Two people sit next to eachother at a table, arms touching, one has dark skin while the other has light skin, and they both show eczema in different manifestations with magnifying glasses inspecting the differences in each.

Atopic Dermatitis: Differences Amongst Racial and Ethnic Groups

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. It can affect different racial and ethnic groups in different ways and cause varying presentations. It typically occurs in infancy and early childhood but can persist through adulthood. Genetic and environmental factors often work in conjunction with each other to influence an individual’s risk for AD but those with a family history of the condition are more likely to develop it as well.

What does eczema look like on dark or Black skin?

Most people think of atopic dermatitis or eczema and picture a red, itchy rash. This may be true in those with fair, pale skin, but is not necessarily true of those with darker skin tones. In people with darker brown or Black skin, the redness isn’t always visible, and it may be a darker brown, purple, or gray.1

After treatment, darker-skinned patients may have more changes in their skin pigment than lighter-skinned patients – the healed skin might look darker or lighter for a while until the eczema or atopic dermatitis is controlled. This can take several months and may be distressing or bothersome to some patients.

Is the itch and severity different for patients of color?

Itching of atopic dermatitis and eczema has been shown to be greater in African-American patients than white patients, and more severe disease is often seen in African-Americans than in whites.1 Different forms of atopic dermatitis may be seen in patients of color, as well: patients may have small bumps on the arms and legs, known as popular eczema; or they may develop bumps around hair follicles, called follicular accentuation.1

Among which racial and ethnic groups is AD most common?

Overall, higher rates of AD were seen in Africa and Oceania when compared to India and Northern and Eastern Europe.2 In the US, AD is more commonly diagnosed in African-American children than white children.2 Other studies of AD among children in the US show that African-American children are disproportionately diagnosed with AD (19.4%), compared to white children (16.1%) and Hispanic children (7.8%).3

Do genetic factors play a role?

AD is thought to have a genetic component, and genome-wide association studies (GWASs) are being done, focusing also on African-American, Hispanic, and Asian populations since these are often understudied in this condition.2 Variations have been seen among ethnic groups, which can help with the treatment of atopic dermatitis. Right now, FLG loss-of-function mutations are the best-studied genetic risk factors for atopic dermatitis.2 When this mutation occurs, the skin barrier protein filaggrin is affected, which helps to regulate skin pH and epidermal hydtation.2 These mutations are also associated with more severe and persistent atopic dermatitis.2

Filaggrin mutations across ethnic groups

Oddly enough, these are seen more commonly in white patients than in African-American or Asian patients, even though atopic dermatitis is more common in African-American patients.2 Instead, further studies found that African-American patients might have loss-of-function mutations of FLG2, which encodes a protein that resembles filaggrin.2 Other studies have found that some FLG loss-of-function variants are only found in children of very specific ancestry, some of which were not seen in white patients – but these variants tended to yield more persistent AD.4

Is treatment different among different groups?

The treatment for AD is similar among all races and ethnicities.1 Lots of moisturizing of the skin and gentle skincare are cornerstones of treatment. It should be noted, however, that differences in treatment among varying ethnic and racial groups are vastly understudied. The clinical, epidemiologic, and molecular differences among ethnic groups may have significant therapeutic implications, and this needs to be further explored.2

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