Other studies indicate differences in the genetic risk factors for atopic dermatitis. “Whereas atopic dermatitis patients of European ancestry frequently have filaggrin null gene mutations, the prevalence of this specific gene mutation in African Americans and other groups of African ancestry with dark skin is lower,” says Dr. Alexis, who spoke on atopic dermatitis at the Skin of Color Seminar Series (SOCSS) in New York City in May. “This finding suggests that there may be other genetic factors that are more predisposing in individuals of African ancestry.”
The trend in the typical cytokine profile seen in atopic dermatitis among East Asian patients vs. Caucasians is also different. “East Asians have a higher tendency to have a predominant Th17 and Th22 cytokine profile and a more psoriasiform presentation of atopic dermatitis,” says Dr. Alexis, referencing a 2015 article in the Journal of Allergy and Clinical Immunology.
The erythema associated with atopic dermatitis can be masked by background pigment, “so instead of increased redness, it may look like darkness or hyperchromia or hyperpigmentation instead of classic erythema,” Dr. Alexis says. “Thus, using clues like papulation, lichenification, scaling and excoriation is more reliable in assessing the severity of atopic dermatitis in darker skin.”