Best Practices in Managing Atopic Dermatitis in Skin of Color - Episode 1

Overview of Atopic Dermatitis in Patients of Skin of Color

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Drs. Neal Bhatia and Angela Lamb provide an overview of atopic dermatitis and its prevalence in patients with skin of color (SOC).

Neal Bhatia, MD: Hello and welcome to this Dermatology Times® DermView titled, “Best Practices in Managing Atopic Dermatitis in Skin of Color.” My name is Dr Neal Bhatia, I’m the director of clinical dermatology at Therapeutics Clinical Research in San Diego, California. Joining me today in this discussion are my colleagues, first is Dr Angela Lamb, associate professor at the department of dermatology at the Ichan School of Medicine at Mount Sinai Hospital. She’s medical director of the patient access center system, vice chair of clinical operations and strategy, all in the department of dermatology in New York. Also from New York is Dr Omar Noor. He is the co-owner and medical director of Rao Dermatology in New York and New Jersey. Dr Noor, Dr Lamb, good to see both of you.

Omar Noor, MD, FAAD: Good to see you too, thanks for having us.

Angela Lamb, MD: Thank you for having me.

Neal Bhatia, MD: Our discussion today is going to focus on the understanding of atopic dermatitis in general. We’re going to focus mainly on the condition in patients with skin of color. We’ll also discuss the available pharmacologic options for management of this disorder, and focus on some questions for which I think all of us would benefit from all of our expertise. With that, Dr Lamb, I’m going to give you the broad question, give us all an overview of atopic dermatitis, where it stands today. Talk about what you see in your experience so far in different ethnic groups and different geographic centers, obviously in New York you’re exposed to a lot of different populations. Give us an overview of where you see atopic dermatitis today.

Angela Lamb, MD: Sure. We all know some of the hardcore statistics; atopic dermatitis is certainly on the rise. We’re not sure if that’s because it’s increasing, which we think it is, or that it’s being diagnosed more often. This is something I think will carry on into our conversation, because often, atopic dermatitis is misdiagnosed in patients who have darker skin. Just on a scientific level, we are finding that there are differences with atopic dermatitis in white, brown and black skin. We see that filaggrin deficit that we always talked about and learned about in residency is actually not as common in patients who have black skin.

African American patients do not exhibit the filaggrin mutations, and have distinct attenuations of Th17 [T helper 17 cells] and Th1 [T helper cell type 1] axes activation. In Asian patients, we definitely see that they have a stronger Th17 and Th22 activation than African American patients and European patients with atopic dermatitis.

With this in mind, we’re hoping that as we get more precision medicine, we’ll be able to target these things. When we’re looking at patients with different phenotypes we can say, I want to pick this medication or that medication, the JAK [Janus kinase] inhibitors, dupilumab, or the topicals, based on what we know about their skin type.

Neal Bhatia, MD: That’s excellent. As we get into it, we’ll get into grading, especially in trials, but also how that could translate to the average dermatologist talking about upcoding erythema, which might be more violaceous and still more active in darker skin, as well as some of the variations on distributions on surface area. Let’s keep that in mind as we go forward. I liked the way you bridged the clinical into it, because that is going to drive therapeutic options, as well as understanding food, bathing, water, and all the other components that go along with someof the other nuts and bolts.

Transcript Edited for Clarity