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Atopic Dermatitis in SOC

CE / CME

Addressing the Disproportionate Burden of Moderate to Severe Atopic Dermatitis in Patients With Skin of Color: Expert Perspectives for NPs and PAs

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit

Released: January 15, 2025

Expiration: January 14, 2026

Victoria Garcia-Albea
Victoria Garcia-Albea, PNP, DCNP
CME/CE Information

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Patient Perspective: Psychosocial Burden of AD

Let’s hear from a patient on their experience with AD.

Epidemiology, Pathogenesis, and Comorbidities

AD is a very common condition with significant clinical implications. Data indicate that the disease affects approximately 3% to 20% of children, with onset typically occurring between 3 to 6 months of age.1 Of patients diagnosed with AD, 60% develop the condition by age 1 and 85% by age 5, demonstrating that the majority of cases emerge during early childhood.2 Up to 60% of cases persist into adulthood, suggesting a chronic disease trajectory. Although 40% of patients may outgrow the condition, clinicians should exercise caution when discussing prognosis as it is not a guarantee.2 It is important to note that approximately 1 in 4 adults with AD report symptom onset in adulthood, even without a childhood history of the disease.3

AD is characterized by cycles of flares and symptom exacerbations, followed by periods of remission, with this pattern repeating and worsening over time. Real-world evidence demonstrates the challenging nature of this condition, with patients experiencing an average of 7.5 flares annually—more than once every other month.4 Furthermore, 74.2% of patients report either no remission or less than 3 months of symptomatic relief within a 12-month period.5

This pattern underscores the chronic, relapsing, and remitting nature of AD, highlighting the significant impact on patient quality of life and the need for comprehensive management strategies.

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Epidemiology of AD in Racial and Ethnic Minorities

Patients with AD demonstrate a higher prevalence in urban areas compared to rural or suburban settings. In particular, Black children in urban areas exhibit a significantly increased incidence of this condition.

In the United States, approximately 9.6 million children have AD. Among these patients, 16% are European American and 19% are Black, indicating a higher proportion among Black pediatric patients. For adults with AD, the distribution shows a more balanced representation: 13% are Asian or Pacific Islander, 11% are White American, 10% are Black, and 13% are Native American.6 This adult demographic pattern contrasts with the pediatric distribution, where Black children demonstrate a markedly increased likelihood of developing the condition.7,8

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Social Determinants of Health

Social determinants of health play a significant role in patients with AD. Patients experiencing economic instability—including parental unemployment, lower income, high expenses, and increased debt—face substantial health disparities.

Similarly, patients living in neighborhoods or physical environments that limit opportunities for exercise, outdoor play, or escape from pollution, as well as those facing lower education opportunities, literacy barriers, or language obstacles, are at higher risk. Additional factors, such as food insecurity and community or social barriers—including elevated stress, experiences of discrimination, and lack of social support systems—further contribute to negative health outcomes.9

Healthcare access represents another crucial dimension of these social determinants. Patients with lower health coverage, reduced access to medical appointments, and diminished quality of care experience significant negative impacts on their overall health outcomes. These challenges collectively impact patients’ overall health outcomes, including mortality, morbidity, life expectancy, healthcare expenditures, health status, and functional limitations. It is essential to account for these determinants when assessing and managing patients with AD to provide comprehensive and effective care.9

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Impact of Health Disparities on AD Outcomes

Specifically, healthcare disparities have a significant impact on the outcomes of patients with AD. Racial and ethnic minority patients are more likely to have treatment-resistant disease, meaning that even when receiving the standard of care, their treatments are less likely to be effective. These patients are also more likely to face poor social determinants of health, such as lower socioeconomic status, including annual incomes of less than $30,000, living in older homes or multiple homes, and having lower levels of education.7,10

Black and Hispanic patients are more likely to have moderate to severe disease manifestations. Specifically, Black and Asian children demonstrate increased AD-related office visits, suggesting more challenging disease control and management. Despite the need for frequent medical attention, these patients often encounter greater challenges in assessing care.11,12

Healthcare professionals (HCPs) must recognize and address these systemic challenges to ensure comprehensive care for all patients, regardless of racial or ethnic background.

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Impact of Environment on AD

The environment plays a significant role in AD. Stress is a known trigger for symptoms, highlighting the importance of a strong social support system for these patients. Nutrition also impacts disease outcomes, as dietary diversity has been shown to modulate allergic symptoms.13,14

Environmental factors, including anthropogenic conditions, such as air quality and pollution, negatively influence disease outcomes. Urban environments characterized by worse air quality and more pollution levels consistently correlate with increased disease severity. Patients residing in densely populated urban areas are more likely to experience more challenging disease control. Climate-related factors – including temperature fluctuations, UV light exposure, and humidity levels – further contribute to the complex environmental landscape affecting patient health.13,14 

HCPs must comprehensively assess these environmental determinants when developing treatment strategies.

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Economic Factors Impacting Black Patients

Economic factors disproportionately affect Black patients with AD. Data show that they tend to be younger, experience lower household incomes, and are more frequently enrolled in Medicaid health insurance programs. They are more likely to live in urban areas, experience poorer disease control, and have higher rates of skin infections.15

Racial factors directly influence healthcare economics, with Black patients experiencing notably higher out-of-pocket costs for prescription medications, as these prescriptions are less frequently covered by insurance. They also have increased emergency room visits, partly due to reduced access to dermatology care in many areas, and undergo more outpatient laboratory testing.15

The financial impact extends beyond immediate medical expenses. These patients face a higher likelihood of financial strain on their families. More out-of-pocket expenses often impact household budgets and reduce their available disposable income, limiting the ability for patients to afford items that may improve disease management, such as humidifiers, dust mite covers, and high-quality vacuums.15

HCPs must critically examine these systemic barriers and recognize that economic constraints directly compromise comprehensive disease management.

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