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A recent paper in offers comprehensive guidance to diagnosing atopic dermatitis (AD) in people of color.

Among the conclusions: typical AD disease scoring tools, which routinely rely on erythema, may delay diagnosis and under-predict severity in this population, the experts noted.

Co-author Shawn Kwatra, MD, is an associate professor of dermatology at The Johns Hopkins University School of Medicine in Maryland and director of the Johns Hopkins Itch Center. His exchange with the Reading Room has been edited for length and clarity.

What was the intent of this paper?

Kwatra: Our paper highlights differences in the pathogenesis, clinical presentation, and treatment options for AD in skin of color patients.

What are the key take-home points?

Kwatra: Our study includes various points to consider when assessing for AD:

• Skin of color patients are disproportionately affected by AD; they carry a greater disease burden, and often present later in the disease process.
• Clinical manifestations of AD can vary in different racial and ethnic populations, often with greater extensor and papular involvement in Black patients and psoriasiform scaling in Asian patients.
• Assessing itch intensity is a useful bedside tool to objectively assess disease severity in these patients.

What does the future hold in this area?

Kwatra: Work is ongoing to study personalized medicine approaches to AD. Clinical outcomes are difficult to measure in skin of color patients, as existing tools to assess AD rely heavily on erythema.

Updates to diagnostic tools are needed to assist clinicians in early diagnosis and intervention of AD.\