313 Assessment of racial differences of atopic dermatitis characteristics in a diverse outpatient cohort in the United States

Abstract

Abstract Atopic dermatitis (AD) can present differently across racial groups. To promote equality and consistency, dermatologists and other providers should properly recognize the heterogeneous manifestations of AD across racial groups. Yet, little is known about differences in how the commonly different features of AD occur by race. We assessed racial differences in the proportions of select key features of AD. The healthcare claims database from a large metropolitan tertiary care medical centre was queried for patients with physician-diagnosed AD using International Classification of Disease, Tenth Revision and Clinical Modification codes L20.x. Medical records were reviewed for demographics, comorbidities and documentation of Hanifin-Rajka criteria. The frequency of each criterion was evaluated by race (White, Black, Asian and Multiracial–Other). Overall, 766 patients with AD were included in the study; 374 (48.8%) were White, 284 (37.1%) Black, 89 (11.6%) Asian and 19 (2.5%) multiracial/other, 558 (68.2%) were female, 50 (6.1%) were age <18 years, 456 (55.7%) age 18–49 years and 313 (38.2%) age ≥50 years. Compared to White patients, Black patients had significantly higher proportions of personal (81.4% vs. 57.3%) and family (63.3% vs. 42.2%) history of atopic disease, perifollicular accentuation (60.6% vs. 36.9%) and xerosis on physical exam (84.2% vs. 73.9%)(P ≤ 0.03 for all). Multiracial/other patients had elevated proportions of a history of dry skin (81.3%), xerosis on physical exam (86.7%) and elevated Immunoglobulin E levels (75.0%). Black and multiracial/other patients had food hypersensitivity compared to White patients (50.0% and 71.4% vs. 35.1%, P = 0.04). There were marginally significant differences in the proportion of early-age AD onset (56.9% vs. 41.8%, P = 0.07) and anterior neck fold involvement (42.6% vs. 25.3%, P = 0.06) in Asian compared to White patients. There were no significant racial differences in the likelihood of other Hanifin-Rajka criteria, including pruritus, flexural dermatitis, chronic dermatitis, ichthyosis, nipple eczema, hand/foot dermatitis, immediate skin reactivity, subcapsular cataracts, cutaneous infections, pruritus when sweating, intolerance to wool/lipid solvents, environmental/emotional factors worsening AD, or white dermatographism. Our results suggest there are racial differences in AD characteristics even within a single region. These differences may be attributable to population-differences in genetics, environmental exposures, skincare practices etc. Future research is needed to understand the mechanisms and treatment responses of these heterogeneous AD presentations.