Dermatological Conditions like Eczema Can Be More Severe for individuals with Black or Latinx skin-Explanation of the Cause
"Man, that itchin' was relentless," recalls dermatologist Oma Agbai, MD, about a Black patient she once treated for severe eczema. This woman, an adult by then, had endured eczema since childhood with little improvement, and after a sleepless night, she sought Dr. Agbai's help. Her skin, thin and discolored from years of topical steroid use, was a stark reminder of the battle she'd been fighting.
Dr. Agbai, who serves as the Director of Multicultural Dermatology and Hair Disorders at the University of California, Davis, Health, candidly admitted, "For patients with severe eczema, using topical treatments is like trying to put out a house fire with a garden hose. Often it's just not enough."
Unfortunately, the story of under- treatment and unmet needs is all too common for Black and Latinx individuals with eczema. In a 2023 study, these communities were found to be disproportionately affected, with many struggling to access proper care, experiencing persistent symptoms, and facing emotional turmoil as a result.
Eczema is a group of inflammatory skin conditions that manifest as itchy skin, scaly patches, rashes, and blisters. While the exact cause is still uncertain, research points to an overactive immune system, a weakened skin barrier, and filaggrin-related genetic mutations as possible culprits. When someone lacks enough filaggrin, their skin becomes more susceptible to irritation and eczema flare-ups.
Approximately 7% of American adults have eczema, according to recent Centers for Disease Control and Prevention data. Women are more prone to the condition, and Black and Latinx individuals tend to grapple with more persistent and severe symptoms than other racial and ethnic groups.
Dr. Agbai has witnessed the emotional toll eczema takes on her patients. "One woman confided in me that her eczema had caused anxiety and depression," she remembers. "She felt like no one truly understood how bad things were."
To demolish the disparities in eczema care that Black and Latinx individuals face, understanding the root causes is crucial. Researchers have begun to uncover explanations, tracing genetic and environmental factors, financial constraints, and access to care as primary contributors.
Genetic and environmental factors play a part. For instance, a Cincinnati Children's Hospital Medical Center study discovered multiple gene variants in Black Americans linked to the risk of developing atopic dermatitis – the most common type of eczema. This genetic predisposition might help explain why Americans with African ancestry are more susceptible to this ailment. Additionally, family history of eczema, allergies, or asthma increases the likelihood that someone develops the condition, with these conditions being more prevalent in communities of color. Black Americans are also 1.5 times more likely to be diagnosed with asthma than individuals of other races and ethnicities.
Underlying differences in disease presentation, immune responses, and skin barrier function in people of color can drive more severe eczema. Additionally, underrepresentation in clinical trials, systemic barriers to care, misdiagnosis, and underdiagnosis, and limited awareness among healthcare providers concerning the unique clinical features of eczema in skin of color all contribute to under-treatment.
Nevertheless, recent years have seen an increase in research focused on addressing the unique needs of patients with skin of color. Efforts to develop new objective measures for assessing disease severity and evaluating newer treatments like biologics specifically in these populations are underway. Yet, ongoing efforts are needed to improve clinical trial diversity and ensure equitable access to effective treatments.
- Dr. Agbai's patient's severe eczema, persisting despite years of treatment, highlights the medical-conditions and health-and-wellness challenges that individuals of color often face, especially in the context of skin-conditions like eczema.
- The 2023 study underscores the significance of addressing genetic and environmental factors in understanding skin-conditions like eczema, revealing higher risk and prevalence of atopic dermatitis in Black Americans, which may be attributed to specific gene variants and familial history of related conditions.
