Atopic Dermatitis in Individuals of Asian and African Ancestry: A Scoping Systematic Review

Chiedu Ufodiama; Blessing  Fabowale-Makinde; Christine  Kleyn

doi:10.5826/dpc.1303a259

Atopic Dermatitis in Individuals of Asian and African Ancestry: A Scoping Systematic Review

Authors

Chiedu Ufodiama Department of Dermatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford; Dermatology Centre, Salford Royal Hospital, Manchester NIHR Biomedical Research Centre, University of Manchester; Wythenshawe Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
Blessing Fabowale-Makinde Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, Kent, UK
Christine Kleyn Department of Dermatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford; Dermatology Centre, Salford Royal Hospital, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK

Keywords:

atopic dermatitis, eczema, skin of colour, african skin types, asian skin types, skin equity

Abstract

Introduction: Atopic Dermatitis (AD) affects individuals from all ethnicities and backgrounds. It has the highest global disease burden of dermatoses. There is a widely held belief that the presentation of AD is not described well in individuals with non-European ancestry in peer-reviewed literature. However, to our knowledge, this has not been investigated previously

Objective: To quantify the number of peer-reviewed literature describing the appearance of clinical features of AD in non-European ancestry, particularly those originating from the Asian and African continents.

Methods: A systematic scoping review between December 2020 and January 2021 was performed to quantify the number of studies describing AD in individuals of African and Asian ancestry.

Reuslts: Sixteen studies were identified. None of the studies provided a clear description of AD in our population groups. Two studies described features of lichen planus like-AD in African American individuals. All studies reported on observed clinical features of AD.

Conclusions: The review confirmed a lack of literature describing AD in populations of non-European heritage. It should encourage authors to make a deliberate effort to describe the appearance of clinical features of AD to enable understanding of how they may differentiate in individuals originating from different parts of the globe.

References

Laughter, M. R. et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990–2017*. British Journal of Dermatology 184, 304–309 (2021).

Ring, J. et al. Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults. Journal of the European Academy of Dermatology and Venereology 33, 1331–1340 (2019).

British Association of Dermatologists - Educational resources for clinicians on skin of colour. https://www.bad.org.uk/healthcare-professionals/education/skin-of-colour-resources.

Lomax, N., Wohland, P., Rees, P. & Norman, P. Journal of Ethnic and Migration Studies The impacts of international migration on the UK’s ethnic populations. Journal of Ethnic and Migration Studies 46, 177–199 (2019).

Lomax, N., Wohland, P., Rees, P. & Norman, P. The impacts of international migration on the UK’s ethnic populations. Journal of Ethnic and Migration Studies 46, 177–199 (2020).

Hanifin, J. M. & Rajka, G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) Suppl 92, 44–47 (1980).

Thyssen, J. P., Andersen, Y., Halling, A.-S., Williams, H. C. & Egeberg, A. Strengths and limitations of the United Kingdom Working Party criteria for atopic dermatitis in adults. Journal of the European Academy of Dermatology and Venereology 34, 1764–1772 (2020).

Tricco, A. C. et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine vol. 169 467–473 Preprint at https://doi.org/10.7326/M18-0850 (2018).

Taylor, S. C., Kelly, A. P., Lim, Henry. W. & Anido Serrano, M. Taylor and Kelly’s Dermatology for Skin of Color. (McGraw Hill Education, 2016).

Saleh, J., Vasicek, B., Swan, J., Speiser, J. & Mudaliar, K. A Rare Case of Lichen Planus-Like Atopic Dermatitis Involving the Hands. Am J Dermatopathol 42, 215–217 (2020).

Summey, B. T., Bowen, S. E. & Allen, H. B. Lichen planus-like atopic dermatitis: Expanding the differential diagnosis of spongiotic dermatitis. Journal of Cutaneous Pathology 35, 311–314 (2008).

Lopez Carrera, Y. I. et al. Epidemiology, Diagnosis, and Treatment of Atopic Dermatitis in the Developing Countries of Asia, Africa, Latin America, and the Middle East: A Review. Dermatology and Therapy 9, 685–705 (2019).

Vachiramon, V., Tey, H. L., Thompson, A. E. & Yosipovitch, G. Atopic dermatitis in African American children: Addressing unmet needs of a common disease. Pediatric Dermatology 29, 395–402 (2012).

Nnoruka, E. N. Current epidemiology of atopic dermatitis in south-eastern Nigeria. International Journal of Dermatology 43, 739–744 (2004).

Kaufman, B. P., Guttman-Yassky, E. & Alexis, A. F. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment. Experimental Dermatology 27, 340–357 (2018).

Silverberg, J. I. et al. Distribution of atopic dermatitis lesions in United States adults. Journal of the European Academy of Dermatology and Venereology 33, 1341–1348 (2019).

Murad, M. H., Asi, N., Alsawas, M. & Alahdab, F. New evidence pyramid. Evidence-Based Medicine vol. 21 Preprint at https://doi.org/10.1136/ebmed-2016-110401 (2016).

Kulthanan, K., Samutrapong, P., Jiamton, S. & Tuchinda, P. Adult-onset atopic dermatitis: A cross-sectional study of natural history and clinical manifestation. Asian Pacific Journal of Allergy and Immunology 25, 207–214 (2007).

Ebede, T. & Papier, A. Disparities in dermatology educational resources. J Am Acad Dermatol 55, 687–690 (2006).

Lester, J. C., Taylor, S. C. & Chren, M. M. Under-representation of skin of colour in dermatology images: not just an educational issue. British Journal of Dermatology vol. 180 1521–1522 Preprint at https://doi.org/10.1111/bjd.17608 (2019).

Nijhawan, R. I., Jacob, S. E. & Woolery-Lloyd, H. Skin of color education in dermatology residency programs: Does residency training reflect the changing demographics of the United States? J Am Acad Dermatol 59, 615–618 (2008).

Vaughan, L. & Thelwall, M. Search engine coverage bias: Evidence and possible causes. Information Processing and Management 40, 693–707 (2004).

Allen, H. B., Jones, N. P. & Bowen, S. E. Lichenoid and other clinical presentations of atopic dermatitis in an inner city practice. J Am Acad Dermatol 58, 503–504 (2008).

Dhar, S. & Banerjee, R. Atopic dermatitis in infants and children in India. Indian Journal of Dermatology, Venereology and Leprology 76, 504–513 (2010).

Kumar, M. K., Singh, P. K. & Tahir, M. M. A. The clinico-epidemiological profile and the risk factors associated with the severity of atopic dermatitis (AD) in eastern Indian children. Journal of Clinical and Diagnostic Research 6, 1162–1166 (2012).

Lee, H. J. et al. Minor cutaneous features of atopic dermatitis in South Korea. International Journal of Dermatology 39, 337–342 (2000).

Liu, P. et al. Clinical features of adult/adolescent atopic dermatitis and chinese criteria for atopic dermatitis. Chinese Medical Journal 129, 757–762 (2016).

Tanei, R. & Katsuoka, K. Clinical analyses of atopic dermatitis in the aged. Journal of Dermatology 35, 562–569 (2008).

Wang, X. et al. Prevalence and clinical features of adult atopic dermatitis in tertiary hospitals of China. Medicine (United States) 96, (2017).

Yew, Y. W., Thyssen, J. P. & Silverberg, J. I. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 80, 390–401 (2019).