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It's time to talk about atopic dermatitis in skin of colour
More inclusive terminology needed to describe atopic dermatitis terminology in darker skin types (1,100 words, 5 minutes)
The way atopic dermatitis (AD) is described in textbooks and other teaching materials needs to be revised to better represent how AD appears in diverse skin tones, Dr. Marissa Joseph told the Atopic Dermatitis Summit on April 23, 2022.
Dr. Joseph is an academic dermatologist at the University of Toronto and medical director of the Schachter Dermatology Centre at Women's College Hospital.
She noted that most of the world’s population has skin types from Fitzpatrick IV to VI. Recognizing the diagnostic differences between those patients and those with lighter skin tones is particularly important in areas with highly diverse populations.
In particular, Dr. Joseph said a new term is needed to discuss erythroderma in patients with darker skin tones. Erythroderma is traditionally described as a widespread significant eruption, usually redness and scaling over 80 to 90% of the body. But in patients of colour, that redness is not present, she said.
“Often in patients with skin of colour or deeper skin tones, [the lack of redness] is not appreciated, which is why some of the data suggest that we may be under-calling the severity of atopic dermatitis in these patient populations,” said Dr. Joseph.
Descriptions of AD should also include other traits the condition may have in dark skin, including:
Dyspigmentation as a sign of active disease
The presence of nummular lesions
Lesions on extensor surfaces
Bottom Line: The language used to describe and discuss AD should be inclusive of how it presents in skin of colour. Non-inclusive descriptions may contribute to delayed care and poorer outcomes.
From the literature on AD in skin of colour
The risk of atopic comorbidities and atopic march progression among Black and White children with mild-to-moderate atopic dermatitis: A cross-sectional study
This study aimed to evaluate differences in atopic illnesses and subsequent atopic march progression among a US national cohort of Black and White children with physician-diagnosed mild-to-moderate AD.
Data on 8,014 children enrolled in the Pediatric Eczema Elective Registry (PEER)—37.7% White and 52% Black.
Children with the most extended AD duration demonstrated a more prevalent familial history of eczema, seasonal allergies, and asthma than those with shorter AD duration.
The researchers observed that longer AD duration increased a child’s risk of having other allergic diseases.
Black children had lower risks of developing asthma, allergic rhinitis, food allergies, and animal allergies than White children.
Insights in skin of colour patients with atopic dermatitis and the role of skin care in improving outcomes
This paper describes the outcome of a literature review, panel discussions, and an online review process conducted to explore best clinical practices in treating AD patients with skin of colour (SOC). The authors provide guidance on skincare for these patients.
One finding was that treating and maintaining AD in patients with SOC should be proactive, effectively control inflammation longitudinally, including effective skin barrier protective strategies, and consider cultural practices.
The authors conclude that more robust comparative studies are needed to understand racial and ethnic variations in AD better. This will help tailor patient education and foster individualized treatment, prevention, and skin care approaches.
Differences in prescriptions for systemic medications and nonsteroidal topicals among children with atopic dermatitis
This cross-sectional study reviewed records of patients younger than 18 years old with atopic dermatitis (AD) who were seen at a large children's hospital between 2009 and 2017.
Among the findings, the authors found that Black and Hispanic patients were less likely to be prescribed topical nonsteroidal agents than White patients. Non-White patients were also less likely to be prescribed systemic medications, suggesting that further examination of potential disparities in pediatric AD treatment is needed.
The financial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States
Researchers aimed to characterize categories, impacts, and associations of caregiver-reported out-of-pocket atopic-dermatitis (AD)-related healthcare expenses for US children.
They contacted 113,502 National Eczema Association members to complete an online survey. Of those, 1,447 completed the study, and 1,118 met the inclusion criteria.
Predictors of harmful financial impact among children included Black race (adjusted OR [95% confidence interval]: 3.86 [1.66-8.98] p=0.002) and ≥$1000 annual out-of-pocket expenditures (6.98 [3.46-14.08], p<0.0001).
Compared to adults with AD, survey respondents reported increased out-of-pocket expenses for:
Emergency room visits
Hygiene and bathing products
Specialized cleaning products
Clothing and bedding
VIDEO: Dr. Luz Fonacier discusses the diagnosis and management of atopic dermatitis, American College of Allergy, Asthma & Immunology
At the intersection of skin and society
The Royal Ontario Museum in Toronto has returned two artifacts belonging to Plains Cree Chief Poundmaker to his descendants, reports CBC News.
After months of conversation, on Feb. 22, 2023, the museum returned a ceremonial pipe and saddle to Chief Poundmaker’s family members.
Efforts to repatriate Poundmaker’s belongings and sacred objects from collections around the world have been led by Pauline Poundmaker, or Brown Bear Woman, the great-great-granddaughter of the historic chief.
Chief Poundmaker, whose Cree name is Pitikwahanapiwiyin, was active in the 19th century and was critical in negotiations that led to Treaty 6, which covers the west-central portions of present-day Alberta and Saskatchewan.
In an interview with the news outlet, Paula Poundmaker said the repatriation ceremony on Feb. 22, 2023, was the first time she had seen the two artifacts in person.
“I had a moment there where I couldn’t hold back the tears. The significance of being here and the honour it is to be able to bring these artifacts home. It’s hard to describe.”
Several of Chief Poundmaker’s belongings were taken and housed in museums after the Northwest Rebellion in 1885. That year, Poundmaker was convicted of treason for leading his warriors in the battle against Canadian Forces after government soldiers attacked 1,500 Indigenous people, including women and children. The chief served was imprisoned for seven months, dying shortly after release.
March is Red Cross Month in Canada
March is National Ethics Awareness Month in the US.
March 10 is Histotechnology Professionals Day in the US.
Something to think about in the week ahead. . .
Immanuel Kant, German philosopher, 1724-1804
In an article in the Washington Post, Indian dermatologist Dr. Alpana Mohta discussed the growing use of neurotoxins to inhibit sweating at the hairline in Black women.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
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