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INTRODUCTION

KEY POINTS

  • Atopic dermatitis (AD) is a common inflammatory skin disorder that may affect individuals of any age, sex or race.

  • Genetic, environmental, and cultural factors likely contribute to differences in the prevalence of AD in skin of color populations compared with lighter-skinned individuals of European descent.

  • Erythema, which is the clinical hallmark of inflammation in the skin, is more difficult to detect in darker-skinned individuals.

  • Postinflammatory hyper- and hypopigmentation are of particular concern in patients with skin of color.

  • Follicular prominence is a characteristic presentation of AD in patients of African descent and is rarely seen in Fitzpatrick skin types I to III.

  • As with other skin types, the mainstay of treatment of AD in patients with skin of color involves recommended bathing practices and the judicious use of emollients, topical corticosteroids, and calcineurin inhibitors.

Atopic dermatitis (AD) is a common inflammatory skin disease that may affect individuals of any age, sex or race.1,2 It arises most commonly in childhood or infancy and is characterized by a chronic, relapsing course. Although the etiology of AD is not completely understood, genetic and environmental factors are thought to play important roles in its pathogenesis. The diagnosis of AD is based on a constellation of clinical features, which includes a chronic pruritic eruption that usually involves the flexural skin and occurs in conjunction with numerous associated features, such as an early age of onset and a personal or family history of atopy (ie, asthma, hay fever, and/or AD). Variations in clinical presentation, frequency, cultural perception, and response to treatment can be seen among individuals of different racial groups.

EPIDEMIOLOGY

The epidemiologic data pertaining to AD in non-Caucasian populations are limited. To illustrate this point, less than 60% of AD studies published in the United States in the last decade reported patients’ races. Of these studies, the subject population included 62.1% white, 18.0% black, 6.9% Asian, and 2.0% Hispanic individuals.3

Several population studies have demonstrated considerable geographical and racial variations in the prevalence of AD.4,5,6 Based on incompletely understood environmental factors, AD appears to be more common in industrialized nations and urban settings than in developing countries and rural communities.7 Population surveys in northern Europe, the United States, and Japan have reported prevalence rates of 15.6%, 17.2%, and 21%, respectively, whereas a prevalence of 8.5% was reported in a recent study from southeastern Nigeria.8,9,10,11 However, with increased urbanization and the adoption of Western lifestyles, the prevalence of AD appears to be on the rise in developing countries, as it is in more industrialized nations.11

Several epidemiologic studies have shown AD to be more common in individuals with skin of color compared to Caucasians. A prospective, 12-month observational study of 182 babies born in Australia found that AD developed in 21%, 44%, ...

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