Atopic dermatitis (AD), sometimes referred to as eczema, is the most common chronic skin condition in children. Children of color have a higher reported prevalence of AD compared with their White counterparts. The purpose of this article is to discuss the differences of AD in skin of color (SOC), including clinical findings and management, with an emphasis on early recognition to avoid more severe, persistent disease. School nurses are on the frontline for these students with their ability to guide families and help support students with AD in the school setting.
AlexisA.Woolery-LloydH.AndriessenA.CallenderV.GonzalezM.HeathC.HanG. (2022). Insights in skin of color patients with atopic dermatitis and the role of skincare in improving outcomes. Journal of Drugs in Dermatology, 21(5), 462-470. https://doi:10.36849/JDD.6609
Ben-GashirM. A.HayR. J. (2002). Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. The British Journal of Dermatology, 147(5), 920-925. https://doi:10.1046/j.1365-2133.2002.04965
4.
BoguniewiczM.FonacierL.Guttman-YasskyE.OngP. Y.SilverbergJ.FarrarJ. R. (2018). Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 120(1), 10-22.e2. https://doi.org/10.1016/j.anai.2017.10.039
5.
BrarK. K.NicolN. H.BoguniewiczM. (2019). Strategies for successful management of severe atopic dermatitis. The Journal of Allergy and Clinical Immunology: In Practice, 7(1), 1-16. https://doi.org/10.1016/j.jaip.2018.10.021
6.
BrunnerP. M.Guttman-YasskyE. (2019). Racial differences in atopic dermatitis. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 122(5), 449-455. https://doi.org/10.1016/j.anai.2018.11.015
7.
ChanI. L.CohenS.da CunhaM. G.MalufL. C. (2019). Characteristics and management of Asian skin. International Journal of Dermatology, 58(2), 131-143. https://doi:10.1111/ijd.14153
8.
CroceE. A.LevyM. L.AdamsonA. S.MatsuiE. C. (2021). Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations. The Journal of Allergy and Clinical Immunology, 148(5), 1104-1111. https://doi:10.1016/j.jaci.2021.09.015
9.
DavisE. C.CallenderV. D. (2010). Postinflammatory hyperpigmentation: A review of the epidemiology, clinical features, and treatment options in skin of color. The Journal of Clinical and Aesthetic Dermatology, 3(7), 20-31.
10.
EichenfieldL. F.TomW. L.ChamlinS. L.FeldmanS. R.HanifinJ. M.SimpsonE. L.BergerT. G.BergmanJ. N.CohenD. E.CooperK. D.CordoroK. M.DavisD. M.KrolA.MargolisD. J.PallerA. S.SchwarzenbergerK.SilvermanR. A.WilliamsH. C.ElmetsC. A.. . .SidburyR. (2014). Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology, 70(2), 338-351. https://doi.org/10.1016/j.jaad.2013.10.010
FischerA. H.ShinD. B.MargolisD. J.TakeshitaJ. (2017). Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. Journal of the American Academy of Dermatology, 77(6), 1060-1067. https://doi:10.1016/j.jaad.2017.08.035
13.
GraysonC.HeathC. R. (2020). Dupilumab improves atopic dermatitis and post-inflammatory hyperpigmentation in patient with skin of color. Journal of Drugs in Dermatology, 19(7), 776-778. https://doi.org/10.36849/JDD.2020.4937
14.
Guttman-YasskyE.BissonnetteR.UngarB.Suárez-FariñasM.ArdeleanuM.EsakiH.SuprunM.EstradaY.XuH.PengX.SilverbergJ. I.MenterA.KruegerJ. G.ZhangR.ChaudhryU.SwansonB.GrahamN.PirozziG.YancopoulosG. D. D.HamiltonJ. D. (2019). Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. The Journal of Allergy and Clinical Immunology, 143(1), 155-172. https://doi.org/10.1016/j.jaci.2018.08.022
15.
HajarT.LeshemY. A.HanifinJ. M.NedorostS. T.LioP. A.PallerA. S.BlockJ.SimpsonE. L., & The National Eczema Association Task Force. (2015). A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. Journal of the American Academy of Dermatology, 72(3), 541-549.e2. https://doi.org/10.1016/j.jaad.2014.11.024
16.
