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Atopic Dermatitis Across Shades of Skin

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Abstract

Atopic dermatitis (AD) is a chronic, heterogeneous inflammatory skin disease that is associated with immense patient burden globally. There is increasing appreciation of disparities among patients identified as having skin of color (SOC), which often refers to patients of non-White race or non-European ancestry, but can broadly include individuals from a number of different racial, ethnic, ancestral, and skin pigmentation groups based on definition. In this narrative review, we discuss key terminology as it relates to AD across shades of skin, including modern definitions of ‘race’, ‘ethnicity’, and ‘SOC’. We then synthesize the current literature describing disparities in AD prevalence, disease recognition, and burden alongside current data regarding genetic and immunologic findings across SOC populations. In the context of these findings, we highlight key concomitant social determinants of health, including environmental factors, socioeconomic status, and access to care, for which race often serves as a proxy for true biological and genetic differences. Finally, we discuss future efforts to shift to a more inclusive understanding of AD to encompass all shades of skin, to ensure equitable representation of diverse populations in high impact research, and intensify efforts to address the critical upstream factors driving observed disparities.

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Author notes

  1. Victor L. Quan, Taylor Erickson, and Karishma Daftary have contributed to this work equally.

Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA

    Victor L. Quan, Taylor Erickson, Karishma Daftary & Raj Chovatiya

Authors
  1. Victor L. Quan
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  2. Taylor Erickson
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  3. Karishma Daftary
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  4. Raj Chovatiya
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Correspondence to Raj Chovatiya.

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Funding

RC received funding from NIH Grant Number K12 HS026385.

Conflict of interest

RC has served as an advisory board member, consultant, speaker, and/or investigator for AbbVie, Apogee, Arcutis, Argenx, ASLAN, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, Galderma, Genentech, Incyte, LEO Pharma, L’Oréal, Novan, Inc., Pfizer Inc., Regeneron, Sanofi, and UCB. VQ, TE, and KD have no conflicts to disclose.

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Author contributions

R Chovatiya had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: R Chovatiya. Acquisition of data: VL Quan, T Erickson, K Daftary, R Chovatiya. Analysis and interpretation of data: VL Quan, T Erickson, K Daftary, R Chovatiya. Drafting of the manuscript: VL Quan, T Erickson, K Daftary, R Chovatiya. Critical revision of the manuscript for important intellectual content: VL Quan, T Erickson, K Daftary, R Chovatiya. All authors read and approved the final manuscript.

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Quan, V.L., Erickson, T., Daftary, K. et al. Atopic Dermatitis Across Shades of Skin. Am J Clin Dermatol 24, 731–751 (2023). https://doi.org/10.1007/s40257-023-00797-1

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