Volume 52, Issue 10, October 2023

Diagnosis, assessment and management of atopic dermatitis in children with skin of colour

Christian Gan    Roland Brand    Rachael S Foster    Jemma Weidinger    Michelle Rodrigues   
doi: 10.31128/AJGP-01-23-6684   |    Download article
Cite this article    BIBTEX    REFER    RIS


It is important to be able to manage patients regardless of ethnicities. The understanding of skin diseases, including atopic dermatitis, in patients with skin of colour (SOC) is lagging compared with that in patients with lighter skin and has been identified as an educational gap among medical practitioners.


This paper synthesises the latest literature on the diagnosis, assessment, treatment outcomes and cultural considerations for managing atopic dermatitis in children with SOC in the general practice setting.


Atopic dermatitis in children with SOC can vary from traditional descriptions and appear psoriasiform, lichenoid, scaly, papular, hypopigmented or violaceous. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in children with SOC.


Atopic dermatitis is one of the most common inflammatory skin conditions affecting children. Skin of colour (SOC) is a term that refers to skin types darker than the skin tones of those of European descent, including but not limited to people with Asian, African, Latino, Middle Eastern, Mediterranean, and Indigenous Oceanic backgrounds. SOC can also apply to people of mixed ethnicities. Approaching atopic dermatitis in people with SOC has been identified as an educational gap in many parts of the world.1,2

Here, we describe the most pertinent clues and considerations when approaching a child with SOC who might have atopic dermatitis.


Children with SOC presenting with atopic dermatitis lack the classical textbook presentation of poorly defined pruritic, erythematous patches and plaques affecting the flexor surfaces.

Contrary to classic textbook descriptions, atopic dermatitis in Asian children (in particular, Chinese, Japanese and Korean children) tend to be psoriasiform in morphology, with standout features including well-demarcated lesions, prominent scale and lichenification (Figure 1).3 Children of Black ethnicity often present with papules distributed over extensor surfaces, again mimicking the extensor of psoriasis, more than the classic flexural distribution of atopic dermatitis.

Figure 1. Atopic dermatitis presenting as lichenified, scaly, grey-to-pink plaques over the flexural surfaces of the knees (A, B), elbow (C) and back of the neck (D) in a boy with skin of colour.

Figure 1. Atopic dermatitis presenting as lichenified, scaly, grey-to-pink plaques over the flexural surfaces of the knees (AB), elbow (C) and back of the neck (D) in a boy with skin of colour.

Papular lesions and lichen planus-like lesions are often seen in those with richly pigmented skin.4–7 Atopic dermatitis on the periumbilical area in those of Black ethnicity have also been reported.5

In richly pigmented skin, atopic dermatitis rarely presents with erythema; instead, it appears violaceous, grey or dark brown. Postinflammatory dyspigmentation is a hallmark feature of atopic dermatitis in children with SOC. Dyspigmentation describes hyper- or hypopigmented skin around a present or previously inflamed eczematous lesion and might be as distressing as the disease itself for some patients (Figure 2).4

Figure 2. (A) Atopic dermatitis presenting with dark brown lesions in an Indian child. (B, C) Postinflammatory hypopigmentation following resolution of atopic dermatitis of the lower legs in an infant.
Figure 2. (A) Atopic dermatitis presenting with dark brown lesions in an Indian child. (BC) Postinflammatory hypopigmentation following resolution of atopic dermatitis of the lower legs in an infant.

Differences in the clinical presentation of atopic dermatitis in children with SOC are summarised in Table 1 and Figure 3. Secondary cutaneous manifestations of atopic dermatitis seen in children with SOC are described in Table 2.