HanifinJ. M.ReedM. L., & Eczema Prevalence Impact Working Group. (2007). A population-based survey of eczema prevalence in the United States. Dermatitis: Contact, Atopic, Occupational, Drug, 18(2), 82-91. https://doi:10.2310/6620.2007.0603
17.
KaufmanB. P.Guttman-YasskyE.AlexisA. F. (2018). Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Experimental Dermatology, 27(4), 340-357. https://doi:10.1111/exd.13514
18.
KimY.BlombergM.Rifas-ShimanS. L.CamargoC. A.Jr.GoldD. R.ThyssenJ. P.LitonjuaA. A.OkenE.AsgariM. M. (2019). Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. The Journal of Investigative Dermatology, 139(4), 827-834. https://doi:10.1016/j.jid.2018.10.029
19.
ManjunathJ.SilverbergJ. I. (2022). Atopic dermatitis is associated with multiple behavioral problems in US children and adolescents. Dermatitis: Contact, Atopic, Occupational, Drug, 33, S52-S60. https://doi.org/10.1111/jdv.17840
20.
McKenzieC.SilverbergJ. I. (2019). Associations of unsafe, unsupportive, and underdeveloped neighborhoods with atopic dermatitis in US children. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 122(2), 198-203.e3. https://doi:10.1016/j.anai.2018.10.022
21.
MitchellK. N.TayY. K.HeathC. R.SilverbergN. B. (2021). Review article: Emerging issues in pediatric skin of color, Part 2. Pediatric Dermatology, 38(Suppl. 2), 30-36. https://doi:10.1111/pde.14774
22.
NelsonA. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666-668.
23.
PappK.SzepietowskiJ. C.KircikL.TothD.EichenfieldL. F.LeungD.FormanS. B.VenturanzaM. E.SunK.KuligowskiM. E.SimpsonE. L. (2021). Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: Results from 2 phase 3, randomized, double-blind studies. Journal of the American Academy of Dermatology, 85(4), 863-872. https://doi.org/10.1016/j.jaad.2021.04.085
24.
PuarN.ChovatiyaR.PallerA. S. (2021). New treatments in atopic dermatitis. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 126(1), 21-31. https://doi.org/10.1016/j.anai.2020.08.016
25.
ShawT. E.CurrieG. P.KoudelkaC. W.SimpsonE. L. (2011). Eczema prevalence in the United States: Data from the 2003 National Survey of Children’s Health. The Journal of Investigative Dermatology, 131(1), 67-73. https://doi:10.1038/jid.2010.251
26.
SilverbergJ. I. (2015). Health care utilization, patient costs, and access to care in US adults with eczema: A population-based study. JAMA Dermatology, 151(7), 743-752. https://doi:10.1001/jamadermatol.2014.5432
27.
SilverbergJ. I.BarbarotS.GadkariA.SimpsonE. L.WeidingerS.Mina-OsorioP.RossiA. B.BrignoliL.SabaG.GuilleminI.FentonM. C.AuziereS.EckertL. (2021). Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 126(4), 417-428.e2. https://doi:10.1016/j.anai.2020.12.020
28.
TackettK. J.JenkinsF.MorrellD. S.McShaneD. B.BurkhartC. N. (2020). Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatric Dermatology, 37(1), 142-146. https://doi:10.1111/pde.14058
29.
TaylorS. C.AlexisA. F.ArmstrongA. W.Chiesa FuxenchZ. C.LimH. W. (2022). Misconceptions of photoprotection in skin of color. Journal of the American Academy of Dermatology, 86(3S), S9-S17. https://doi.org/10.1016/j.jaad.2021.12.020
30.
VachiramonV.TeyH. L.ThompsonA. E.YosipovitchG. (2012). Atopic dermatitis in African American children: Addressing unmet needs of a common disease. Pediatric Dermatology, 29(4), 395-402. https://doi.org/10.1111/j.1525-1470.2012.01740.x
31.
WaldmanA. R.AhluwaliaJ.UdkoffJ.BorokJ. F.EichenfieldL. F. (2018). Atopic dermatitis. Pediatrics in Review, 39(4), 180-193.