AD more prevalent in children with skin of colour
Dr. Danielle Marcoux describes the clinical presentation of atopic dermatitis in children with skin of colour (685 words, reading time: 3.5 mins)
Atopic dermatitis (AD) is more prevalent in children with skin of colour, specifically, children who are of African-American, Asian or Pacific Islander descent, compared to children with Caucasian skin, noted Dr. Danielle Marcoux during her presentation at Skin Spectrum Summit in Montreal.
“Right now, around the world, one in five children have some manifestation of atopic dermatitis. Fortunately, less than 10 per cent have moderate-severe,” said Dr. Marcoux.
The clinical presentation of AD is different in both children and adults with skin of colour compared to patients with Caucasian skin, she said. Different clinical characteristics include erythema that is more grey, violet or brown in colour; dyschromia; follicular accentuation, particularly in African- Americans; and lichenification in Asians, and there is often extensor involvement.
Erythema is an important factor when using the SCORing Atopic Dermatitis (SCORAD) scale to rate the severity of a child’s AD, said Dr. Marcoux. “If you adjust the erythema score ... the child could be six times more likely to be rated as having severe AD.” For example, “if you say there is no erythema, you lower the score of the child.”
Dyschromia is “a source of anxiety for parents because they see changes in colour on their children’s skin,” said Dr. Marcoux. “It is all the post-inflammatory hyperpigmentation. When it is more round and white, we label it pruritus alba, which [means] white scales.”
“As far as phenotypes, Asians have more well-demarcated lesions with increased scaling and lichenification,” she noted. However, “in African Americans, there is more extensor involvement; there is also more perifollicular accentuation and scattered distinct papules on the extensors and trunk.”
Dr. Marcoux went on to point out the importance of education: “Therapeutic education, in all chronic diseases, is fundamental; you don’t just hand out a prescription. [Atopic dermatitis] is disturbing to parents; they are worried. They need reinforcement and education.”
The takeaway: There are differences in the presentation of AD between adults and children, as well as between different Fitzpatrick skin types, which means that dermatologists need to educate themselves on these differences.
Would you mind answering two brief survey questions on your experiences as a healthcare practitioner? Please click below:
FROM THE LITERATURE ON ATOPIC DERMATITIS
Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis
The incidence of atopic dermatitis was found to be higher in Hispanic and Black children in the U.S. compared to White children, according to a recent study that looked at 1,437 mother-child pairs with known atopic dermatitis.
A clinician's reference guide for the management of atopic dermatitis in Asians
Atopic dermatitis presents differently in Asian skin, with more demarcated lesions and more prominent scaling, according to authors of this study. Researchers said that in treating atopic dermatitis in Asian patients, clinicians should take a more holistic approach which takes into account cultural nuances.
African American ancestry contribution to asthma and atopic dermatitis
Atopic dermatitis and asthma disproportionately affect African Americans. This may be due to genetic variants, but an understanding of these disparities is affected by the underrepresentation of African Americans in genetic studies of these conditions. Researchers emphasized the need for large scale genetic studies of these conditions in patients of African ancestry.
VIDEO: Most know UV protection is important, but still fail to protect themselves, survey says
AT THE INTERSECTION OF SKIN & SOCIETY
London-based primary care physician Dr. Neil Singh explores the racial biases in medical training, research, and technology, which have embedded harmful prejudices in his practice and the practices of his colleagues. In the article, titled “Decolonizing Dermatology: why black and brown skin needs better treatment,” he discusses the dangers of medical professionals viewing white skin as the default. Look for our interview with Dr. Singh in next week’s newsletter.
THIS WEEK
September is Acne Awareness Month
Monday, Aug. 31-Sept. 2 International Council of Nurses NP APN Nursing Network Conference
Thursday, Sept. 3 - Sept. 6 Tongue Thrust and Beyond: A Myofunctional Therapy Course
Something to think about during the week ahead:
NEXT WEEK
An interview with Dr. Neil Singh, author of the recent article published in The Guardian titled “Decolonizing Dermatology: why black and brown skin needs better treatment.” Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.
Don’t forget to register now for the Skin Spectrum Summit 2020 Webinar Series, beginning October 1, 2020. Sign up here