Are There Health Disparities in Atopic Dermatitis?
Atopic dermatitis (AD) is the most common kind of eczema, with more than 18 million adults in America living with the condition.1 It’s very common in childhood and usually appears within the first 6 months of infancy. For some people, the AD eventually disappears and resolves, but for others, it can be a life-long condition, and sometimes severe. While the exact cause of AD is not known, it’s thought to be a combination of genetics and other factors, resulting in activation of the immune response, which then causes inflammation that causes the itchy rash. AD often co-exists with two other allergic conditions: asthma and hay fever.1
What does atopic dermatitis look like?
AD typically presents as a red, itchy rash on the arms, cheeks, and legs. In patients of color, the AD can look darker brown, purple, or grey in color.2 Different forms of AD may also present in people of color, including the development of small bumps on the arms and legs, as well as bumps around hair follicles.2
How is atopic dermatitis treated?
Treatment for AD depends on how severe it is, and the same treatments are recommended in people of all races or ethnicities.1,2 Individuals can learn how to control their AD, which includes avoiding triggers that may cause a flare-up, including dry skin, chemical irritants, stress, seasonal allergies or dust, and temperature changes.1 Regular bathing and skincare routine, as well as adhering to the prescribed treatment regimen, can help control AD as well.
Treatment regimens can include:1
- Topical medications put on the skin
- Phototherapy (light treatment)
- Immunosuppressant drugs that minimize the response of the immune system
- Biologic drugs that target certain parts of the immune system
- Systemic steroids are used for extreme cases of AD, but are not generally recommended
AD diagnosed in patients of color
African-American, Asian, and multi-racial children have a higher prevalence of eczema than non-Hispanic white children.3 Approximately 11 percent of children (although some studies put the prevalence at nearly 20 percent) in the US experience eczema, with 17.1 percent of Black children living with it, 11.2 percent of white children, and 13.7 percent of Hispanic children.4,5
Quality of life for patients of color
Despite the fact that AD is more likely to be seen in children of color, there is a lack of representation of racial and ethnic minorities in medical research, including dermatological research.3 Almost half (47 percent) of dermatologists and dermatology residents also reported that their medical training did not prepare them enough for skin conditions in people of color.3 There are also a lack of studies regarding the efficacy of treatments for AD in patients of color, particularly with systemic treatments for AD.6
Children with atopic dermatitis
Children of color with AD may experience disruptions in school attendance due to their AD. Non-Hispanic black children were more likely to report 6 or more missed days of school in the previous 6 months because of their AD, which is akin to the US Department of Education’s definition of chronic school absenteeism.5 This can have a significant impact on their education and learning, affect how they are perceived by the teacher and other school staff, and affect their social relationships.
Doctor visits and patients of color
Non-white children are less likely – up to 30 percent less likely – to see a doctor for their eczema, regardless of their insurance status or household income.4,7 However, among those non-Hispanic African-American children who did see a doctor for eczema, they report more visits and more prescriptions for eczema and are more likely to see a dermatologist for eczema than non-Hispanic white children.7 This may be because eczema in this population is more severe, but because children of color are less likely to see a doctor for the skin condition, there are significant disparities in overall treatment for eczema and AD.3,7
Currently, the treatment for AD is the same across race and ethnicity. However, children of color who saw a doctor for their eczema were more likely to get prescription treatment, as well as more likely to see a dermatologist for the AD.7 This may be related to disease severity, but more research is needed. Children of color with eczema were also found to be, on average, a year to a year and a half younger than white children when seeing a doctor, and more likely to have concurrent asthma.4
Attitudes about AD among patients of color
A study among Black and white parents of pediatric dermatology patients found that Black parents had significantly less trust in the medical research community and less likely to enroll their child in a research study – however, if the study was low-risk, they were just as likely to enroll their child in the study as white parents.3 This might be circuitous: if patients don’t see themselves represented, they are less likely to trust the medical establishment, and therefore less likely to participate in research, furthering the lack of representation.
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