Diagnosing atopic dermatitis in people of color is more challenging than in people with lighter skin tones. This issue is not only getting more attention within professional medical circles, but in layman’s publications as well. Many articles such as EverydayHealth’s Too Many Doctors Are Misdiagnosing Disease on Skin of Color and WebMD’s How Eczema Affects Darker Skin Tones attest to the public’s growing interest in this area.
As dermatologists, we at Masterclasses in Dermatology recognize that people of color have long been under-served. For example, until recently, the majority of medical articles and pictures have focused on people with light skin tones. Fortunately, our field is improving in this area and for good reason: people of color actually have a higher incidence of atopic dermatitis (AD). An article in the peer-reviewed journal Annals of Allergy, Asthma, & Immunology titled Racial Differences in Atopic Dermatitis, states that, “In the United States, AD prevalence was found to be higher in African American (19.3%) compared with European American (16.1%) children.”
What Are Masterclasses in Dermatology?
Masterclasses in Dermatology offers interdisciplinary education tailored to dermatologists. We feature topics across a wide range of medical and surgical diseases highlighting novel imaging techniques, innovations, and advocacy. Our multidisciplinary approach gathers experts from multiple therapeutic areas, e.g., gastroenterology, rheumatology, dermatology, surgery, and ophthalmology to teach and interact with our dermatology practitioner audience and multidisciplinary, pharmaceutical colleagues.
Our next conference will take place in person at the Ritz-Carlton in Sarasota, Florida on February 23-26, 2023 and will, of course, include diagnosis and treatment of chronic inflammatory skin diseases. Physicians Brian Kim and Emma Guttman will be discussing the latest treatments for hives, eczema, and prurigo nodularis on Saturday, February 25th.
Dr. Kim is the director of the Mark Lebwohl Center for Neuroinflammation and Sensation at Mount Sinai as well as the director of the Clinical Center for Itch. Dr. Guttman is one of the world’s leading experts in inflammatory skin diseases and the current president of the International Eczema Council. You can be sure that the challenges of treating skin of color will be on their list of topics!
Meet Dr. Brian Kim
Dr. Kim is one of the Key Opinion Leaders (KOLs) that you will meet and learn from at the next Masterclasses in Dermatology session. He is a world renowned researcher who is dedicated helping patients with itch and other skin conditions. His research seeks to understand the regulatory mechanisms that control neuro-immune interactions at the skin barrier surface. Understanding how immune responses interface with the sensory nervous system to regulate inflammation, sensation, and immunity will further our ability to treat sufferers of atopic dermatitis.
According to his Mount Sinai profile, since 2006 he has authored/co-authored 83 articles relating to the physiology and treatment of itch. For example:
- The Sensation of Itch: From Biological Discovery to Medical Treatment, Journal of Investigative Dermatology, 2022.
- Psychometric Properties of the Itch Numeric Rating Scale, Skin Pain Numeric Rating Scale, and Atopic Dermatitis Sleep Scale in Adult Patients with Moderate-to-Severe Atopic Dermatitis, Health and Quality of Life Outcomes, 2021.
- Treatment of Atopic Dermatitis with Ruxolitinib Cream (JAK1/JAK2 inhibitor) or Triamcinolone Cream, Journal of Allergy and Clinical Immunology, 2020.
Some are even specific to how different ethnicities experience skin diseases. For example:
- Ethnic Variations in Scalp Pruritus and Hair Loss, Journal of the American Academy of Dermatology, 2021.
- Associating Filaggrin Copy Number Variation and Atopic Dermatitis in African-Americans: Challenges and Opportunities, Journal of Dermatological Science, 2020.
- Uncommon Filaggrin Variants Are Associated with Persistent Atopic Dermatitis in African Americans, Journal of Investigative Dermatology, 2018.
Meet Dr. Emma Guttman
Dr. Guttman is another Key Opinion Leader that you will meet and learn from at our next Masterclasses in Dermatology session. Dr. Guttman is president of the International Eczema Council, is on the scientific advisory board of the National Eczema Association, and is the director of The Laboratory of Inflammatory Skin Diseases at the Icahn School of Medicine at Mount Sinai.
Under Dr. Guttman’s direction, the latter has made major contributions to the understanding of atopic dermatitis. For example, according to its website, the lab has:
- Shown that atopic dermatitis has distinct phenotypes based on ethnicity, age, and other factors.
- Developed the only comprehensive molecular maps of AD, defining skin differentiation and immune-circuits characterizing this disease.
- Established the reversibility of the AD phenotype.
- Defined a series of biomarkers that are now accelerating testing of novel pathway-specific drugs for AD.
- Contributed directly to many of the recently developed treatments for AD.
- Begun testing multiple targeted-therapeutics for AD.
According to her Mount Sinai profile, Dr. Guttman has authored/co-authored 240 peer-reviewed articles. For example:
- New Therapies for Atopic Dermatitis, Annals of Allergy, Asthma & Immunology, 2022.
- Pioneering Global Best Practices in Atopic Dermatitis: Results from the Atopic Dermatitis Quality of Care Initiative, Clinical and Experimental Dermatology, 2022.
- Biologics for Treatment of Atopic Dermatitis: Current Status and Future Prospect, The Journal of Allergy and Clinical Immunology, 2021.
