Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Raj J. Chovatiya, associate professor at Rosalind Franklin University of Medicine and Science Chicago Medical School, about diagnosing and treating atopic dermatitis in patients with darker skin tones. Learn what he tells his trainees about diagnosing atopic dermatitis in skin of color. Find out how a greater understanding of the condition in darker skin tones can impact treatment choice. Watch as Dr. Chovatiya shares his patient approach. (Patients aren’t textbooks!) Plus hear Dr. Chovatiya’s guidance in understanding the latest research on atopic dermatitis treatments.
Further Reading
If you want to read more about atopic dermatitis in patients with skin of color, check out the following articles published in the Journal of Drugs in Dermatology:
ABSTRACT
Atopic Dermatitis (AD) is a chronic inflammatory skin disease that characteristically demonstrates upregulation of type 2 immune responses, impaired skin barrier function, and increased Staphylococcus aureus colonization.1,2 Intense and persistent pruritus is a defining feature of moderate-to-severe atopic dermatitis.3 AD has canonically been thought of as a disease that starts in childhood and rarely persists into adulthood.4 More recent work has shown that adult-onset AD is not an uncommon occurrence and that there is increasing evidence of lifelong, persistent disease that can extend beyond childhood.5,6 There appear to be important racial differences in AD prevalence, incidence, severity, and persistence in the United States (US).7 Indeed, African American (AA) and Latinx people in the US appear to experience higher rates of AD prevalence and disease burden.8 The pathophysiology of AD also appears to have differences racially; FLG mutations are 6 times less common in AA patients compared to European American patients with AD.7 Furthermore, while all ethnic groups of patients with AD have an immune phenotype characterized by strong TH2 activation, there appears to be significant difference in immune phenotype polarization, wherein Asian patients with AD have stronger TH17/TH22 activation and AA patients with AD have the highest serum IgE levels and largely lack TH1 and TH17 activation.7
Dupilumab Treatment Improves Lichenification in Atopic Dermatitis in Different Age and Racial Groups
ABSTRACT
Background: Lichenification, common in moderate to severe atopic dermatitis (AD) at any age, is often difficult to treat. This analysis assessed dupilumab vs placebo in AD lichenification by age and race-defined groups.
Methods: This post hoc analysis included pooled data from five clinical trials of dupilumab (NCT03054428, NCT03345914, NCT02277743, NCT02277769, NCT02395133), including 1,997 patients aged 6 to 88 years of all races with moderate to severe AD.
Results: Placebo/dupilumab randomized groups analyzed by age (n=1,535) included 123/244 children, 85/166 adolescents, and 460/457 adults; groups analyzed by self-reported racial background (n=1,902) included 132/234 Asian, 74/112 Black/African American, and 427/923 White patients. Dupilumab treatment resulted in nominally significant reductions vs placebo in Global Individual Signs Score lichenification from week 1 (adults/adolescents) or week 2 (children) through week 16. Lichenification measured by SCORing Atopic Dermatitis and Eczema Area and Severity Index improved similarly. By week 16, dupilumab significantly improved lichenification, with nominal significance vs placebo across all racial groups.
Conclusion: Dupilumab treatment resulted in rapid and sustained improvement in lichenification across anatomic regions in all ages. Lichenification improved to a similar extent across racial groups.
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