Table 1. Clinical manifestations of atopic dermatitis in children with skin of colour
Well-demarcated plaques
Prominent scale
Papular morphology
Follicular prominence
Violaceous, grey or brown colour
Postinflammatory dyspigmentation
Extensor surface distribution
Psoriasiform variants, lichenoid variants
Table 2. Secondary cutaneous manifestations of atopic dermatitis in children with skin of colour
Secondary cutaneous manifestation Description
Palmar hyperlinearity Accentuation of linear markings on the palm7–10
Dennie-Morgan folds Infraorbital fold creases often with surrounding dyspigmentation7–9,11
Labial melanocytic macules Pigmented macular freckling usually of the lower lip12
Prurigo nodularis Firm, pruritic, abraded, thickened, often dyspigmented nodules13
Lichen amyloidosis Rippled hyperpigmented papules coalescing into plaques often over extremities and associated with chronic scratching

Figure 3. Follicular atopic dermatitis over the chest (A), abdomen (B), back (C), arms (D, E) and lower legs (F) in a boy with richly pigmented skin. Postinflammatory hyperpigmentation surrounds the atopic dermatitis lesions over the arms (D, E). Small prurigo nodules are also noted behind the knees (F).

Figure 3. Follicular atopic dermatitis over the chest (A), abdomen (B), back (C), arms (D, E) and lower legs (F) in a boy with richly pigmented skin. Postinflammatory hyperpigmentation surrounds the atopic dermatitis lesions over the arms (D, E). Small prurigo nodules are also noted behind the knees (F).

Differential diagnoses

The diagnosis of atopic dermatitis is clinical. However, differential diagnoses in patients with SOC include psoriasis, lichen planus, lichen nitidus and tinea corporis.


Erythema is difficult to appreciate in patients with richly pigmented skin. A reliance on erythema might risk underestimation of the severity of atopic dermatitis in this demographic.14 Assessment of the level of greyness might offer greater accuracy in the assessment of ‘erythema’ in those with SOC.6

The challenges in assessing erythema applies to traditional severity assessment scores such as the Eczema Area and Severity Index (EASI).15 Historically, the EASI was a research tool to assess severity. Online calculators have made the score more accessible, and it can be a useful clinical tool in patients with SOC, who are at greater risk of underestimation of severity. Increasing the erythema score by one point in patients with SOC has also been suggested to avoid underestimation of eczema severity in this group.15

Studies of quality of life (QOL) impairments in children of Asian ethnicity found pruritus, sleep disturbance and embarrassment are important impairments of QOL in this group.16 Most studies published on the impacts of atopic dermatitis on children of Black ethnicity have been conducted in the US. School absenteeism, sleep deprivation, poorer academic performance and impaired social interactions have all been reported with uncontrolled disease.17,18

Head-to-head comparisons of the specific differences in QOL scores among children of different ethnicities are lacking, although mean scores overall have been compared between different ethnicities.16 Sociocultural differences might provide some explanation for differences in QOL scoring, as well as the way in which cultural groups might interpret questionnaires. Of course, social determinants of health unique to families with SOC must also be considered.

Although imperfect, asking the patient and/or parents about their beliefs surrounding atopic dermatitis, how it affects the family and what their main concerns and treatment goals are will help determine how best to support and manage culturally and ethnically diverse patients with atopic dermatitis.


General measures and trigger avoidance

General measures include the avoidance of triggers, such as environmental allergens (contact with grass, dust, animals), rough clothing, hot showers or baths, soaps, detergents, fragrances and creams that might contain irritating ingredients. Using bland emollient moisturisers is the cornerstone in the management of atopic dermatitis in all patients, and can include inert water-free oils or ointments.19

Simple lifestyle modifications include keeping nails short, using light 100% cotton bed coverings, wearing loose cotton pyjamas and avoiding alcohol-based nappy wipes, antiseptic laundry additives, sleeping bags, hot water bottles and rough clothing that can dry, overheat and irritate the skin.20

Washing bedding and clothes in hot water is effective at killing dust mites and helps clear bacteria that can colonise the skin of patients with atopic dermatitis. Contrary to traditional belief, properly manufactured Merino wool clothing can improve mild-to-moderate atopic dermatitis as long as the design is not scratchy.21 Studies reveal that patients from Asian households might use extra bedding, bedroom heating and/or overdress their children more than other cultural groups, which can exacerbate atopic dermatitis.22

Dilute bleach baths assist with decolonisation of Staphylococcus aureus in children with frequent infective exacerbations of eczema. Variations in S. aureus strains have been identified among groups from different ethnic backgrounds.23 This might potentially explain differences in prevalence and disease severity, but does not yet change treatment recommendations.23 Any exudative or weeping lesions should be swabbed for microscopy, culture and sensitivities, and treated accordingly.

