AD Tx considerations in skin of colour
Potential for treatment-related pigment change, access to advanced therapies should be considered (1,300 words, 6 minutes)
There are nuances in treatment selection that physicians treating atopic dermatitis (AD) in patients with skin of colour should keep in mind to ensure the best outcomes. Toronto dermatologist Dr. Geeta Yadav discussed these nuances during a talk at the 8th annual Skin Spectrum Summit on Sept. 17, 2022.
Dr. Yadav is a dermatologist and the founder and medical director of Facet Dermatology in Toronto. She is also a lecturer in the division of dermatology at the Temerty Faculty of Medicine at the University of Toronto.
During her presentation, she discussed the use of steroids, phototherapy, and advanced therapies in AD.
Topical steroids
When prescribing steroids for darker-skinned patients with AD, physicians must be aware of the possibility of hypopigmentation, said Dr. Yadav, citing clobetasol as an example that can cause skin lightening if delivered topically or by injection.
Steroid-related hypopigmentation can also occur when the medication is being used to address a different condition, such as arthritis, she said.
Steroids can also worsen existing hypopigmentation caused by inflammation from AD.
Phototherapy
Patients with skin of colour may require higher doses of narrowband UVB phototherapy to successfully treat AD. However, Dr. Yadav noted that phototherapy may cause skin darkening in patients with Black or Brown skin. This may be of particular concern for patients from cultures where lighter skin is seen as preferable, she said.
Advance therapies
Patients with darker skin tones may have less access to advanced therapies or novel treatments, said Dr. Yadav. That discrepancy is related to economic factors “and also our own inherent biases and how often we think that those patients are deserving of advanced treatments.”
“Patients may not be able to communicate [with their physician] as effectively,” she said. “Maybe English is not their first language, maybe they are unable to articulate the severity of their disease.”
There is also a need for more data on the efficacy of some therapies for moderate to severe AD in populations of colour, said Dr. Yadav.
Bottom line: Patients with AD and darker skin types may respond differently to common treatments. Physicians should be aware of these differences to achieve the best possible outcomes.
From the literature on AD in skin of colour
The burden of atopic dermatitis and bacterial skin infections among urban-living Indigenous children and young people in high-income countries: A systematic review
This literature review was conducted to provide a global background on the burden of atopic dermatitis (AD) and bacterial skin infections in urban-living Indigenous children and young people in high-income countries.
Researchers reviewed English-language primary observational studies on AD and BSI containing epidemiologic data. They searched medical databases for articles between Jan. 1990 and Dec. 2021.
The investigators found current and severe symptoms of AD were more common in urban-living Indigenous children and young people in high-income countries compared with their non-Indigenous peers, and children had a higher prevalence than adolescents.
Urban-living Indigenous children and young people in high-income countries also had a higher incidence of all measures of bacterial skin infections compared with their non-Indigenous peers. They were over-represented for all measures of bacterial skin infection compared with their proportion of the background population.
Prevalence and risk factors of atopic dermatitis in Chinese adults: A nationwide population-based cross-sectional study
This was a large-scale, nationwide, population-based survey examined 36,700 valid questionnaires of 44,875 initially distributed in 35 cities of 31 provinces in China from July to Dec. 2017.
Overall, the researchers found the one-year prevalence of atopic dermatitis (AD) in Chinese adults was 6.13%. The point prevalence of AD was 2.42%. Being female, living in urban areas, smoking, having atopic comorbidities, or having an atopic family history were associated with an increased risk of AD.
Genetic polymorphism (rs6587666) in FLG protects from eczema in admixed Brazilian children population with high African ancestry
The authors of this study write that genetic variants in filaggrin are key in eczema and are less common in Africans than in Europeans and Asians.
They examined the association between Single Nucleotide Polymorphisms (SNPs) of filaggrin and eczema in a population of admixed Brazilian children and whether African ancestry modifies this association.
The investigators found the T allele of SNP rs6587666 was negatively associated with eczema in an additive model (Odds ratio (OR): 0.66, 95% Confidence interval (CI): 0.47-0.93, p=0.017).
They also found that African ancestry modifies the association between rs6587666 and eczema. The effect of the T allele was higher among individuals with higher African ancestry and the association with eczema was lost in individuals with lower African ancestry.
