Recognizing AD Across All Skin Tones

EP: 1.Understanding Atopic Dermatitis as an Immune-Mediated Disease

EP: 2.Bridging the Gaps: Health Care Professional Knowledge Gaps in AD Pathophysiology

EP: 3.Beyond the Itch: The Full Spectrum of AD Symptoms and Their Impact on Patients

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EP: 4.Recognizing AD Across All Skin Tones

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AD presents with distinct clinical features across different skin tones that require specialized recognition skills for accurate diagnosis. In patients with darker skin, inflammation appears as light purple, dark purple, gray, or may be nearly invisible against darker background pigmentation, contrasting with the classic red appearance in patients with lighter skin. Health care providers must expand their diagnostic criteria beyond erythema to recognize this broader spectrum of inflammatory presentations and avoid missed diagnoses in diverse populations.

Certain morphological features are more prominent in patients with skin of color, including perifollicular prominence manifesting as bumps around hair follicles rather than typical patches. These papular presentations can be the primary manifestation of AD in patients with darker skin tones, requiring clinicians to recognize these variant presentations. Postinflammatory hyerpigmentation represents another critical consideration, as affected areas may become lighter or darker than native skin tone, persisting long after active inflammation resolves and causing significant patient distress.

Disparities in care often result from delays in accessing specialist treatment, leading to more severe disease presentations in many patients with skin of color. Complex social determinants of health, environmental factors, and health care access barriers contribute to seeing more severe lichenification, popular nodules, and greater overall quality-of-life impacts. These factors are not primarily biological but reflect systemic health care inequities that require targeted interventions to ensure equitable access to appropriate dermatologic care and specialized treatments.