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    Treating eczemas in skin of color

    New therapies should “revolutionize” treatment of all patient populations

    Dr. AlexisWhen it comes to treating atopic dermatitis in non-white racial ethnic groups, there are variations in prevalence, genetic factors and clinical presentation.

    In addition, delays in treatment and undertreatment can contribute to a higher risk of pigmentary sequelae, including hyperpigmentation and hypopigmentation.

    “Fortunately, recently approved therapies show promise in improving outcomes of atopic dermatitis in this patient population,” says Andrew Alexis, M.D., chair of the Department of Dermatology at Mount Sinai St. Luke’s and Mount Sinai West in New York City.

    Multiple studies from the United States and the United Kingdom demonstrate that the prevalence of atopic dermatitis is greater in blacks than in whites.

    For example, a study published in the Journal of the American Academy of Dermatology in 1995 found that London-born Caribbean children of African ancestry had a 16.3% prevalence rate of atopic dermatitis compared to a rate of 8.7% in London-born white children.

    Furthermore, in America, African American children were found to be 1.7 times more likely than their white counterpoints to have a diagnosis of atopic dermatitis, even after adjustment for potential confounding variables, according to a 2011 article in the Journal of Investigative Dermatology.

    Another U.S. study, reported in the Archives of Dermatology in 2012, found that blacks, Asians and Pacific Islanders were more likely than whites were to visit physicians for atopic dermatitis.

    “In fact, looking at the number of atopic dermatitis visits, blacks had two-fold higher visits per capita than whites, whereas Asians and Pacific Islanders had six-fold higher visits per capita,” Dr. Alexis tells Dermatology Times. “However, this is not due to greater healthcare utilization, as these non-white groups had lower overall utilization for medical and other skin conditions. This speaks to not only the higher prevalence, but the greater burden of atopic dermatitis among various non-white racial ethnic groups.”

    Excluding erythema, non-whites were six times more likely to have severe atopic dermatitis than were their white counterparts, according to a study published in the British Journal of Dermatology in 2002.

    Moreover, studies have shown differences in the lipid content of the epidermis of different populations. For instance, a key lipid, ceramide, is lower in African Americans than in other groups, according to a study from the Journal of Cosmetic Science in 2010, while ceramide/cholesterol ratios were found to be lower in Africans compared to whites in a study in the British Journal of Dermatology in 2010.

    Next: Genetic factors

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