Inflammation in pediatric skin of colour
Recognizing presentations of inflammatory conditions in different skin types, and cultural competence for effective parent counselling are key (1,270 words, 6 minutes, 20 seconds).
Welcome back to Skin Spectrum Weekly, as we move into 2022. We hope you had a relaxing holiday season and your new year is starting smoothly.
Good cultural competence can help the parents of children with Black or Brown skin ensure inflammatory skin conditions in their children are managed effectively with good outcomes and quality of life improvements.
This message was part of a talk by Dr. Danielle Marcoux at the 7th annual Skin Spectrum Summit on Nov. 4, 2021.
Dr. Marcoux is a clinical professor at the University of Montreal and Sainte-Justine University Medical Center, Department of Pediatrics, Dermatology Division, in Montreal.
It is important for dermatologists to recognize that inflammatory skin conditions such as atopic dermatitis (AD) have different prevalence and presentations in various populations, Dr. Marcoux noted.
AD prevalence is “higher in African American, Asian and Pacific Islanders—up to 30 per cent,” she said.
AD can also arise from a range of gene mutations in these groups, leading to differences in how the disease functions. “Asian AD phenotypes are more psoriasiform, on a cellular, molecular and clinical level.”
Asian patients also experience a nummular form of AD, Dr. Marcoux said. African American children, in contrast, often have more follicular accentuation and lichen-planus-like lesions on their extensor surfaces, she said.
Many of the standard scoring systems for AD severity, including SCORAD and EASI, rely on skin erythema as a measure of severity. This measure is not accurate in darker skin types, Dr. Marcoux said.
Erythema “does underestimate the severity of AD in darker skin types. If we adjust for erythema scores, we will see that Black children have a six times higher risk of being diagnosed with severe AD. So new severity measurement tools are required.”
Alternative scores, which take into account factors such as follicular accentuation, lichenification, and non-reddening dyschromia such as ‘greythema’ are needed, she said.
Recognizing the severity of AD in different skin types is one way dermatologists can support their patients with enhanced competence. Dr. Marcoux also provided these other cultural competence tips:
Inflammatory conditions in children, such as diaper dermatitis, allergic contact dermatitis, and AD can lead to post-inflammatory dyspigmentation. The parents of these children will often be concerned this loss of pigment is vitiligo and will need to be reassured this hypopigmentation is temporary.
Dark-skinned children with curly hair may be using pomades for hairstyling and can develop amorphic closed comedones with mild inflammation on the forehead and temples.
Visible conditions, including pigment changes, can have a strong impact on quality of life in children. Recommending camouflage products to the parents of children with these conditions can not only directly improve quality of life by disguising the condition. Still, it can also improve treatment adherence and therapeutic outcomes.
The use of essential oils and other topical natural ingredients is on the rise, and so there may be an increase in the risk of contact allergy to these agents. Findings in the literature have shown that Asian or African American children who are patch tested for contact allergies are two times more likely to have concurrent AD than White children who are patch tested, so it is worth considering contact allergy as an exacerbating factor in children with severe AD in these populations.
Bottom line: Understanding how inflammatory conditions present in different skin types and how those presentations impact the lives of young patients' lives can lead to earlier and more accurate diagnosis and better patient experience and outcomes.
From the literature on pediatric dermatology in skin of colour
Children with atopic eczema experiencing increased disease severity in the pollen season more often have hay fever at a young age and a dark skin type
A study designed to investigate the phenotype characteristics of children who experience atopic eczema flares in the spring and summer has found it is most common in children with dark skin who have hay fever.
The study was a retrospective database analysis that included 110 children, aged up to 17 years, with difficult to treat atopic eczema. Of those, 36% reported flares during the pollen season. Children who reported this type of seasonal flaring were more likely to be sensitized to one or more forms of pollen and were more likely to report hay fever than children who did not flare during this season. They were also more likely to have dark skin types.
Fair-y Tales: An analysis of children's books about sun safety
Commercial children’s books about sun protection inadequately represent darker skin tones, according to a study. The books also do not incorporate all the American Academy of Dermatology (AAD) sun protection guidelines.
The authors of the study searched the internet for children’s books about sun protection and compared the contents of those books to the AAD guidelines. These books were also assessed for reading level, author profession, and skin tone representation.
In the 17 books that met the study criteria, only one depicted people with dark skin tones on the cover, and three depicted them within the story. Of 19 of the AAD sun protection factors, the median number of factors mentioned within the books was nine (range 3-13).
Nail discolouration in pediatric skin of colour patients
This review article details variations in nail pigmentation that can occur in children with skin of colour and the common causes of these variations. Causes of melanonychia discussed include ethnic pigmentation, nail matrix melanocytic activation or hypermelanosis, nail lentigo and nail matrix nevus. The article touches on the need to reassure parents of these children that these pigment changes are usually due to benign causes. However, the rare case of nail colour changes as a sign of melanoma is also investigated.
Facial hypopigmentation in skin of colour: An atypical presentation of lichen nitidus
This small case series describes eight pediatric patients with skin of colour who presented with facial hypopigmentation. Clinical examination revealed features consistent with lichen nitidus (LN) confined to the face.
The study authors note that LN is typically found on the trunk, genitalia, and upper extremities, so it is unusual to find it on the face. Their discussion provides several key features that can help a clinician distinguish LN from other hypopigmented lesions on the face.
VIDEO: Doctor V - Baby Moisturisers | Skin Of Colour | Brown Or Black Skin
At the intersection of skin and society
This coming March 18 to 20, Halifax will host the third edition of the National Black Canadians Summit.
As described on the event webpage, the summit’s mission is:
To collect experience-based data and tangible recommendations to continue to inform the “Canadian Strategic Action Plan for the International Decade for People of African Descent: 2017-2024” which draws on the strengths of initiatives across the country, identifies gaps in existing programs and prioritizes areas where government support needs to be strengthened.
Summit events include a series of strategic planning sessions, panel discussions and presentations where participants from across Canada are invited to share their perspectives on justice, education, health, migration, wealth, and poverty.
The summit is supported by the United Nations, the Legislative Assembly of Nova Scotia, as well as individual business leaders, cabinet ministers, government representatives, community leaders, youth and professionals. It is hosted by the Michaëlle Jean Foundation and streamed live for international attendance.
More details about the summit as well as a registration link are available on the event’s page: https://www.blackcanadiansummit.ca/halifax-2022
This week
January is National Mentoring Month in the US
January is Tamil Heritage Month in Canada
Jan. 12 is National Pharmacist’s Day in the US
Something to think about in the week ahead…
Next week
We continue our coverage of the 2021 Skin Spectrum Summit next week with Dr. Marissa Joseph’s talk on atopic dermatitis in skin of colour. Dr. Joseph touches not only on diagnostic challenges but also on some of the unmet needs in treatment.