Dermatology: how to manage atopic dermatitis in patients with skin of colour

Managing Atopic Dermatitis in Patients With Skin of Color

Atopic dermatitis is a chronic inflammatory dermatological condition associated with intense pruritus seen in all age groups and ethnic diversities. It can have a significant impact on the quality of life. The options for treatment include skincare, topical therapies, systemic therapies, and phototherapy. Treatment of atopic dermatitis may be associated with several challenges including suboptimal efficacy, risk of adverse events, and limited patient satisfaction. A better understanding of the pathophysiology of atopic dermatitis has resulted in the evaluation of many treatment options. Phosphodiesterase 4 plays a role in the pathogenesis of atopic dermatitis and hence can be a target for treatment. Crisaborole 2% ointment is a phosphodiesterase 4 enzyme inhibitor approved for the treatment of mild-to-moderate atopic dermatitis in patients above 2 years of age by the USFDA. Currently, it is not approved for use in Indian patients. In this article, the role and potential place of crisaborole in the management of atopic dermatitis in Indian patients based on global experience and evidence is discussed.

T Cell Epitope-Specific Defects in the Immune Response to Cat Allergen in Patients with Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects diverse ethnic groups with varying prevalence. Despite a predominance of studies in individuals of European ancestry, AD has been found to occur more frequently in Asian and Black individuals than Whites. Therefore, an understanding of the unique clinical features of AD in diverse ethnic groups, as well as the differences in genetic polymorphisms that influence susceptibility to AD and response to current therapies, is paramount for management of an increasingly diverse patient population. In this article, we review key nuances in the epidemiology, pathophysiology, clinical presentation and treatment of AD in non-White ethnic groups, which are largely underappreciated in the literature. We highlight the need for studies evaluating the tissue molecular and cellular phenotypes of AD in non-White patients, as well as greater inclusion of minority groups in clinical trials, to develop targeted treatments for a multi-ethnic population.

What's new in atopic dermatitis?

EASI p-EASI: Utilizing a combination of serum biomarkers offers an objective measurement tool for disease severity in atopic dermatitis patients

IgE-Dependent Activation of T cells by Allergen in Atopic Dermatitis: Pathophysiologic Relevance

In humans, oxidative stress is involved in many diseases such as atherosclerosis, Parkinson's disease, heart failure, myocardial infarction, Alzheimer's disease, Fragile X syndrome and chronic fatigue syndrome. Atopic dermatitis (AD), also known as atopic eczema, is a non-contagious, relapsing inflammatory skin disease which is characterized by eczema and pruritus. The skin reacts abnormally to irritants, food and environmental allergens and it becomes very itchy, which leads to scratching, redness and flaky skin. Very little study has been done to find out the relationship between oxidative stress and Atopic dermatitis. The aim of our work was to evaluate the status of oxidative stress in patients of Atopic dermatitis in comparison with healthy control subjects. Twenty five patients of known Atopic dermatitis and 25 normal healthy controls of same age group were included in the study. Estimations of oxidants like Malondialdehyde (MDA), enzymatic antioxidants like Superoxide dismutase (SOD), Catalase, Glutathione peroxidase (GPX) and non-enzymatic antioxidants like reduced Glutathione (GSH), Vitamin A, Vitamin E and Vitamin C were done to assess the oxidative stress. Atopic dermatitis patients were more prone to damage caused by Reactive Oxygen Species (ROS) or Oxidants, than controls, which was evident from an increase of Malondialdehyde and a decrease of enzymatic and non enzymatic Antioxidants. Antioxidants may possibly be beneficial in the treatment of Atopic dermatitis, which must be substantiated by further studies.

