Atopic dermatitis severity and treatment patterns do not differ among diverse racial and ethnic groups in the United States, according to a recent study.
Atopic dermatitis (AD) has heterogeneous manifestations across regional and racial groups. Previous studies in the United States found racial and ethnic differences in AD disease patterns, including risk factors for severity, treatment patterns, and access to care. However, it is unclear whether these differences are attributable to racial disparities.
A study in the Archives of Dermatological Research assessed the racial and ethnic differences in disease severity and treatment patterns in a diverse outpatient population of AD patients in the United States.
A total of 833 patients were included in this retrospective observational study; 48.9% were White, 36.9% were Black, 11.6% were Asian, 2.6% were Multiracial/Other, and 6.5% were Hispanic. Of the population, 68.4% of patients were female. The age distribution between 0 and 17 years comprised 6.1%, 18–49 years comprised 55.7%, and ≥ 50 years comprised 38.3%.
Atopic Dermatitis Severity Differences
Overall, 55.8% of patients had 0–10%, 32.3% had 11–50%, and 11.9% had 51–100% highest-reported body surface area (BSA) of involvement; 34.5% of patients had mild, 38.7% had moderate, and 26.8% had severe highest-reported physician’s global assessment (PGA) AD severity scores. There were no statistically significant associations between body surface area (BSA) (Fisher’s exact test, P= 0.19 and P= 0.44) or PGA (P= 0.63 and P= 0.57) and race or ethnicity. Moreover, there were no significant interactions of race or ethnicity with gender or age as predictors of BSA or PGA.
Ethnic Differences in Topical Treatments
Overall, 70% of Black, 67.4% of Asian, 66.6% of White, and 45% of Multiracial/Other patients used only topical therapy for AD. Asian and Multiracial/Other patients were more likely to use topical calcineurin inhibitors (TCI) than White or Black patients (chi-square, P= 0.01). No interactions of race and ethnicity with gender or age were found as predictors of using topical corticosteroids or TCI.
Differences in Advanced Treatments
There was a difference in dupilumab use by race, with 35% of Multiracial/Other patients using it compared to 20.1% of White, 15.7% of Asian, and 13.6% of Black patients (chi square, P= 0.03). There was no difference in dupilumab use by ethnicity. Use of oral corticosteroids, immunosuppressants, GABAergics, or NB-UVB did not differ by race. There were no interactions of race and ethnicity with gender or age as predictors of dupilumab prescription or oral corticosteroid, immunosuppressant, GABAergic, or NB-UVB use.
In conclusion, AD’s overall severity and treatment patterns did not significantly differ among racial and ethnic groups in this diverse cohort.
Sanfilippo, E., Chatrath, S., Patel, N., & Silverberg, J. I. (2023). Assessment of racial and ethnic differences of atopic dermatitis severity and treatment patterns in a diverse outpatient cohort in the United States: a retrospective observational study. Archives of Dermatological Research. https://doi.org/10.1007/s00403-023-02696-1