Atopic dermatitis disproportionately affects patients with skin of color.1 Beyond prevalence disparities, mounting evidence reveals that Black and Asian populations experience greater disease severity and persistence compared to other demographic groups.1,2 These disparities reflect complex interactions among genetic factors, environmental exposures, healthcare access barriers, and importantly, diagnostic and treatment gaps that perpetuate inequitable outcomes.1-3
The clinical presentation of atopic dermatitis varies significantly based on skin color, with increased tendency toward papulo-like lesions and lichenification in Black and African American patients compared to other populations.4 Traditional severity assessment tools that rely heavily on erythema detection systematically underestimate disease severity in richly pigmented skin.1 Reliance on classical erythema presentation in diagnosing atopic dermatitis may lead to underdiagnosis and undertreatment of severe disease patients with skin of color, as erythema manifests more subtly in richly pigmented skin types.1 Recently, many resources now define erythema to include red, brown, violaceous, or gray appearances, acknowledging that inflammation manifests differently across skin tones.5 However, implementation of these updated definitions remains inconsistent in clinical practice.1,5
Limitations on resources depicting AD on skin of color further contribute to provider uncertainty when diagnosing dermatologic conditions in certain populations.6 These diagnostic challenges further compound systemic barriers affect treatment access.1,3
Recent guideline revisions position IL-13 targeted therapies as foundational elements in comprehensive atopic dermatitis management in patients with skin of color, supporting earlier systemic intervention for optimal outcomes.1,4 Advancing health equity requires robust provider education on phenotypic variations and systemic treatment approaches that address barriers to equitable care.
