<p>Atopic dermatitis (AD) can present differently across racial and ethnic lines, with variations in lesion types and severity, and this may lead to delays in diagnosis or incorrect treatment. Understanding these differences, asking objective questions to involve patients in their own care, and addressing treatment disparities can help optimize care and ensure better outcomes for every patient with AD.</p>

It is important to recognize that AD can have different presentations, particularly in patients with skin of color. In Black patients, for instance, AD commonly presents with more papular or bumpy lesions, slightly more fibrosis and skin thickening, and slightly more involvement of the extensor areas, such as the knees and elbows. In addition, sometimes the disease is diagnosed later and at a greater severity level in Black patients. This is often because erythema can be difficult to visualize on skin of color.

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There can also be different disease manifestations. For example, some Asian patients have an AD phenotype that presents as a more psoriasis-like thickening of the skin. If you biopsy that skin, sometimes it shows psoriasis or parapsoriasis, which can lead to delays in diagnosis or incorrect treatment. This happened to many of my patients before they saw me.

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It is important to understand the different ways in which AD can present and to ask patients objective questions to appropriately assess them, such as questions about itch severity. You can ask your patients, “On a scale from 0 to 10, where 0 is nothing and 10 is the worst imaginable, what’s the worst itch you’ve had in the last 24 hours?” Their answer can help you risk stratify. If they say that it is above a 7, you really need to consider systemic therapy, even if there does not appear to be a lot of erythema on the patient’s skin. These types of questions about the different dimensions and presentations of AD are very important to consider when assessing patients.

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I think that racial and ethnic disparities in AD treatment can be best addressed by educating our peers, especially for clinicians whose training was not carried out in a diverse setting. I also think that asking objective questions about itch, disease severity, and other aspects of a patient’s AD symptoms may help. Fortunately, some clinical features of AD are shared across racial and ethnic lines, and there does not appear to be a disparity in treatment response among those with equal access to care.