The Clinical Diversity of Atopic Dermatitis.

Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with diverse cutaneous presentations. Differences in clinical phenotypes in skin of color (SOC) patients with AD have been previously noted in race-based analyses. We conducted a narrative review to better characterize the clinical diversity of AD and understand these differences in the context of race, ethnicity, and SOC. Notable racial and ethnic differences in clinical phenotypes have been observed; however, these analyses often are limited by deeper understanding of the true causative factors driving observed differences. Dermatologists should be familiar with the heterogeneity of AD lesional morphology and inflammation severity across all skin types.

Colorism attitudes and use of skin lightening agents in the United States.

Skin lightening (SL) is a practice involving the use of chemicals to lighten the skin that is more common among skin of color (SOC) individuals, particularly women, and can lead to adverse health consequences. Objective: In this study, we examine SL habits, including both general lightening and lightening for the treatment of a skin condition, among SOC individuals in the United States and the role of colorism in motivating these behaviors. Methods: A cross-sectional survey was administered to SOC individuals through ResearchMatch, an online national health registry. Demographics, rates of SL, SL habits, and perceived colorism among SL users and nonusers were collected and analyzed with χ2, Fisher's exact, Analysis of variance (ANOVA), Spearman correlation, and t tests. Results: A total of 455 participants completed the survey. Ninety-seven participants (21.3%) reported using SL agents: 73.2% (71/97) used SL agents for the treatment of a skin condition and 26.8% (26/97) used the products for general SL. Only 22.6% (22/97) of SL users consulted a medical provider before using the products. Forty-four participants (45.4%) were unaware of their SL product ingredients, and 35.1% (34/97) reported using hydroquinone-based products. Composite colorism scores were significantly higher in SL users than nonusers (20.03 vs 18.20; P < .001). Limitations: This study used self-reported racial/ethnic groups to characterize those with SOC rather than assessing actual skin tones of participants, which could have led to variability. Conclusion: SL among SOC individuals is prevalent in the U.S. and poses a health risk, as many SL users are unaware of product ingredients, do not consult a medical provider before use, and have access to potentially unsafe formulations. Dermatologists should address skin tone and pigmentary concerns with their SOC patients.

Atopic Dermatitis Across Shades of Skin.

Atopic dermatitis (AD) is a chronic, heterogeneous inflammatory skin disease that is associated with immense patient burden globally. There is increasing appreciation of disparities among patients identified as having skin of color (SOC), which often refers to patients of non-White race or non-European ancestry, but can broadly include individuals from a number of different racial, ethnic, ancestral, and skin pigmentation groups based on definition. In this narrative review, we discuss key terminology as it relates to AD across shades of skin, including modern definitions of 'race', 'ethnicity', and 'SOC'. We then synthesize the current literature describing disparities in AD prevalence, disease recognition, and burden alongside current data regarding genetic and immunologic findings across SOC populations. In the context of these findings, we highlight key concomitant social determinants of health, including environmental factors, socioeconomic status, and access to care, for which race often serves as a proxy for true biological and genetic differences. Finally, we discuss future efforts to shift to a more inclusive understanding of AD to encompass all shades of skin, to ensure equitable representation of diverse populations in high impact research, and intensify efforts to address the critical upstream factors driving observed disparities.

Capturing the Diversity of Dermatology-What's in a Name?

As research related to skin of color (SOC) in dermatology continues to grow, it is increasingly important to precisely define terminology. The terms 'SOC', 'race', and 'ethnicity' are frequently used to analyze differences in dermatologic disease onset, severity, and outcomes. These terms are used interchangeably, are ill-defined across research studies, and frequently conflate biologic and socially constructed categories. SOC has been thought to represent differing degrees of pigment or melanin in the skin, however skin pigment is quite variable among races and ethnicities. Furthermore, certain individuals with less skin pigment may socially consider themselves to be SOC, while the inverse is also true. Fitzpatrick skin phototype classifications in SOC dermatology, while commonly used as an objective measure of diversity, also present with numerous limitations and inaccuracies. We seek to highlight strengths and weaknesses of the current terminology used in SOC dermatology and recommend a more holistic understanding of reported differences, including a framework reflective of upstream socioeconomic, environmental, and historical factors that may be most relevant to reported associations.

