australia. Barriers to effective AD management must be identified and responsibly addressed for socioeconomically disadvantaged and remote-living communities to achieve healthcare equity.

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“…18 However, current guidelines are similar across all skin types, with regular emollients and topical steroids being the mainstay of treatment for most patients with mild to moderate disease. 19 It is important to consider that topical steroids carry a greater risk…”

Section: Atopic Dermatitismentioning

confidence: 99%

“…of hypopigmentation in darker skin. 19 Furthermore, regarding systemic treatments for severe disease, studies have found that Black patients have a higher risk of alopecia secondary to methotrexate and a lower bioavailability of ciclosporin, thus requiring higher doses. 20,21…”

Section: Eliza Hutchison Rakeb Yoseph and Hannah Wainmanmentioning

confidence: 99%

Skin of colour: essentials for the non-dermatologist

2023

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Doctors-in-training often receive an inadequate dermatology education. Furthermore, studies have highlighted the underrepresentation of skin of colour (SOC) in dermatological teaching, learning resources and research. Our image-based questionnaire, distributed to all internal medicine trainees in southwest England, highlighted knowledge gaps regarding SOC among training physicians. It is intrinsically more challenging for clinicians to confidently formulate dermatological diagnoses in SOC.In this review, we provide guidance for physicians to help make the diagnostic process more straightforward. First, we outline how skin colour is determined and classified. We discuss how inflammation presents in SOC, with the typical 'erythema' that physicians often associate with inflammation being a less prominent feature in darker skin tones. We then summarise nine important conditions that we believe physicians working in all specialties should be able to identify in patients with SOC, covering both conditions encountered on the medical take and conditions disproportionately affecting individuals with SOC. The population of the UK is rapidly diversifying; thus, as physicians, we have a professional duty to educate ourselves on dermatological conditions in SOC to provide the best quality of care for all our patients, regardless of their skin type.

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Dermatology: how to manage atopic dermatitis in patients with skin of colour

Cited by 10 publications

References 62 publications

Overview of Atopic Dermatitis in Different Ethnic Groups

Overview of Atopic Dermatitis in Different Ethnic Groups

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Diverse Skin Types in Australia

Skin of colour: essentials for the non-dermatologist

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