When approaching environmental triggers, it is important to frame the discussion around respect of the culture of the child and their family, especially if the trigger might relate to a culturally related clothing, activity or value.

Topical therapies

Topical corticosteroid for atopic dermatitis should not be applied sparingly. Adequate amounts of topical steroid are needed in order to properly break the itch–scratch cycle. Studies have revealed that underuse of topical steroids often leads to more severe and difficult-to-control eczema in the long term.24 The adequate use of topical steroids for flares is necessary to avoid progression and more flares of atopic dermatitis.24,25 Moderate (Class II) topical corticosteroids, including methylprednisolone aceponate 0.1% ointment (Advantan, LEO Pharma, Newstead, Qld, Australia), triamcinolone acetonide 0.02–0.05% ointment (ARISTOCORT, Aspen Pharmacare, St Leonards, NSW, Australia) and betamethasone valerate 0.02–0.05% cream (Celestone M, Organon Pharma, Macquarie Park, NSW, Australia), can be used on the face for up to a few days for the treatment of severe flares.26 Potent (Class III) topical steroids, such as betamethasone dipropionate 0.05% ointment (Diprosone, Organon Pharma, Macquarie Park, NSW, Australia), can be used on the torso and limbs until the skin feels normal.26 Patients who require more than two weeks of continuous use without improvement should be considered for referral to a dermatologist.

Topical treatments can be applied with occlusive dressings for small, lichenified and treatment-resistant areas, or with wet dressings for severe flares with widespread skin involvement. The Royal Children’s Hospital Melbourne eczema page provides practical advice on the application of wet dressings.20

Topical calcineurin inhibitors such as pimecrolimus 1% cream and tacrolimus 0.03–0.1% ointment have been widely used in all skin types with good efficacy and comparable safety profiles.27 Although pimecrolimus is available for the treatment of atopic dermatitis on the Pharmaceutical Benefits Scheme (PBS), tacrolimus needs to be made at a compounding pharmacy and is not PBS subsidised. These agents are effective for atopic dermatitis on the face and neck, as well as flexural areas, and as maintenance therapy in those with severe and chronic atopic dermatitis. The advantage of tacrolimus is that it is compounded in an ointment base that does not contain preservatives, and so does not sting active dermatitis upon immediate application (as opposed to pimecrolimus, which is in a cream). These products should be considered for persistent or difficult-to-control atopic dermatitis on the face. Calcineurin inhibitors can cause a burning sensation during the first few days of use.28

Potent topical steroids can have a bleaching effect and are sometimes incorrectly obtained for this cosmetic effect by patients who attempt to self-treat areas of hyperpigmention.29 Unfortunately, this can precipitate side effects including skin atrophy, telangiectasia and steroid acne. More commonly, however, postinflammatory hypopigmentation is pronounced in children with SOC once the active flare has resolved. The skin is smooth and has reduced pigment (as opposed to the absolute depigmentation seen in vitiligo). This is often a concern for cosmetic reasons and it is important to discuss that the atopic dermatitis has caused this issue, with the treatment being time and gentle sun exposure, not topical steroids. It is also important to explain that this does not represent thinning of the skin. Pityriasis alba describes ill-defined patchy facial hypopigmentation that is thought to be a mild eczematous dermatitis more common in patients with SOC. In these cases, daily pimecrolimus cream is an effective, steroid-sparing treatment.30

Crisaborole 2% ointment is a Therapeutic Goods Administration-approved phosphodiesterase 4 inhibitor that is used in cases of mild-to-moderate atopic dermatitis, but it is currently not PBS subsidised.19 The main side effect of crisaborole is stinging and irritation at the application site. Crisaborole has demonstrated efficacy and a low frequency of adverse events in patients with SOC.31

When atopic dermatitis cannot be adequately controlled by topical therapy, a referral to a dermatologist is usually required for additional therapeutic options, as described below.


