The clinical presentation of atopic dermatitis (AD) in skin of color varies widely, which may create a challenge for clinicians.
"We see very heterogenous and broad clinical presentations across the diverse patient populations that we see," Andrew F. Alexis, MD, MPH, said during the 3rd Annual Revolutionizing Atopic Dermatitis (RAD) Virtual Conference. "Some of these differences might be related to population variations in skin barrier function, immunologic factors, genetic factors, and environmental factors, which all interplay to produce variations in the clinical presentation and overall impact of AD. Many nongenetic factors also contribute to differences that we see, including some socioeconomic and other factors that feed into health disparities."
Alexis, professor of clinical dermatology at Weill Cornell Medicine, New York City, discussed four main clinical features of AD in skin of color, as follows.
Erythema Is Less Visible Because It Is Masked by Pigment
"There can be some masking of the redness and alteration of that color such that it doesn't look bright red as it would in the background of lightly pigmented skin," Alexis said. "Instead, the [AD lesions] have shades of grayish-red or grayish-brown or reddish-brown. It's important to recognize this clinical presentation and look carefully and assess the patient — not just visually but with palpation and take into consideration symptomatology so that you don't fall into the trap of calling an AD lesion postinflammatory hyperpigmentation," he noted.
