Understanding Atopic Dermatitis
Patients often need information to review at home after they are diagnosed with a condition. Evidence-based information both clarifies and supplements what patients are told during an office visit with an allergist. Understanding Atopic Dermatitis is a medically reviewed patient resource available as a free download on AllergyAsthmaNetwork.org – it’s an “Eczema 101” for new patients and those who live with AD.
Differences and Disparities (Data about incidence)
Eczema in Skin of Color
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[Editorial] 2019: The effect of being African American on atopic dermatitis.
The effect of being African American on atopic dermatitis.
Donald Y.M. Leung, MD, PhD., Ann Allergy Asthma Immunol., Vol. 122, Issue 1, p1.
➤ The key driving forces shaping AD phenotypes are linked to a combination of skin epithelial dysfunction and polarized immune pathways that may drive the different endotypes.7
• Adding to the complexity, race is emerging as another factor to consider, e.g. Asians with AD have an increased IL17 related immune response layered on top of the Type 2 immune response seen in all forms of AD. This may account for the increased psoriasiform appearance to eczema in Asian patients.
➤ African Americans with AD have been understudied despite the fact that they may have more severe AD. Therefore there is an unmet need to identify the immune activation pathways in African American patients with AD. A new study published in the current issue of The Annals of Allergy, Asthma and Immunology by Guttman-Yassky and her colleagues 8
• have evaluated potential differences in the molecular profile of skin from African Americans with AD compared to the skin of European Americans with AD with the goal of determining whether there are differences that might improve treatment options for African Americans. Their results indicate that the Type 2 and Th22 immune responses in African Americans with AD are similar to European Americans but African Americans have lower levels of interferon gamma and IL17 expression than European Americans. This immune imbalance may increase the atopic propensity of African Americans with AD.
[News Release] 2020: Black and Hispanic children in the U.S. have more severe eczema than white children.
Black and Hispanic children in the U.S. have more severe eczema than white children.
Jonathan Silverberg, MD. ACAAI Press release, November 13, 2020.
[Study] 2020: Racial Disparities in Allergic Outcomes Persist to Age 10 in Black and White Children
Racial Disparities in Allergic Outcomes Persist to Age 10 in Black and White Children,
Alexandra Sitarik, Suzanne Havstad, Haejin Kim, Edward M. Zoratti, Dennis Ownsby, Christine Cole Johnson, Gensa Wegienka. Ann Allergy Asthma Immunol., Vol 124, Issue 4, pp 342-349.
[Study] 2018: Racial differences in atopic dermatitis.
Racial differences in atopic dermatitis.
Patrick M Brunner, MD, MSc; Emma Guttman-Yassky, MD, PhD., Ann Allergy Asthma Immunol., Vol. 122, Issue 5, pp 449-455.
Eczema in Skin of Color
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[Study] 2021: Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy
Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy
Mark Corbett, MD; Abby Allen, NP; Nichole Bobo, MSN, RN; Michael B. Foggs, MD; Luz S. Fonacier, MD; Ruchi Gupta, MD; Rachel Kowalsky, MD; Erin Martinez; Wendy Smith Begolka, MBS; Cherie Zachary, MD; Michael S. Blaiss, MD.
Ann Allergy Asthma Immunol., Vol 130, Issue 3, pp 392-396.E2.
Epub 2023 https://www.annallergy.org/article/S1081-1206(22)02001-4/fulltext#articleInformation
The prevalence and severity of atopic dermatitis (AD) and food allergies are higher among individuals with skin of color compared to White individuals. The American College of Allergy, Asthma, and Immunology (ACAAI) conducted a study to investigate the impact of racial disparities on patients with skin of color affected by AD and food allergies.
- A significant portion of survey respondents (68%) acknowledged that racial disparities hindered adequate treatment for AD and food allergies among individuals with skin of color.
- Challenges highlighted were related to limited access to care, financial burdens, insufficient policies and infrastructure for safe foods and patient education, and a lack of inclusive research involving skin of color.
- Proposed solutions included increasing the participation of individuals with skin of color in clinical trials and medical education, enhancing healthcare provider knowledge about diagnosing and treating these conditions in such populations, improving access to safe foods, developing culturally relevant patient materials, and extending appointment times for those in need.
The ACAAI’s research identified existing challenges and suggested potential solutions to address racial disparities in the diagnosis and management of AD and food allergies in individuals with skin of color.
[Study] 2021: Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood: A Longitudinal Cohort Study
Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood: A Longitudinal Cohort Study
Chloe Kern, BA; Joy Wan, MD, MSCE; Kaja Z. LeWinn, ScD; Faustine D. Ramirez, MD; Yong Lee, MD; Charles E. McCulloch, PhD; Sinéad M. Langan, MSc, PhD; Katrina Abuabara, MD, MA, MSCE
JAMA Dermatol. September 1, 2021
- Severe atopic dermatitis was associated with childhood depression symptoms. There were correlations with internalizing symptoms for children.
- Mild or moderate atopic dermatitis did not have associations with childhood depression. Although, there was a 29% to 84% increased risk of internalizing behaviors beginning at age 4.
- These results are important to understand because childhood depression and internalizing behavior have been linked to adult depression, anxiety, other psychiatric disorders, and poor general health.
[Article] 2017: Racial and ethnic disparities abound in eczema care
Rachael Zimlich, RN, BSN; Contemporary Pediatrics, November 14, 2017.
➤ Black children are more likely to suffer from severe cases of eczema, but are less likely to see a doctor for treatment than white children, according to a new report.
[Commentary] 2017: Dermatological evaluation in patients with skin of color: the effect of erythema on outcome measures in atopic dermatitis
Dermatological evaluation in patients with skin of colour: the effect of erythema on outcome measures in atopic dermatitis
P.B. Chansky L. Mittal V.P. Werth, British Journal of Dermatology, April 2017. Vol. 176, Issue 4, pp 853-854
[Study] 2020: Structural racism and its influence on the severity of atopic dermatitis in African American children
Structural racism and its influence on the severity of atopic dermatitis in African American children
Kelly Jo Tackett, Frances Jenkins, Dean S Morrell, Diana B McShane, Craig N Burkhart
Pediatr Dermatol. 2020 Jan;37(1):142-146.
[Study] 2019: Atopic dermatitis in adolescents with skin of color
Atopic dermatitis in adolescents with skin of color
Poladian K, De Souza B, McMichael AJ. Cutis. 2019 Sep;104(3):164-168. PMID: 31675392.