Rate of Patch Testing Induced Anaphylaxis.

Background: Although allergic contact dermatitis is a type IV hypersensitivity reaction, type I hypersensitivity reactions, such as anaphylaxis, have been reported during patch testing. Objective: The aim of this study was to identify reported cases of anaphylaxis from patch testing and estimate its rate. Methods: A literature review was conducted on PubMed to identify previously reported cases of anaphylaxis after patch testing and suspected allergens. In addition, a survey was distributed to expert patch testing dermatologists to determine the rate of anaphylaxis after patch testing. Results: Three anaphylaxis cases due to patch testing were found in the literature. Twenty-seven of 36 expert patch testers completed the survey for a 75% response rate. These dermatologists have tested an estimated 201,720 patients in their combined careers. From them, 2 cases of patch test anaphylaxis were reported. The rate of anaphylaxis from patch testing was calculated to be 1 in 100,860 tests among our cohort. Conclusions: Patch testing induced anaphylaxis is rare and may be more likely in patients with a history of anaphylaxis. Although rare, dermatologists should have a management plan in place.

Differences in the demographics, incidence, and survival of palmar and plantar acral melanoma: a population-based study.

Acral melanoma (AM) has the worst prognosis of all cutaneous malignant melanomas (CMM). Differences between palmar and plantar tumors have not been well characterized at the population level. The objective of this study was to investigate the differences in demographics, incidence, and survival between palmar and plantar AM. The 2004-2016 National Cancer Database (NCDB) and 2000-2018 Surveillance, Epidemiology, and Results (SEER) databases were used to evaluate differences between palmar and plantar AM. Data were analyzed using Chi-square test, Fisher's exact, T-test, or likelihood ratio test. A total of 5002 participants were included in the study. A greater percentage of tumors occurred on the plantar surface (82.0%) than the palmar surface (18.0%). The incidence of plantar tumors is four times greater than palmar tumors (1.7 vs 0.4 cases per 1,000,000 people per year). Palmar melanomas were more likely to occur in Whites (84.6% vs 76.8%, p < 0.001) and be treated with amputation (28.1% vs 12.9%, p < 0.001) compared to plantar melanomas. Disease-specific five-year survival was similar for all palmar (80.8%) and plantar tumors (78.2%). While subtle differences do exist between palmar and plantar tumors, they behave similarly overall and should be treated as one entity.

Skin tone preferences and their influence on skin care behaviors.

Knowledge regarding skin tone preferences and their influence on skincare behaviors among people of color is limited. The objective of this study was to determine whether there is a difference between ideal and actual skin tone among people of color and whether this difference is associated with tanning and sunscreen use. This was a one-time, voluntary, anonymous, electronic survey designed in REDCap and delivered through ResearchMatch, a national electronic, recruitment tool. Eligible participants were at least 18 years old and self-identified as Black, Asian, Latinx, American Indian/Alaskan Native or Mixed Race. In total, 548 completed survey results were analyzed using SAS. Only the Latinx population was found to have a significant preference for tanner skin (p < 0.05). The Latinx population had significantly more subjects that participated in outdoor tanning than both the Black (p < 0.0001) and Asian population (p < 0.05). Latinx participants who indicated a preference for tanner skin were 2.8 times more likely to never use sunscreen than those without this preference (OR = 2.821, CI = 1.029-7.732, p < 0.05). Our findings have implications for how dermatologists screen, treat, and educate Latinx and skin of color populations.

A case of annular atrophic lichen planus in a child and review of the literature.

Lichen planus (LP) is an inflammatory disease affecting both adults and children that may present with numerous rare morphologies. LP and its many subtypes can prove difficult to treat and often leave patients with dyspigmentation. Additionally, pruritus associated with LP can be distressing to patients. The aim of this report is to highlight an uncommon subtype, annular atrophic lichen planus, which uniquely presented in a child, to emphasize the importance of early disease recognition and finally, to demonstrate successful treatment with topical monotherapy with clobetasol propionate ointment.