Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects diverse ethnic groups with varying prevalence. Despite a predominance of studies in individuals of European ancestry, AD has been found to occur more frequently in Asian and Black individuals than Whites. Therefore, an understanding of the unique clinical features of AD in diverse ethnic groups, as well as the differences in genetic polymorphisms that influence susceptibility to AD and response to current therapies, is paramount for management of an increasingly diverse patient population. In this article, we review key nuances in the epidemiology, pathophysiology, clinical presentation and treatment of AD in non-White ethnic groups, which are largely underappreciated in the literature. We highlight the need for studies evaluating the tissue molecular and cellular phenotypes of AD in non-White patients, as well as greater inclusion of minority groups in clinical trials, to develop targeted treatments for a multi-ethnic population.

Personalized medicine—concepts, technologies, and applications in inflammatory skin diseases

“…It will be interesting to see if the reported Japanese/Korean AD phenotype extends to the larger Chinese and Indian populations, and also, to include migration studies (investigating Asian American, Asian European, as well as local Asian AD) to evaluate the genetic, epigenetic, and environmental (exposome/microbiome) effects on the development of AD. The above considerations of course also apply to other non-European ethnic groups, including the African population, who is likely to have yet other genetic susceptibilities, as recently reviewed by Kaufman et al (217) and Brunner et al (218). Fig.…”

“…The above considerations of course also apply to other non‐European ethnic groups, including the African population, who is likely to have yet other genetic susceptibilities, as recently reviewed by Kaufman et al. and Brunner et al. .…”

The oral Janus kinase/spleen tyrosine kinase inhibitorASN002 demonstrates efficacy and improves associated systemic inflammation in patients with moderate‐to‐severe atopic dermatitis: results from a randomized double‐blind placebo‐controlled study

“…Several cytokines including Th1/interferon‐γ, Th2/IL‐4, IL‐13, IL‐31, IL‐33, IL‐5, Th17/Th22/IL‐17 and IL‐22 have been shown to be increased in AD, suggesting the possible involvement of Th1, Th2 and Th17 pathways in disease pathogenesis . Moreover, the relative role of these pathways varies with age and ethnicity . For example, Th17 activation has been shown to be higher in children and Asian patients .…”

“…Atopic dermatitis (AD) is a chronic inflammatory skin disease with a lifetime prevalence as high as 20% . Moderate‐to‐severe AD is characterized by the presence of eczematous lesions over large surface areas associated with intense pruritus, which can significantly impair quality of life . Currently available treatments include topical corticosteroids, calcineurin inhibitors and phototherapy, which often have more limited efficacy in patients with extensive disease .…”

A new era for translational atopic dermatitis research and management

“…Therefore, a thorough understanding of the unique genetic, clinical and molecular features of AD across a broad range of ethnic AD subtypes is critical. Here, Kaufman et al review key factors in the epidemiology, pathophysiology, clinical presentation and treatment of AD in non‐White ethnic groups and describe that variability in the frequency and type of mutations in genes involved in skin barrier function (ie FLG, FLG‐2, SPINK5) and innate/adaptive immunity (ie IL‐4, IL‐13, DEFB1) likely impacts the incidence and severity of AD in certain populations. The differential expression of inflammatory cytokines may explain the predominance of more lichenified, well‐demarcated and scaly lesions in Asians compared to Whites …”