Kristine Kucera, PA-C, MPAS, DHS
Atopic dermatitis is more prevalent in African American (19.3%), compared with European American children. Yet, challenges in diagnosing and treating atopic dermatitis in individuals with skin of color persist. These challenges include complexities of identifying the condition due to variations in symptoms and appearance on darker skin tones. In the most simple terms, the same rash or condition looks different on skin of different colors. As dermatology providers, we need to be aware of the varying presentations of the same conditions in skin of all colors.
A recent article reports the suggested addition of specific criteria for diagnosing AD in patients with skin of color. Speakers at the Skin of Color Update 2023 discussed the value of adapting the original major and minor criteria to account for diverse patient populations. It is suggested that a sub-criterion be added under typical morphology and distribution to include extensor papular involvement and lichenification or psoriasiform thickening of skin in skin of color patients. Additionally, it was suggested that post inflammatory hypopigmentation and hyperpigmentation be added.
These new criteria could assist in providing dermatology practitioners a more accurate assessment in individuals with diverse skin types, enhancing the quality of care for patients with different ethnic backgrounds.
Earlier and more effective treatment not only improves quality of life. It may also reduce the economic impact of eczema on patients with skin of color. Research has shown that, compared to non-blacks, black individuals with AD reported more out of pocket costs for prescription medications covered (74.2% vs. 63.6%) and not covered (65.1% vs. 46.5%) by insurance, emergency room visits (22.1% vs. 11.8%), and outpatient laboratory testing (33.3% vs. 21.8%).
Kristine Kucera, PA-C, MPAS, DHS, is Assistant Clinical Professor, University of Texas Southwestern, Medical Center PA Program, Dallas, TX. She is a member of the DEF Advisory Council.
References:
Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122(5):449-455. doi:10.1016/j.anai.2018.11.015
Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States. Arch Dermatol Res. 2022;314(8):739-747. doi:10.1007/s00403-021-02282-3