Proceedings of the Fifth SKIN SPECTRUM SUMMIT

SSS-2019 02-10-20_Layout 1 2/12/2020 5:17 PM Page 10
ATOPIC
DERMATITIS
Clinical presentation of AD
in children with skin of colour
Dr. Danielle Marcoux
Atopic dermatitis (AD) is more prevalent in children with skin of
colour, specifically children who are of African-American, Asian or
Pacific Islander decent, compared to children with Caucasian skin,
noted Dr. Danielle Marcoux during her presentation at Skin Spectrum
Summit in Montreal.
“Right now, around the world, one in five children have some manifestation
of atopic dermatitis. Fortunately, less than 10 per cent have moderate-severe,”
said Dr. Marcoux.
The clinical presentation of AD is different in both children and adults
with skin of colour compared to patients with Caucasian skin, she said. Different
clinical characteristics include erythema that is more grey, violet or
brown in colour; dyschromia; follicular accentuation, particularly in African-
Americans; and lichenification in Asians, and there is often extensor involvement.
Erythema is an important factor when using the SCORing Atopic Dermatitis
(SCORAD) scale to rate the severity of a child’s AD, said Dr. Marcoux. “If you
adjust the erythema score ... the child could be six times more likely to be
rated as having severe AD.” For example, “if you say there is no erythema, you
lower the score of the child.”
Dyschromia is “a source of anxiety for parents because they see changes
in colour on their children’s skin,” said Dr. Marcoux. “It is all the post-inflammatory
hyperpigmentation. When it is more round and white, we label it pruritus
alba, which [means] white scales.”
“As far as phenotypes, Asians have more well-demarcated lesions with
increased scaling and lichenification,” she noted. However, “in African
Americans, there is more extensor involvement; there is also more perifollicular
accentuation and scattered distinct papules on the extensors and
trunk.”
Dr. Marcoux went on to point out the importance of education:
“Therapeutic education, in all chronic disease, is fundamental; you
don’t just hand out a prescription. [Atopic dermatitis] is disturbing to
parents; they are worried. They really need reinforcement and education.”
Myths and
misconceptions
in AD
Dr. Kevin Pehr
There are a number of ideas
about atopic dermatitis (AD)
that are outdated but are
still being referenced in practices.
Some of these were described by
Dr. Kevin Pehr at Skin Spectrum
Summit in Montreal.
“We used to say, ‘Don’t worry;
the child will outgrow [AD] when he
is a teenager’ or ‘Don’t worry; she will
outgrow it when she is an adult,’”
said Dr. Pehr. In truth, he said, 40%
of pediatric AD cases persist into
adulthood.
With as many as 10% of children
experiencing AD, that means
4% of all people could have the condition
last through their whole
childhood.
Another idea Dr. Pehr would like
abandoned is the use of antihistamines
to treat itching in AD and to
help children sleep.
“I will probably get arguments on
this. Every textbook will tell you ‘antihistamines’!
No, no, no.”
“There is no histamine release
involved [in AD],” he said. “Yes, if
you give [children] enough at bedtime,
they will fall asleep because
you drugged them with the anti-
10 • Proceedings of 2019 SKIN SPECTRUM SUMMIT