Pediatric skin conditions in darker skin
Skin inflammation, and post-inflammatory pigment changes, are significant challenges in this group (450 words, 2.5 minutes)
Many of the common skin conditions in children, such as diaper dermatitis or atopic dermatitis, can present differently or raise different concerns in skin of colour, noted Dr. Danielle Marcoux during a presentation at the 2020 virtual Skin Spectrum Summit.
Dr. Marcoux is a clinical professor at the University of Montreal and Sainte-Justine University Medical Center, Department of Pediatrics, Dermatology division, in Montreal.
Because of the reactivity of the pigment in darker skin, any inflammation, including diaper rash, could lead to changes in appearance that may worry parents.
“One thing that is very distressing to the parents [of children with diaper dermatitis] is the post-inflammatory hypopigmentation,” Dr. Marcoux said. “Please reassure [the parents] that it is not vitiligo. [The pigment loss] is less well-demarcated. It is hypopigmented, not depigmented.”
Atopic dermatitis (AD) is a concern because it is 30% more common in African Americans, Asians, or Pacific Islanders than in Caucasians and can be more severe, Dr. Marcoux said.
“The mutations can [also] be different than in Caucasians,” she said, noting that filaggrin mutations are less common in darker skin, and TH2-related polymorphism mutations are more common in that group.
Clinical presentations of AD in these populations also differ from presentations in Caucasians, she said. “There is more dyschromia. There is follicular accentuation, ‘Greyhemia’ and severe lichenification.”
Dr. Marcoux said that systems for scoring AD, such as the SCORAD and EASI tools, weigh skin erythema heavily so they may underestimate the severity of AD in darker skin types.
“If you adjust for erythema score, you’ll see that children with darker skin are at six times higher risk of severe AD,” she said.
Oozing in AD is frequent between the ages of six and 18 months, “particularly on the face where the saliva is in contact with that sensitive skin due to a teething period,” said Dr. Marcoux. Therefore, it is important to reassure parents that the facial AD will improve after teething is complete and that the area can be protected with a good-quality cream. This is another area where post-inflammatory hypopigmentation can occur, she said, emphasizing again that it is also important to reassure parents that this pigment change is not vitiligo.
Contact dermatitis is also more frequent in the AD patient than previously thought, Dr. Marcoux said. She noted that young African American or Asian patients were twice as likely to have concurrent AD if they had a positive patch test.
She listed some common sensitizers in this population:
They may react to normally weak sensitizers such as surfactants found in shampoos or skincare products
Lanolin
Weak topical corticosteroids such as tixocortol pivalate
Parthenolide, a purported anti-inflammatory molecule derived from feverfew used in some natural products
Bottom line: Some inflammatory conditions are common and often under-diagnosed in children with darker skin. To ensure these children and their families are well-informed and managed as well as possible, it is important to know how these conditions present differently in these children.
From the literature on pediatric dermatology:
Epidemiology and characterization of atopic dermatitis in East Asian populations: A systematic review
This review of 10 years of epidemiologic studies has found AD rates are rising in children and adults in Asian populations worldwide. In particular, they note that the children of Asian immigrants may be at higher risk for developing AD, potentially due to epigenetic phenomena unique to immigrant populations.
Sociocultural influences on disparities in United States children with atopic dermatitis: A narrative review of the literature
This narrative review examines how sociocultural factors, such as race or ethnicity, neighbourhood, housing type, income level, and family structure, may contribute to AD prevalence and severity disparities seen among children in the U.S.
House dust microbiota and atopic dermatitis; effect of urbanization
Researchers examined the bacteriologic composition of household dust samples taken from the homes of 86 Black South African children. They found differences in microbiota between the dust from homes of children with AD and those without the condition. Differences were also seen between urban and rural homes.
Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective
This retrospective analysis examined the efficacy and safety of dupilumab in a cohort of Asian children and adolescents with moderate-to-severe AD. After 12 to 16 weeks of treatment, improvements were seen in Eczema Area and Severity Index and Investigator’s Global Assessment scores and relevant Quality-of-Life measures. The authors conclude that their findings show this biologic is safe and effective for Asian children and adolescents with moderate-to-severe AD.
VIDEO: Hispanic and black children more likely to miss school due to atopic dermatitis
At the intersection of skin and society
Two Canadian siblings and actors, Shamier Anderson and Stephan James, are launching the country's first-ever award show focused on Black talent in film, television, music, sports, and culture. The show, known as The Black Academy, will be telecast live on CBC TV and CBC Gem in Fall 2022. Already confirmed to run to 2025, it will feature presentations, performances, and tributes to Black cultural producers from Canada.
CBC News interviewed Anderson about the project. He explained that the show grew from the non-profit organization B.L.A.C.K. (Building a Legacy in Acting Cinema + Knowledge) that he and his brother created six years ago.
“What we want to do here is really let people know that we want to celebrate, elevate, and inspire both the Anglophone community and the Francophone community of Black talent across this country,” said Anderson in the CBC interview. “It’s the first of its kind in Canada—which is bittersweet because I can’t believe it’s never existed before, but we’re happy to have it. We’ve got an incredible board of directors, from Vanessa Craft, Alica Hall, Jennifer Holness, Divya Shahani, and Tonya Williams. The impetus of the Black Academy is our long-standing commitment to keep ties in our community [and] elevate Black talent in Canada.”
Read more here:
This week
June 21 is National Indigenous People’s Day
June 26 is National Cancer Wellness Awareness Day
June 27 is National Sunglasses Day in the US
Something to think about during the week ahead…
Next Week
Dr. Jerry Tan explains how to diagnose rosacea in darker skin types. Questions, comments or observations about ethnodermatology? Send them to us at health@chronicle.org. Have a great week, everyone.
