Not everyone is affected by dermatological diseases, such as eczema, in the same way. For example, the prevalence, presentation, and impact of these conditions on people with deeper skin tones, or skin of colour, can be profoundly different from those with lighter skin.
Eczema, also known as atopic dermatitis (AD), is an inflammatory skin condition that causes itchiness, dry skin, rashes, scaly patches, blisters, and even infection1. It’s believed to be caused by a combination of environmental, genetic, and immunological factors2, and can significantly impact the quality of life of those who suffer from it3.
It’s also more prevalent in people with darker skin tones. A U.S. study found that African American children are 1.7 times more likely to develop AD4 than European American children, and Asian individuals and Pacific Islanders seven times more likely than people with white skin to be diagnosed with the disease at an office visit5.
As part of Pfizer’s Diversity, Equity, and Inclusion (DE&I) efforts, we are committed to accelerating awareness of this disparity to improve the equitable diagnosis and treatment of patients of all races and ethnicities.
Feeling good in your skin
Tanya Mohan is a peer support volunteer with the Eczema Society of Canada who has been living with eczema her whole life. She says the physical and emotional challenges of the condition have made it difficult for her to feel good in her skin3.
“Around junior high, I became more concerned with my appearance and would try to hide it from everyone, wearing long sleeves and long skirts in the summer,” she says.
When she was 16 years old, Tanya encountered a difficult experience on public transit that left her feeling stigmatized.
“I was going to Caribana and was wearing a skirt slightly above the knee, and an elderly person loudly commented on my skin, asking if it was contagious and moving away from me on a very crowded streetcar. It was mortifying,” she recalls.
Eczema and skin of colour
Tanya also experienced some challenges in having her eczema properly assessed.
“Getting a diagnosis was not hard, but I think measuring the severity of the disease was challenging given that my flares didn't always look red, inflamed,” she shared.
Flare-ups are often characterized as red and inflamed, even though that’s often only in those with paler skin. However, according to the Eczema Society of Canada, eczema can present as brown, grey or purple and appear darker than the rest of the skin in those with skin of colour6.
For those with darker skin tones, eczema may present in different areas, such as on top or in front of the knees and elbows, and not behind or in the folds, as commonly seen in lighter skin6. It can also be more difficult to diagnose the disease in skin of colour because there is a lack of representation of skin of colour in traditional medical training and textbooks7.
In fact, according to a U.S. study, only 5% to 18% of dermatology textbooks frequently assigned by top North American medical schools include educational images of diverse skin7.
Feeling seen and heard
“When I was first diagnosed [in the early 80s], doctors made an assumption that my eczema wasn't as severe. This caused me to downplay my skin issues,” said Tanya.
Over the years, Tanya has seen quite an improvement in the understanding of how eczema presents in different skin tones. “It’s wonderful to see this transition because you feel identified and heard.”
“As a child, I wanted to see others with my skin who had eczema. I wanted to hear from doctors about what I could expect when it came to side effects. Now the medical community has done a phenomenal job of being more inclusive, studying skin diseases in people of colour, so I am hopeful that the holistic care eczema sufferers require will only get better,” Tanya said.
To address these disparities, more effort is now being made to study the effects of skin conditions, including eczema, on patients with darker skin6.
Pfizer is also committed to ensuring that more patients with skin of colour, like Tanya, are recognized, heard and fully supported throughout their journey with eczema.
For more information on eczema and skin of colour, please visit Eczema and Skin of Colour - The Eczema Society of Canada (eczemahelp.ca).
REFERENCES:
https://eczemahelp.ca/wp-content/uploads/2020/09/ESC-Atopic-Dermatitis-Patient-Journey-Report-2020.pdf Page 1
About Eczema - The Eczema Society of Canada (eczemahelp.ca)
ESC_QUALITY_OF_LIFE_REPORT_2017.pdf (altogethereczema.org) page 8
Kaufman BP, Guttman-Yassky E, Alexis AF. Exp Dermatol. 2018;27(4):340-357.Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357
Kaufman BP, Guttman-Yassky E, Alexis AF. Exp Dermatol. 2018;27(4):340-357.Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357
https://www.eczemahelp.ca/about-eczema/eczema-and-skin-of-colour/
https://www.sciencedirect.com/science/article/abs/pii/S0277953618300790?via%3Dihub