Through a dermatologist, phototherapy, usually narrow band ultraviolet light B (NBUVB), is a treatment option in children old enough to stand still in the ultraviolet cabinet who have not responded to general measures and adequate topical therapy. Children younger than six years of age are generally unsuitable candidates for phototherapy. The treatment is subsidised through Medicare in Australia. Phototherapy usually involves short treatment sessions three times a week at a specialist dermatology clinic. Darker skin types take longer to reach therapeutic doses. Patients with SOC are more resistant to short-term side effects, such as burning, erythema, stinging and blistering, but have a higher risk of developing pigmented lesions, such as lentigines, with prolonged therapy.32,33

Systemic therapies

The routine use of systemic corticosteroids for atopic dermatitis is heavily discouraged but might be appropriate for severe acute exacerbations, as a bridge to systemic therapies or phototherapy or prior to a major life event.34 Regimens might involve oral prednisolone at a dose up to 0.5 mg/kg/day for one to two weeks, followed by tapering over one month. Short courses without tapering can lead to rebound flares.35 Steroid-sparing immunosuppressive agents such as mycophenolate, methotrexate and cyclosporine can be used for severe refractory cases, but are generally prescribed at the discretion of a dermatologist.35

Targeted therapies

Targeted therapies continue to replace traditional steroid-sparing immunosuppressive agents such as azathioprine, mycophenolate and methotrexate in the treatment of atopic dermatitis.

Dupilumab is a new targeted immunosuppressive agent for refractory, severe atopic dermatitis that is PBS approved in children aged >12 years as a fortnightly subcutaneous injection. Clinical trials have shown that dupilumab is effective, including in those with SOC, and might also accelerate the resolution of normal skin tone in patients with postinflammatory dyspigmentation.36 Ethnicity-based comparisons are currently lacking in the literature; however, the data available suggests that dupilumab is well tolerated and efficacious in children regardless of ethnicity.37 Common reported adverse effects are consistent among all ethnic groups and include ocular side effects (eg conjunctivitis), exacerbation of atopic dermatitis, secondary skin infections (bacterial and herpes) and nasopharyngitis.38–41

Oral and topical Janus kinase (JAK) inhibitors such as upadacitinib (RINVOQ, AbbVie, Mascot, NSW, Australia) have demonstrated effectiveness in severe atopic dermatitis, including in studies from countries in which patients with SOC are predominant.42 Oral upadacitinib has been available on the PBS since February 2022 for patients aged >12 years. Some of the more severe potential adverse effects of JAK inhibitors include immunosuppression, thromboembolism and opportunistic infections.19

Management of complications

Postinflammatory hyperpigmentation (PIH) and postinflammatory hypopigmentation are important considerations in children with SOC. Specific treatments are not routinely administered because the dyspigmentation will spontaneously resolve with time as long as the eczema does not recur in the same area.

However, it is important to explain these common sequelae to patients and/or family members and to remind them not to keep treating PIH (flat brown skin staining after the eczema has resolved) with topical therapies targeting atopic dermatitis.

