Atopic dermatitis is a chronic skin disorder that leads to itchy, dry skin, and can look different in different skin tones. Diverse representation in atopic dermatitis clinical research continues to be limited.
Atopic dermatitis, also known as eczema, is a chronic, inflammatory skin disorder that causes dry, itchy, scaly lesions on the skin. Skin discoloration is also a common feature, which can look different based on skin color.
Many skin conditions, including atopic dermatitis, look and behave differently in different skin tones.
These types of conditions are most often studied in people with fair or white skin, which can lead to difficulties when it comes to diagnosis and treatment in people with skin of color.
This article takes a closer look at the disparities that exist in atopic dermatitis research and care, including why the representation of diverse skin tones is so important in eczema clinical trials.
In the United States, people with skin of color are more likely to develop atopic dermatitis than those with white skin. This is especially true of multiracial adults, but research also notes that the prevalence of atopic dermatitis in Black children is roughly 1.7 times higher than in white children.
Despite their increased likelihood of developing atopic dermatitis, African American and Black individuals, as well as others with skin of color are underrepresented in eczema clinical trials.
Dermatologists have recognized the need for more representation in clinical trials. But according to a
Though there are opportunities for improvement, racial diversity is more common in atopic dermatitis studies than in research on other skin conditions. From 2010 to 2015,
There are many reasons why representation matters in clinical trials, especially for skin conditions.
These types of studies are done to help healthcare professionals and researchers learn more about how to properly care for people with these types of skin conditions.
Results from clinical trials can help support earlier detection and better treatment options. Research can also help improve the experiences people have while living with atopic dermatitis.
Diversity in clinical trials is important because not all conditions present the same way in different racial and ethnic groups. Skin conditions may look or feel different, or even have different factors causing them. This can all affect diagnosis, treatment, and outcomes.
Recognizing atopic dermatitis
The physical appearance of atopic dermatitis is a key factor during diagnosis and recognition. Clinicians study the appearance of different skin conditions to help identify each type. People who suspect they may have eczema may also search online for pictures or descriptions of what to look for.
In many cases, available images and descriptions people use to recognize eczema are based on white skin. But eczema may look different in different skin tones. For instance, what presents as redness on white skin may appear as dark brown, purple, or gray in color on darker skin.
Underrepresentation of people with darker skin in studies of atopic dermatitis, and not having access to clinical images including diverse skin tones, may make it harder for healthcare professionals to recognize the condition in skin of color. This can lead to diagnostic-related delays, which can make eczema harder to treat.
Atopic dermatitis treatment
Many new treatments for atopic dermatitis target the underlying biology of the disease — the specific molecules that lead to inflammation in the skin.
Certain types of genetic mutations that cause skin barrier irregularities, such as FLG gene mutations, are also more or less common in different racial and ethnic populations.
If new treatments for atopic dermatitis are not studied in diverse populations, there’s a chance they may not perform as expected in certain groups based on the molecules they target.
Studies comparing the efficacy of eczema treatment in different racial and ethnic groups are lacking, but analyses done after clinical trials are completed may provide some insight.
However, when the effects on non-white individuals were examined based on specific racial and ethnic groups (Asian/Native Hawaiian/Pacific Islander, Black/African American, other/American Indian/Alaskan Native, Hispanic/Latino, and not Hispanic/Latino), the symptom improvement with crisaborole appeared less significant.
This effect may be due to the small populations of non-white participants included in the trials, which can make it hard to detect statical differences.
Atopic dermatitis outcomes
Difficulty recognizing atopic dermatitis and variability in the effectiveness of treatment in skin of color can collectively affect outcomes in atopic dermatitis care.
Other noted factors include social environment, access to care, and more.
The same study also found that Black children who did receive care for their symptoms were more likely to have more visits and more prescriptions than white children, suggesting they had more severe disease.
Other research has also found that people with skin of color may be more likely to experience treatment-resistant atopic dermatitis than people with white skin.
This may be reflective of the delays people with skin of color experience in receiving a diagnosis and care, which may make eczema harder to treat. It could also suggest that current treatment options for atopic dermatitis may be less effective in non-white racial and ethnic groups.
Many groups are working to reduce disparities in atopic dermatitis research.
The American College of Allergy, Asthma, and Immunology, along with the Allergy and Asthma Network, have created a website dedicated to helping healthcare professionals (and others) recognize the symptoms of eczema in skin of color. The website also discusses the unique genetic and environmental factors that lead to the condition in different groups of people.
The National Institutes of Health (NIH) has developed a
The Food and Drug Administration (FDA) has released
Representation of diverse racial and ethnic groups in atopic dermatitis clinical research continues to be limited. This can affect many aspects of atopic dermatitis care, from recognition and diagnosis to treatment and outcomes.
Increasing the diversity of clinical trial participants in atopic dermatitis research can lead to an improved understanding of how to treat this condition in different populations. Many professional organizations and government agencies are working to reach this goal.
If someone is interested in participating in atopic dermatitis research, they can find more information through the National Eczema Association or by talking with their healthcare team.