Atopic dermatitis (AD) is a chronically recurrent inflammatory skin disorder characterized by pruritus, a specific distribution, and a family history. It has recently been reported that the incidence of AD has increased in Korea.1,2 Pruritus, sleep loss, dietary restrictions, and psychosocial factors significantly decrease the quality of life for AD patients.3,4 Recently, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma, and Immunology published the PRACTALL consensus report for the diagnosis and treatment of AD in children and adults.5 The report suggests a stepwise management that includes the addition of multiple therapeutic agents on the basis of the disease severity. The PRACTALL consensus report defines severe or recalcitrant AD as AD that cannot be controlled with topical treatment.6 In the 2009 Korean Work Group Report on the treatment of severe/recalcitrant AD, severe AD is defined as AD with a SCORAD index higher than 50 and that cannot be controlled with conventional treatment,7 while the 2008 Guideline of Atopic Dermatitis in Korean Children defines severe AD by a SCORAD index higher than 40.8 Specific criteria for the definition of recalcitrant and severe AD are necessary. For the management of severe AD, the PRACTALL consensus report recommends systemic therapy such as antimicrobial treatment, systemic corticosteroids, cyclosporin A, azathioprine, anti-histamines, phototherapy, and immunotherapy. Several reports, including the 2009 Korean Work Group Report, have described intravenous immunoglobulin (IVIg) treatment as one of various immunoregulatory treatments. Nevertheless, this treatment was not included in the PRACTALL report.7,9,10 IVIg treatment displays immunomodulatory and anti-inflammatory properties, and its effectiveness in several immune-mediated conditions such as Kawasaki disease and idiopathic thrombocytopenic purpura has been demonstrated.11 IVIg is considered a candidate for the treatment of AD because of its ability to downregulate T-cell function, particularly interleukin-4 production.12,13 A small number of observations on the efficiency of IVIg in AD have been reported, but prospective and randomized studies for its clinical efficiency in childhood AD are sparse. A randomized, placebo-controlled prospective study in childhood AD patients is therefore required.14 Jee et al.14 recently reported therapeutic effects of IVIg in childhood AD; however, this study involved moderate to severe AD patients, and it did not include severe AD patients because the disease severity might have affected the treatment results. Further randomized studies with strict criteria for recalcitrant/severe AD are warranted. In addition, the IVIg effective dose, the dosing interval for initiation and maintenance, the identification of biomarkers (e.g., ECP, ICAM-1, and IL-5/INF-gamma) to determine efficiency, and clear criteria for IVIg indications all require consideration. Currently, we lack evidence-based data supporting the use of IVIg and other immunomodulators in childhood AD. Before IVIg can be recommended, its cost-benefit ratio, course, duration, and adverse reactions compared with alternative therapeutic options must be determined. The effects of novel therapies such as IVIg for recalcitrant/severe AD patients should be verified through repeated research and numerous research discussions.

Addictions seem to be more frequent in atopic dermatitis and psoriasis patients than in the general population. This cross-sectional observational study comparatively evaluated substance-related and behavioural addictions in atopic dermatitis and psoriasis patients and analysed possible addiction patterns. From October 2023 to April 2024, 100 atopic dermatitis and 104 psoriasis patients at a German university hospital completed an anonymous questionnaire, including sociodemographic and health-related parameters, along with validated assessment tools for common addictions (smoking, gambling, alcohol, drugs, food, and internet). More psoriasis patients had at least 1 addiction (50.0% vs 39.0%), were more frequent daily smokers (34.6% vs 15.0%) and reported gambling more frequently than atopic dermatitis patients. No differences emerged regarding gambling addiction. Psoriasis patients showed higher body mass index, with 1.9% addicted to food. Atopic dermatitis patients were more vulnerable to pathological internet use (9.0% vs 2.9%). Low happiness was a risk factor for smoking in atopic dermatitis and for gambling and drug consumption in psoriasis patients. Low disease severity was associated with pathological alcohol intake in psoriasis. Younger age emerged as a ubiquitous risk factor for drug consumption. Distinct addiction patterns in atopic dermatitis and psoriasis patients, influenced by age, happiness, and disease severity, should guide the development of education and screening strategies.

35050 How to manage psoriasis in patients with skin of color

Psoriasis is a chronic inflammatory skin condition that affects diverse ethnic groups with a wide spectrum of skin colours. There are significant differences in how psoriasis presents and impacts the quality of life in non-White individuals. Genetic variations as well as cultural and socioeconomic factors all play a role in such differences and have important implications for the management of psoriasis in skin of colour. Despite these differences, the current psoriasis management is similar across different ethnic backgrounds and is mainly guided by factors such as disease severity, medical comorbidities and patient preferences. This is largely due to the lack of sufficient evidence for psoriasis treatment tailored for patients with skin of colour as most clinical trials are composed of mainly White individuals. Therefore, the focus of this article is to review the current evidence on how epidemiology, clinical presentation and genetic differences in patients with skin of colour with psoriasis may impact treatment strategies. Additionally, pharmacological therapies available to date in these diverse patient cohorts are summarized in this article. The limited data published on this topic reveal a significant need for more investigations with the ultimate goal of incorporating recommendations for patients with skin of colour into the current guidelines for psoriasis treatment. Moreover, awareness of differences in psoriasis presentation amongst individuals with skin of colour may support patients to seek medical care sooner, which could result in earlier diagnosis and lead to improved patient outcomes.