Validation of diagnostic criteria for atopic dermatitis and proposal of novel diagnostic criteria for adult and elderly Chinese populations: A multicentre, prospective, clinical setting-based study
This study was conducted to validate the diagnostic efficacy of three sets of atopic dermatitis (AD) criteria in adult and elderly Chinese populations in a hospital setting.
Investigators recruited 1,034 patients, aged 19 to 95 years, from five university hospital dermatological clinics. Each patient was investigated by two dermatologist panels, one to establish a clinical diagnosis, and the other to identify and record the major or minor signs of Hanifin and Rajka (H&R) criteria, UK Working Party (UKWP) criteria, and Chinese Criteria of Atopic Dermatitis for children (CCAD).
They found CCAD had a higher sensitivity (84.0%), especially among mild and moderate cases of AD (72.7% and 90.3%, respectively), than the H&R (58.0%; p<0.001) and UKWP criteria (56.0%; p<0.001) in diagnosing AD.
The specificity of CCAD (92.7%) was slightly lower than the H&R (97.3%; p<0.001) or UKWP criteria (97.4%; p<0.001). The CCAD had the highest Youden index (0.77), accuracy rate (0.90) and Kappa value (0.76) of the three sets of diagnostic criteria.
The authors write that consistent with results in a population of Chinese children, although the H&R and UKWP criteria had a high specificity for diagnosing AD, their low sensitivity limited their use in adult and elderly Chinese patients.
VIDEO: Health and heritage of Black hair and skin
For Black History Month 2022, a panel of General Practitioners from the Royal College of General Practitioners (UK) discussed the health and heritage of Black hair and skin and what makes it unique.
At the intersection of skin and society
On May 2, 2023, the Canadian Journalism Foundation (CJF) announced the recipients of the Black Journalism Fellowship Program, in partnership with CBC/Radio-Canada, CTV News, The Globe and Mail and the Investigative Journalism Bureau (IJB).
According to a press release, the goals of the fellowship program are to amplify Black voices, improve coverage of Black issues in the news and cultivate future Black media leaders.
Each recipient, a Black journalist with one to five years of experience, will experience a six-month fellowship at CBC/Radio-Canada (English and French), the Globe and Mail, a CTV News newsroom or at the IJB at the University of Toronto's Dalla Lana School of Public Health Sciences.
The fellowship recipients are: Leïla Ahouman, Serena Lope, Mzwandile Poncana, Rahma Shafi, and Daniel Reale-Chin (pictured below.)
The recipients will be recognized at the CJF Awards ceremony on June 13 at the Fairmont Royal York hotel in Toronto.
This week
May is National Sun Awareness Month in Canada
May 15 is Vascular Birthmarks Awareness Day
May 21 is World Day for Cultural Diversity for Dialogue and Development
Something to think about in the week ahead…
Sam Ewing, U.S. baseball player (Ret.)
Next week
We’re taking next Monday off, for the Victoria Day long weekend in Canada. When we return on May 29, we’ll report on the presentation of pigmentary disorders, including progressive macular hypomelanosis and lichen planus pigmentosus, based on a presentation at the Skin Of Colour Update 2022 conference in New York in Sept. 2022 by Dr. Heather Woolery-Lloyd. She is Director of the Skin of Color Division at the University of Miami Miller School of Medicine, and a frequent presenting faculty member at the annual Skin Spectrum Summit conference.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Michael Sidiropoulos (Toronto) discusses discoveries in the role histopathology plays in the diagnosis of skin conditions
A review of new and upcoming treatments for actinic keratoses and keratinocyte carcinomas featuring interviews with Dr. Ilya Shoimer (Calgary), Dr. Alia Bosworth (Halifax), Dr. Mark Lupin (Victoria, B.C.), and Dr. Michelle Pratt (St. John’s, N.L.)
An essay from Dr. Saima Ali (Burnaby, B.C) to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Ali wrote on the challenge of restoring the confidence of patients with skin of colour with the practice of dermatology.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton dermatologist Dr. Ron Vender
Read a recent online edition here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the eighth episode here, where Dr. Shear speaks with dermatologist Dr. Sonja Molin (Kingston, Ont.) about allergology, patch testing, and the growth of Queen’s University’s dermatology division.
And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.