If you’re living with atopic dermatitis (AD) and have darker skin, you already know it doesn’t always look or behave the way medical textbooks suggest. “It presents with distinct coloration, morphologic features, and distribution patterns that differ substantially from those in lighter-skinned individuals,” says Lucie Joerg, a research fellow with the Skin of Color Center at the State University of New York Downstate Health Sciences University in Brooklyn. For example, she says, redness is less common or noticeable in darker skin tones than in lighter skin and might appear purple, gray, or dark brown. People with darker skin tones are also more likely to have bumps and lesions, plus post-inflammatory hyperpigmentation or hypopigmentation can last long after a flare improves.
Part of the reason these differences aren’t always recognized is that people of color have long been underrepresented in clinical trials for AD. “Historically, white participants have made up the largest share of AD trial populations, and Black/African Americans are the most underrepresented racial group in dermatology trials overall. Hispanic/Latino and American Indian/Alaska native populations are also substantially underrepresented,” says Jared Jagdeo, MD, director of the Skin of Color Center at SUNY Downstate Health Sciences University. Asian people have also been underrepresented in many AD studies, despite evidence that the condition may present differently in these populations, including more sharply defined, scaly lesions and features that can overlap with psoriasis.
That gap comes with real consequences. It limits what researchers and clinicians understand about how the condition shows up across skin tones and how well treatments work for different populations. Even commonly used severity scoring tools can miss or underestimate inflammation in darker skin, because they’re based heavily on visible redness, says Dr. Jagdeo.
Differences in recognition, assessment, and research participation can contribute to delays in diagnosis, unequal access to specialists, and variations in treatment. Clinical trials are one way to help close these gaps, by ensuring new therapies are studied in people who reflect the full diversity of people living with the condition.
Read the full article here