Practitioners should explore how the PIH is affecting the child and their family, because it can be as distressing as the atopic dermatitis itself. If the PIH is prolonged and cosmetically disturbing for the patient, topical tyrosinase inhibitors such as hydroquinone 2–5% could be considered. Hydroquinone 4% cream can be applied twice daily for 8–12 weeks. Patients using hydroquinone should be counselled on the risk of a ‘halo effect’ (a lightening of the surrounding skin) and ochronosis, a rare adverse effect of permanent blue–grey discolouration after using high concentrations for a prolonged period.43 Other treatment options, such as retinoids and azelaic acid, can be used over the counter, but can be irritating, causing flares in sensitive skin.43

In addition to textural changes, scarring from severe and longstanding atopic dermatitis is often associated with dyspigmentation. Skin homogeneity in colour and texture is associated with healthiness and attractiveness in many cultures; it is vital to explore the psychosocial impact of atopic dermatitis, especially in patients with dyspigmentation and/or papular changes.44

The psychological burden of atopic dermatitis might result in mental health comorbidities, including anxiety, depression and attention-deficit/hyperactivity disorder.45,46 Disease severity correlates strongly with school absenteeism, sleep disturbance and friendships, and affects playtime and hobbies.47 Children experiencing psychosocial impacts of atopic dermatitis can benefit from input from allied health workers, including psychologists, social workers, nurse educators and dietitians.48


Atopic dermatitis in children with SOC can vary greatly from traditional textbook descriptions. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis itself, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in patients with SOC.

