Atopic dermatitis in teens with skin of color

“Given the social and emotional impact of atopic dermatitis on patients with skin of color, it is imperative to treat the condition appropriately,” the authors write. (©RedConfidential/Shutterstock.com)

Atopic dermatitis can have a profound impact on the quality of life of adolescents and even more so for adolescents with skin of color as severe atopic dermatitis is believed to be six times more common in black children than white children.¹

RELATED: Eczema more common in black patients

On top of that, diagnosing atopic dermatitis in skin of color patients can be a challenge because erythema can be harder to identify in skin with darker tones meaning that atopic dermatitis may be missed or undertreated in deeply pigmented adolescents.¹

Atopic dermatitis can have psychological ramifications for teenagers, write the authors of a recent review of the impact and management of atopic dermatitis in adolescents with skin of color published in Cutis.² “…teenagers with AD report having fewer friends, are less socially involved, participate in fewer sports, and are absent from classes more often than their peers. In black patients with atopic dermatitis, school absences are even more common.”

One US study of 8015 children aged 2–17 years with atopic dermatitis found that black children had a 1.5-fold higher chance of being absent for six days over a six-month school period compared to white children, which led the researchers to suggest that this greater number of school absences was due to atopic dermatitis having a greater impact on quality of life in children with skin of color.³

“Given the social and emotional impact of atopic dermatitis on patients with skin of color, it is imperative to treat the condition appropriately,” the authors write.

Patients with atopic dermatitis are also usually advised to limit their participation in strenuous exercise and other activities because perspiration, irritation and heat-causing itch can irritate their condition. This limit the social lives and leisure activities of adolescents with the condition.⁴

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“Because adolescents often are involved in athletics or have mandatory physical education classes, atopic dermatitis may be isolating and may have a severe impact on self-esteem,” write the review authors.

Adolescents reluctant to participate in sports because of teasing, bullying or symptoms that worsen with heat or sweating might benefit from aggressive treatment with topical and systemic medications, they add.

“Now that dupilumab is available for adolescents, there is a chance that patients with severe and/or recalcitrant disease managed on this medication can achieve better control of their symptoms without the laboratory requirement of methotrexate and the difficulties of topical medication application,” the authors write.

Acne is one of the most common reasons for adolescents to seek dermatologic care, meaning many adolescents with skin of color may have acne in addition to their atopic dermatitis.⁵ But topical retinoids and benzoyl peroxide, which are the usual first line treatment for mild-to-moderate acne in patients with skin of color, may cause dryness and may exacerbate atopic dermatitis.

The review authors therefore suggest adolescents with acne and atopic dermatitis use moisturizers containing ceramide⁶ or that modifications are made to their acne treatment regimens, such as using topical retinoids every other night or mixing them with moisturizers to minimize dryness. Other acne treatment options for adolescents with skin of color and atopic dermatitis include dapsone gel 7.5%⁷ and sulfacetamide.⁸ While isotretinoin is the usual treatment of choice for severe nodulocystic acne  in patients with skin of color, few studies have addressed the complications seen in black adolescents with this treatment, particularly in regards to those who also have atopic dermatitis.

RELATED: Cosmetic needs differ for skin of color patients

Pigmentary changes are always a concern for patients with skin of color, and those with atopic dermatitis and acne are at particular risk of post-inflammatory hyperpigmentation (PIH) or hypopigmentation, the authors note.

It is also important to know that adolescent may use cosmetics to conceal hyperpigmented or hypopigmented lesions caused by acne or other skin diseases, and that use of different cosmetics may contributor to flares. Dermatologists should discuss both cosmetic products and personal care products with their adolescent patients, the authors write, because these patients have an increased risk of sensitization to fragrances.

“Patch testing may be helpful in determining true allergens in some patients,” the review authors write.
 

References:

1. Ben-gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. Br J Dermatol. 2002;147(5):920-5.

2. Poladian K, De Souza B, McMichael AJ. Atopic dermatitis in adolescents with skin of color. Cutis. 2019; 104(03):164-168.

3. Wan J, Margolis DJ, Mitra N, et al. Racial and Ethnic Differences in Atopic Dermatitis-Related School Absences Among US Children. JAMA Dermatol. 2019;

4. Paller AS, Mcalister RO, Doyle JJ et al. Perceptions of physicians and pediatric patients about atopic dermatitis, its impact, and its treatment. Clin Pediatr (Phila). 2002;41(5):323-32.

5. Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol. 2010;3:24-38.

6. Lynde CW, Andriessen A, Barankin B, et al. Moisturizers and ceramide- containing moisturizers may offer concomitant therapy with benefits. J Clin Aesthet Dermatol. 2014;7:18-26.

7. Taylor SC, Cook-bolden FE, Mcmichael A, et al. Efficacy, Safety, and Tolerability of Topical Dapsone Gel, 7.5% for Treatment of Acne Vulgaris by Fitzpatrick Skin Phototype. J Drugs Dermatol. 2018;17(2):160-167.

8. Draelos ZD. The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses. J Drugs Dermatol. 2010;9(3):234-6.