Addressing Quality of Life Specifics Associated With Atopic Dermatitis and Skin of Color

More persistent atopic dermatitis (AD), more severe AD, greater school absenteeism, and increased doctor visits are all factors that may account for great quality of life burden for patients with skin of color and an AD diagnosis. Zakiya Pressley Rice, MD, recently took a deep dive into special considerations for AD in SOC during a Masterclasses in Dermatology virtual meeting with various topics about AD.

Rice is a triple board-certified dermatologist at Dermatology Associates of Georgia in Atlanta and an adjunct clinical professor at the Emory School of Medicine.

Rice's presentation addressed crucial aspects of AD, shedding light on disparities, clinical presentations, and treatment considerations for individuals with diverse skin tones.

Current studies, though limited in number, provide valuable insights. One study indicated that non-Hispanic Black and Hispanic children with less control exhibited more persistent AD than non-Hispanic white children. Another study associated severe AD in children with African American and Hispanic ethnicity. The prevalence of AD in the United States, particularly among Black children, was highlighted, with a significant impact on school absenteeism and overall quality of life.

Additionally, the session addressed disparities in healthcare utilization. African American, Asian, and Pacific Islander patients demonstrated higher doctor visit rates for AD compared to white patients. Interestingly, Black and Hispanic children were more likely to visit primary care doctors or emergency rooms, even with the same overall number of visits, indicating potential disparities in access to specialized care.

Rice explored the potential reasons behind these disparities, questioning whether they were rooted in genetics or environmental factors. While acknowledging some genetic differences, Rice suggested that socio-economic factors might play a more significant role, as observed in her practice in an affluent area.

The presentation delved into the clinical manifestations of AD in SOC, noting differences in presentation, distribution, and morphology compared to lighter skin tones. The heterogeneity of AD at both the molecular and clinical levels was emphasized, with particular attention to variations in presentation among different ethnic groups.

Addressing treatment considerations, Rice discussed the importance of maximizing evaluation and treatment in AD and SOC. A key point was the necessity of higher energy settings in phototherapy for SOC patients due to increased melanin production.

The session highlighted ongoing challenges in clinical trials, where representation of Black and African American participants often falls short. Rice commended a recent study led by Andrew Alexis, MD, for achieving substantial representation in SOC patients, indicating the need for more inclusive research.

In conclusion, Rice's session underscored the substantial burden of AD in SOC populations, emphasizing the importance of understanding and addressing disparities in diagnosis, treatment, and clinical trials.

Reference

Rice ZP. Considerations for AD in SOC. Presented at Arm Yourself With Knowledge Atopic Dermatitis Meeting; October 17, 2023.