Key points

  • Traditional textbook descriptions of atopic dermatitis are not representative of atopic dermatitis in patients with SOC.
  • Unique psoriasiform, lichenoid, scaly or papular forms of atopic dermatitis are often seen in patients with SOC.
  • Unique secondary features of atopic dermatitis in patients with SOC include things like labial pigmentation and prurigo nodularis.
  • A grey scale to determine the severity of atopic dermatitis might help avoid underestimating the severity of the condition.
  • Possible topical steroid‑induced hypopigmentation and postinflammatory dyspigmentation should be addressed at the initial consultation.
  • Cultural views and desires should be considered in the planning of treatment.
  • Allied health team members should be involved in patient care to optimise patient outcomes.
Competing interests: MR has received honoraria for lectures and/or is a consultant for AbbVie, Sanofi, Pfizer, Bristol Myers Squibb (BMS), and is on the BMS advisory board, as well as medical advisory boards for BMS and the Global Vitiligo Foundation, the communications Committee for the Global Vitiligo Foundation and national and international committees for the Skin of Colour Society; is the Secretary General of the Asian Society for Pigment Cell Research and on the council of the Vitiligo Association of Australia; and is Patron and Chair of the Dermatology Society for Undergraduates. CG, RB, RSF and JW have no conflicts of interest to disclose.
Provenance and peer review: Commissioned, externally peer reviewed.
Funding: None.
Correspondence to:
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log
  1. Onasanya J, Liu C. Dermatology education in skin of colour: Where we are and where do we go? Can Med Educ J 2021;12(6):124–25. Search PubMed
  2. O’Connor C, Gallagher C, Bourke J, Murphy M. Confidence of Irish dermatologists in caring for patients with skin of colour. Clin Exp Dermatol 2022;47(1):169–71. Search PubMed
  3. Noda S, Suárez-Fariñas M, Ungar B, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol 2015;136(5):1254–64. Search PubMed
  4. 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):340–57. Search PubMed
  5. Vachiramon V, Tey HL, Thompson AE, Yosipovitch G. Atopic dermatitis in African American children: Addressing unmet needs of a common disease. Pediatr Dermatol 2012;29(4):395–402. Search PubMed
  6. Zhao CY, Hao EY, Oh DD, et al. A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate- to dark-skinned patients. Br J Dermatol 2017;176(4):985–92. Search PubMed
  7. Nnoruka EN. Current epidemiology of atopic dermatitis in south-eastern Nigeria. Int J Dermatol 2004;43(10):739–44. Search PubMed
  8. Fukuie T, Yasuoka R, Fujiyama T, Sakabe JI, Taguchi T, Tokura Y. Palmar hyperlinearity in early childhood atopic dermatitis is associated with filaggrin mutation and sensitization to egg. Pediatr Dermatol 2019;36(2):213–18. Search PubMed
  9. Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis. Ann Allergy Asthma Immunol 2019;122(5):449–55. Search PubMed
  10. Wu WH, Chan TC, Chu C-Y. Asian type atopic dermatitis. CosmoDerma 2022;2:48. doi: 10.25259/CSDM_47_2022. Search PubMed
  11. Uehara M. Infraorbital fold in atopic dermatitis. Arch Dermatol 1981;117(10):627–29. Search PubMed
  12. Kang IH, Jeong KH, Lee MH, Shin MK. Atopic labial pigmentation: A new diagnostic feature in Asian patients with atopic dermatitis. Int J Dermatol 2018;57(7):817–21. Search PubMed
  13. Boozalis E, Tang O, Patel S, et al. Ethnic differences and comorbidities of 909 prurigo nodularis patients. J Am Acad Dermatol 2018;79(4):714–19.e3. Search PubMed
  14. Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in Black children compared with their White counterparts. Br J Dermatol 2002;147(5):920–25. Search PubMed
  15. Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The Eczema Area and Severity Index – a practical guide. Dermatitis 2022;33(3):187–92. Search PubMed
  16. Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: A systematic review. Arch Dermatol Res 2022;314(5):445–62. Search PubMed
  17. Wan J, Margolis DJ, Mitra N, Hoffstad OJ, Takeshita J. Racial and ethnic differences in atopic dermatitis-related school absences among US children. JAMA Dermatol 2019;155(8):973–75. Search PubMed
  18. Cheng BT, Silverberg JI. Association of pediatric atopic dermatitis and psoriasis with school absenteeism and parental work absenteeism: A cross-sectional United States population-based study. J Am Acad Dermatol 2021;85(4):885–92. Search PubMed
  19. Goh MS, Yun JS, Su JC. Management of atopic dermatitis: A narrative review. Med J Aust 2022;216(11):587–93. Search PubMed
  20. The Royal Children’s Hospital Melbourne (RCH). Eczema. RCH, 2020. Available at [Accessed 24 March 2023]. Search PubMed
  21. Fowler JF Jr, Fowler LM, Lorenz D. Effects of merino wool on atopic dermatitis using clinical, quality of life, and physiological outcome measures. Dermatitis 2019;30(3):198–206. Search PubMed
  22. Watson L, Potter A, Gallucci R, Lumley J. Is baby too warm? The use of infant clothing, bedding and home heating in Victoria, Australia. Early Hum Dev 1998;51(2):93–107. Search PubMed
