Nov 7, 2019
Pediatric atopic dermatitis (AD) is more prevalent in African
American children. Dr. Lynn McKinley-Grant, president of the Skin
of Color Society, talks with Dr. Amy McMichael about the
quality-of-life impact on pediatric patients with AD as well as
skin care in this patient population. They also discuss the
clinical presentation of
AD in the skin of color population. “We have to open our minds
up to all of the ways that atopic dermatitis can look in every skin
type,” Dr. McMichael says. “Then we don’t miss it, and we don’t
minimize how severe it is when we’re taking care of those
patients.”
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We bring you the latest in dermatology news and
research:
1. Nemolizumab for prurigo nodularis impresses in phase 2b
study
Interleukin-31 signaling is a promising therapeutic target in
prurigo nodularis.
2. Acoustic pulse boosts laser tattoo
removal
Device “clears” skin cells after single passes and allows single
office visits to pack more punch.
3. Severe psoriasis associated with increased cancer risk,
mortality
Because these were associations only, any
underlying mechanism is still unclear.
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Things you will learn in this episode:
- African American children with AD (aged 2-17 years) have a
1.5-fold higher chance of being absent for 6 days in a 6-month
school period than do non-Hispanic children, and they have higher
chronic absenteeism, compared with white children.
- Some parents/guardians purchase topical products with
fragrances that are inappropriate for patients with AD. “Consumers
have no idea what’s good, so they just buy them and they use them,”
Dr. McMichael says. “They can often make things a lot worse.”
- Resident training should focus on learning how skin diseases
present in all skin types. “You do have to be cognizant of pigment
being present and wonder, ‘OK, is this postinflammatory or is this
truly inflammatory?’ ” Dr. McMichael advises.
- For children who want to engage in athletics, treatment should
be more aggressive. Consider using systemic treatments more readily
or prescribing dupilumab (Dupixent).
“We have to be cognizant of when flares occur that perhaps these
patients should not participate in activities at that time, but if
they want to -- and certainly it’s healthy to do so -- then we need
to step up to the plate and treat them appropriately,” emphasizes
Dr. McMichael.
- Patients with AD have a higher prevalence of contact
sensitization to fragrances, including balsam of Peru. It is
essential to find out what products your patients with AD are using
on their skin. Ask them such questions as: What are you using
to cleanse your face? What are you using as a moisturizer? Do you
put anything else on your face or skin?
- Debunk inaccurate information that your patients and parents
are consuming about AD medications. “You have to encourage them
that it’s not all about steroids. We have other options now and
that they need to consider them,” Dr. McMichael adds.
Hosts: Lynn McKinley-Grant, MD (Howard
University College of Medicine, Washington, DC)
Guests: Amy
McMichael, MD (department of dermatology, Wake Forest
University, Winston-Salem, N.C.)
Show notes by: Jason Orszt, Melissa Sears,
Elizabeth Mechcatie
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