Atopic Dermatitis and Skin of Color
Although research into ethnicity-specific pathways continues, so far treatment for eczema doesn’t vary with ethnicity. To date, medications and interventions have similar efficacy and safety across ethnic groups. The overriding challenge for physicians treating patients with darker skin tones is diagnosis.
As mentioned above, teaching materials have been disproportionately skewed towards lighter skin tones. However, that’s not the end of the issue. AD often presents quite differently in more richly pigmented skin, making it harder to diagnose. Atopic dermatitis in people of color can present as:
- Purple, grayish, or darker brown patches
- Raised bumps/permanent goosebumps
- Dark circles around the eyes
- Lesions on/around joints
To help ameliorate this situation, the American College of Allergy, Asthma, and Immunology has teamed up with the Allergy & Asthma Network to create a website to aid physicians and patients recognize eczema in people with all skin types. EczemaInSkinofColor.org, aims to address the “social and economic factors that can affect successful diagnosis, management, and treatment in people of color.”
Among the resources that EczemaInSkinofColor.org offers, is an image gallery of photos for a closer look at eczema in skin of color. This can be of very helpful to dermatologists who may not have treated many patients of color. As we said, familiarity with how eczema looks in skin of color is essential in making a correct diagnosis. The website is also designed to help doctors and patients differentiate eczema in skin of color from other diseases and it includes helpful information on eczema management and treatment.
Resources for Your Patients
The National Eczema Association, for which Dr. Guttman is an advisor, is a resource to which you may want to guide your patients. It has a plethora of information about the many forms of eczema, including atopic dermatitis, as well as tips for managing their symptoms. There is information specific to children, what treatments are available, what research is being done, and ways to connect with others coping with eczema. There is also a very useful page called “For Your Patients” which offers an eczema products directory, downloadable fact sheets, and a link to the EczemaWise App which helps with symptom tracking.
It also has many blogs related to AD and skin of color which may be of help to you and/or your patients. Often, hearing the stories of fellow sufferers can help patients feel less isolated and more hopeful. Just a few of the many titles which offer a glimpse into what is available:
- Everything You Need to Know About Eczema in Skin of Color
- Why skin of color matters too
- Eczema in Skin of Color: What You Need to Know
- Eczema on Black Skin: NEA Community Members Share Their Experiences
A Reminder for Your Patients: Preventing Flare Ups
Your patients are busy and perhaps forgetful about the importance of self-care. Others may like some information that is understandable by non-physicians, yet comes from a reputable and recognizable medical source. One such resource is a Mayo Clinic article, Atopic Dermatitis (Eczema). Besides explaining what AD is, it recommends that eczema sufferers develop a basic skin care routine to help prevent eczema flare ups. For example, to help reduce the drying effects of bathing, you can remind your patients to:
- Moisturize your skin at least twice a day. Creams, ointments, shea butter, and lotions seal in moisture. Choose a product or products that work well for you, ideally, unscented ones.
- Use petroleum jelly on your baby’s skin to help prevent development of atopic dermatitis.
- Take a daily bath or shower. Use warm, rather than hot, water and limit your bath or shower to about 10 minutes.
- Use a gentle, non-soap cleanser. Choose a cleanser that’s free of dyes, alcohols, and fragrance. Especially avoid deodorizing and/or antibacterial soaps as they remove too much of the skin’s natural oils and dry the skin. Soap can be especially irritating to the skin of young children; skip the bubble bath.
- Avoid scrubbing the skin with a washcloth or loofah.
- Pat dry. After bathing, gently pat the skin with a soft towel.
- Apply moisturizer while your skin is still damp (within three minutes).
The article also will remind your patients of some of the many common triggers for flare ups. Although most of them have probably learned the hard way to avoid them, it never hurts to remind your patients what they are. For example:
- Rough wool fabric
- Dry skin
- Skin infection
- Heat and sweat
- Cleaning products
- Dust mites and pet dander
- Smoke from tobacco
- Cold and dry air
- Other irritating chemicals
Join Us in February in Beautiful Sarasota, FL
You can register for the next Masterclasses in Dermatology on our registration page. Our “Early Bird Special” which provides a significant discount ends September 30th. You can check out our full agenda on our website and see who our faculty is, who our exhibitors will be, and learn what CME credits will be available.
All meeting and meal functions will be held at the beautiful The Ritz Carlton Sarasota, but many nearby hotels such as The Westin and Art Ovation are just a short walk away from the meeting venue! Enjoy the sunshine and kick your feet up after an exciting day of learning and networking!
A Final Word
Eczema’s impact on the quality of life in people of color can be significant. When eczema is persistent or uncontrolled in people of color, the hypo/hyperpigmentation from delayed treatment can lead to long-lasting pigmentary changes or scarring. In fact, skin discoloration may be more bothersome to people of color than the itch and inflammation; it can even cause severe anxiety and distress.
We hope you will join us for this potent, interdisciplinary meeting and expand your network of colleagues from around the nation and the world in the practices of gastroenterology, rheumatology, dermatology, surgery, and ophthalmology. Not only will you gain insights into treating patients with skin of color, but all the emerging and exciting treatments and interventions that will help you better serve your patients!