Research on the role of race and ethnicity in the pathophysiology of atopic dermatitis (AD) is limited. Variations in the epidemiology, clinical presentation, and disease course in skin of color SOC AD patients have been reported. This manuscript seeks to offer insights into distinct features of AD in populations with (SOC) and provide recommendations on the role of skincare in treating AD amongst diverse populations. A literature review followed by panel discussions and an online review process explored best clinical practices in treating AD patients with SOC and providing expert guidance for skincare use, including gentle cleansers and moisturizers. Some studies have identified differences in skin barrier properties in racial/ethnic groups affected by AD that may have implications for barrier function. Variations in the clinical presentation – including morphology, severity, and distribution – of AD in populations with SOC have been reported. Epidemiologic studies suggest a higher prevalence among self-identified Blacks/African Americans and greater health care utilization for AD among both Blacks/African Americans and Asian/Pacific Islanders. Pigmentary sequelae, including hyper- hypo- and depigmentation is a distinct feature of AD in patients with SOC that may contribute to the quality of life impact of the disorder. Xerosis may be more stigmatizing in SOC due to greater visibility of scale and dryness in the context of melanin-rich skin. Racial/ethnic variations in the prevalence of pruritus have also been reported, which may in turn have implications for AD in SOC. Treatment and maintenance of AD in patients with SOC should be proactive, effectively control inflammation longitudinally, include effective skin barrier protective strategies, and consider cultural practices. Robust comparative studies are needed to better understand racial/ethnic variations in AD. Further research will help to tailor patient education and foster individualized approaches to treatment, prevention, and adjunctive skin care across the diverse spectrum of patient populations. J Drugs Dermatol. 2022;21(5):462-470. doi:10.36849/JDD.6609.

Introduction: Patients with atopic dermatitis (AD) and skin of color can have heterogeneous presentations and treatment responses. In the pivotal phase 3 ADORING 1 and 2 trials, tapinarof cream 1% (VTAMA®, Dermavant Sciences, Inc.) once daily (QD) was significantly efficacious and well tolerated versus vehicle in adults and children down to 2 years of age with AD. Objective: Here, we report analyses of efficacy by skin color in ADORING 1 and 2, based on patients’ self-identified race and investigator-assessed Fitzpatrick skin type. Methods: In ADORING 1 and 2, patients with a Validated Investigator Global Assessment for Atopic DermatitisTM (vIGA-ADTM) score of ≥3, an Eczema Area and Severity Index score of ≥6, and body surface area involvement of 5–35% were randomized 2:1 to tapinarof cream or vehicle QD for 8 weeks. The primary efficacy endpoint was a vIGA-ADTM score of 0 (clear) or 1 (almost clear) and ≥2-grade improvement from baseline at Week 8. Secondary endpoints included proportion of patients with a ≥75% improvement in Eczema Area and Severity Index (EASI75). Results: Of the 407 and 406 randomized patients, 8.8–15.3% were Asian, 26.5–35.0% were Black, 44.8–56.8% were White, and 2.7–5.2% were Other groups (American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or multiple races) across trials. Patients with Fitzpatrick skin types IV, V, and VI represented 23.8–25.1%, 20.6–22.2%, and 7.6–8.9%, respectively, of patients (>50% in both trials). Across trials, vIGA-ADTM responses (ranges) for tapinarof versus vehicle were: Asian, 39.5–48.9% vs 3.7–18.5%; Black, 43.1–47.0% vs 17.5–24.1%; White, 49.4–52.1% vs 12.2–14.5%; and Other, 26.0–44.8% vs 0.0–40.2%. EASI75 responses for tapinarof versus vehicle were: Asian, 47.6–76.6% vs 17.7–20.2%; Black, 48.9–55.3% vs 25.7–30.0%; White, 61.4–67.8% vs 19.6–20.7%; and Other, 38.3–63.3% vs 0.0–40.6%. Similarly, high and consistent vIGA-ADTM and EASI75 responses were reported with tapinarof versus vehicle in patients with Fitzpatrick skin types I–III and IV–VI. Conclusion: Tapinarof cream 1% QD was consistently efficacious among all racial groups and Fitzpatrick skin types in adults and children down to 2 years of age with AD, including patients with skin of color, who were highly represented in these trials.

Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights