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Cultural practices may trigger AD flares
Understanding dietary and grooming practices could provide insight into triggering factors and improve patient counselling (895 words, 5 minutes)
A better understanding of differences in day-to-day cultural practices can help physicians improve atopic dermatitis (AD) outcomes in patients with skin of colour.
This was part of a talk by Dr. Renée Beach at the 8th annual Skin Spectrum Summit on Sept. 17, 2022.
“Expanding our definition of what is typical, and what is the day-to-day practice can help us better treat our patients,” she said.
Dr. Beach practices medical and cosmetic dermatology at DermAtelier on Avenue in Toronto and is an assistant professor at the University of Toronto.
As an example, Dr. Beach cited a case where a patient had persistent AD on her fingers. The condition was not improving despite the patient adhering to therapy and the family being engaged. It was not until Dr. Beach realized that the patient was eating using her hands, a cultural norm for her family, that progress was possible.
Dr. Beach described some other cultural practices that could trigger flares or cause unwanted secondary effects related to AD:
Perfume and fragrances can be irritating to the skin and cause AD flares
Lightening agents to counter hyperpigmentation associated with AD, particularly ones containing botanicals or citrus agents, can cause allergic contact dermatitis or phytophotodermatitis
As a safer approach for managing AD-associated hyperpigmentation, Dr. Beach recommended the on-label use of cysteamine. She said that hydroquinone, while touted as the gold standard, is rarely effective for more than eight weeks. Azelaic acid gel, which is often used off-label to treat hyperpigmentation, can be irritating for many patients.
Bottom Line: Physicians can benefit from knowing the cultural practices of their patients that might include the use of products that can induce AD flares or be used by patients to try and manage AD-induced pigment changes.
From the literature on atopic dermatitis in skin of colour
Overview of atopic dermatitis in different ethnic groups
This review article discusses differences in the presentation of atopic dermatitis (AD) among different ethnic groups, as well as differences in genetic contributions to the disease.
Topics covered include filaggrin mutations and Th2 hyperactivation.
“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,” the authors write.
Global epidemiology and disparities in atopic dermatitis
This article describes the global epidemiology of atopic dermatitis (AD) and disparities that exist in various populations and regions across the globe. The authors note that both AD prevalence and burden vary widely both within and between countries inhabited by the same ethnic groups. They write this finding suggests that strong environmental influences in disease expression, socioeconomics and affluence are the main drivers of AD.
Topics include inequities in access to healthcare and the quality of healthcare provided among racial and ethnic minority groups, including disparities in access to therapies.
Dermatology Quality of Life Index scores in Bangladeshi patients with atopic eczema and their families in East London
This cross-sectional, quantitative study examined patients of Bangladeshi origin living in East London, U.K., who had atopic eczema (AE). Children and young adults aged zero to 30 years were included.
Overall, 460 Bangladeshi children and 98 adults were recruited.
Researchers found that the highest affected domains in parental Quality of Life (QoL) were the burden of care, extra housework and emotional distress. For children, itching and sleep were the highest.
The investigators conclude that many external factors other than AE disease severity affect the QoL of patients and their families, especially in under-represented minority groups who face different linguistic and cultural barriers.
Atopic dermatitis in skin of colour. Part 1: New discoveries in epidemiology and pathogenesis
This paper discusses the rising prevalence of atopic dermatitis (AD) in developing countries such as those in Southeast Asia and Latin America.
Also discussed is how variations between ethnic groups in physiological measures such as transepidermal water loss, ceramide-to-cholesterol ratio, and skin sensitivity, alongside pathological barrier and immune system dysfunction processes, may ultimately lead to the distinct phenotypes seen clinically.
The authors also touch on potential differences in the psychosocial impacts of AD on individuals of different ethnic groups.
VIDEO: Atopic dermatitis diversity in presentation
At the intersection of skin and society
A new Heritage Minute film has been released focusing on the mill town of Paldi, B.C., founded in 1917 by Sikh immigrant Mayo Singh.
The Heritage Minutes are a collection of bilingual 60-second short films, each depicting a significant person, event or story in Canadian history. The first in the series was released in 1991.
According to The Canadian Encyclopedia, Singh first named the community—one of the first multi-ethnic, migrant towns on Vancouver Island—after himself as Mayo Siding. Because there was already a town named Mayo in the Yukon, Singh renamed the community Paldi, after his home village in District Hoshiarpur in Punjab, India, in 1936.
The Heritage Minute is written from the perspective of Bishan Kaur, a Sikh woman who immigrated to the community in 1927.
May is Melanoma Awareness Month in Canada/
May 5 is World Hand Hygiene Day
May 5 is African World Heritage Day
Something to think about in the week ahead…
—Erich Fromm, U.S. psychologist, 1900-1980
In an interview with the American Journal of Managed Care, New York dermatologist Dr. Andrew F. Alexis discusses some of the challenges in diagnosing skin conditions in darker skin types. He also speaks about ways medical providers can improve their skills in this area.
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 new 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
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.