Atopic dermatitis in pediatric patients with skin of color-perspectives

“If you will notice, I added the word “perspectives” to my session title, because perspectives on what I have seen in my practice is what I am sharing with you today,” began Candrice R. Heath, MD, FAAP, FAAD, assistant professor of Dermatology, director, Pediatric Dermatology, and faculty scholar, Office of Health Equity, Diversion, and Inclusion, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.

Heath first shared some basics with attendees: a definition of skin of color (African Americans, Asians, Hispanics or Latinx, Indigenous People, and Pacific Islanders) and noted that “The term ‘race’ is faulty. It may not equal biological/genetic inheritance, and there is not one gene or characteristic that separates every person of one race from another.”

And, she added, although skin of color does not always mean economically disadvantaged, patients with skin of color often are still marginalized in health care.

For treatment of atopic dermatitis in this population, Heath emphasized considering new perspectives and seeing the value in “challenging ourselves to understand the impact of what happens outside the exam room on our patients” with atopic dermatitis (AD).

Case in point: Heath noted a study of a 6-year-old Black girl brought into a dermatologist by her parents. The child had dark marks and pruritus, with postinflammatory hyperpigmentation as the presenting complaint. The diagnosis was AD; the family was sent on their way, “feeling that the doctor had no understanding of their concerns,” said Heath, which included worries that the child might have to deal with troubling dark spots for the rest of her life.”

Heath emphasizes here verbalization with the family: explain to them that you see the pigmentation change, explain that controlling AD can have a positive impact on quality of life, and the remaining pigmentation can be treated.

“There are several concerns in your exam room that may be invisible,” states Heath. “These can include that fear that dark spots will last forever; experience with a dermatologist who did not seem to understand their skin or hair type; a general mistrust of health care; scars, and more.”

Concerns like these are understandable, backed by data: hospitalizations for AD has been associated with being nonwhite and having Medicaid. Furthermore, nonHispanic Black children and Hispanic children had greater odds of persistent AD than White children, and AD prevalence and persistence were highest in children in the urban United States who are female or black. Some of the reasons for this disparity in AD can include social and economic risk factors (lower household income, lower parental education attainment, exposure to smoking and more).

So, going forward, how can pediatric dermatologists help? “Help us get closer to obtaining health equity,” suggests Heath. “Advocate for children and families of color, such as getting involved in safe, quality low-income or public housing issues in your community. Prioritize learning about all skin tones and hair types. Let’s commit to advocating for what our patients deserve.”

Reference

Heath, CR. Atopic dermatitis in pediatric patients with skin of color-perspectives. SPD 2022 47th Annual Meeting. July 8, 2022. Indianapolis, Indiana.