  23. Merriman JA, Mueller EA, Cahill MP, et al. Temporal and racial differences associated with atopic dermatitis Staphylococcus aureus and encoded virulence factors. mSphere 2016;1(6):e00295-16. Search PubMed
  24. Tier HL, Balogh EA, Bashyam AM, et al. Tolerability of and adherence to topical treatments in atopic dermatitis: A narrative review. Dermatol Ther (Heidelb) 2021;11(2):415–31. Search PubMed
  25. Feldman SR, Cox LS, Strowd LC, et al. The challenge of managing atopic dermatitis in the United States. Am Health Drug Benefits 2019;12(2):83–93. Search PubMed
  26. Aung T, Aung S. Selection of an effective topical corticosteroid. Aust J Gen Pract 2021;50:651–55. Search PubMed
  27. Eichenfield LF, Lucky AW, Langley RG, Lynde C, Kaufmann R, Todd G, et al. Use of pimecrolimus cream 1% (Elidel®) in the treatment of atopic dermatitis in infants and children: The effects of ethnic origin and baseline disease severity on treatment outcome. Int J Dermatol 2005;44(1):70–75. doi: 10.1111/j.1365-4632.2004.02234.x. Search PubMed
  28. Abędź N, Pawliczak R. Efficacy and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis: Meta-analysis of randomized clinical trials. Postepy Dermatol Alergol 2019;36(6):752–59. Search PubMed
  29. Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatol Online J 2014;5(4):436–40. Search PubMed
  30. Fujita WH, McCormick CL, Parneix-Spake A. An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of pityriasis alba. Int J Dermatol 2007;46(7):700–5. Search PubMed
  31. Callender VD, Alexis AF, Stein Gold LF, et al. Efficacy and safety of crisaborole ointment, 2%, for the treatment of mild-to-moderate atopic dermatitis across racial and ethnic groups. Am J Clin Dermatol 2019;20(5):711–23. Search PubMed
  32. Ware OR, Guiyab J, Okoye GA. Phototherapy in skin of color. Dermatol Clin 2020;38(1):63–69. Search PubMed
  33. Alexis AF. Lasers and light-based therapies in ethnic skin: Treatment options and recommendations for Fitzpatrick skin types V and VI. Br J Dermatol 2013;169 Suppl 3:91–97. Search PubMed
  34. Drucker AM, Eyerich K, de Bruin-Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol 2018;178(3):768–75. Search PubMed
  35. Wollenberg A, Oranje A, Deleuran M, et al. ETFAD/EADV Eczema Task Force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016;30(5):729–47. Search PubMed
  36. Grayson C, Heath CR. Dupilumab improves atopic dermatitis and post-inflammatory hyperpigmentation in patient with skin of color. J Drugs Dermatol 2020;19(7):776–78. Search PubMed
  37. Pagan AD, David E, Ungar B, Ghalili S, He H, Guttman-Yassky E. Dupilumab improves clinical scores in children and adolescents with moderate to severe atopic dermatitis: A real-world, single-center study. J Allergy Clin Immunol Pract 2022;10(9):2378–85. Search PubMed
  38. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med 2016;375(24):2335–48. Search PubMed
  39. Cork MJ, Thaçi D, Eichenfield LF, et al. Dupilumab provides favourable long-term safety and efficacy in children aged ≥6 to <12 years with uncontrolled severe atopic dermatitis: Results from an open-label phase IIa study and subsequent phase III open-label extension study. Br J Dermatol 2021;184(5):857–70. Search PubMed
  40. Alexis AF, Rendon M, Silverberg JI, et al. Efficacy of dupilumab in different racial subgroups of adults with moderate-to-severe atopic dermatitis in three randomized, placebo-controlled phase 3 trials. J Drugs Dermatol 2019;18(8):804–13. Search PubMed
  41. Thibodeaux Q, Smith MP, Ly K, Beck K, Liao W, Bhutani T. A review of dupilumab in the treatment of atopic diseases. Hum Vaccin Immunother 2019;15(9):2129–39. Search PubMed
  42. Li C, Sun X, Zhao K, et al. Efficacy and safety of Janus kinase inhibitors for the treatment of atopic dermatitis: A systematic review and meta-analysis. Dermatology 2022;238(4):725–35. Search PubMed
  43. Anvery N, Christensen RE, Dirr MA. Management of post-inflammatory hyperpigmentation in skin of color: A short review. J Cosmet Dermatol 2022;21(5):1837–40. Search PubMed
  44. Lu Y, Yang J, Xiao K, Pointer M, Li C, Wuerger S. Skin coloration is a culturally-specific cue for attractiveness, healthiness, and youthfulness in observers of Chinese and western European descent. PLoS One 2021;16(10):e0259276. Search PubMed
  45. Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol 2013;131(2):428–33. Search PubMed
  46. Schmitt J, Buske-Kirschbaum A, Roessner V. Is atopic disease a risk factor for attention-deficit/hyperactivity disorder? A systematic review. Allergy 2010;65(12):1506–24. Search PubMed
  47. Xu X, van Galen LS, Koh MJA, et al. Factors influencing quality of life in children with atopic dermatitis and their caregivers: A cross-sectional study. Sci Rep 2019;9(1):15990. Search PubMed
  48. LeBovidge JS, Elverson W, Timmons KG, et al. Multidisciplinary interventions in the management of atopic dermatitis. J Allergy Clin Immunol 2016;138(2):325–34. Search PubMed

Atopic dermatitisDermatologyPaediatricsSkin of colour

Download article