Presentations of Cutaneous Disease in Various Skin Pigmentations: Atopic Dermatitis

Date

2023

Authors

Thompson, Jordan
Nguyen, Cecilia
Nguyen, Daniel
Wong, Christopher
Scheufele, Christian
Carletti, Michael
Weis, Stephen

ORCID

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Abstract

Background

Atopic dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin disorder classically affecting flexural areas of the body. It presents in any age group, but commonly develops during infancy and early childhood and morphologic subtypes exist due to varying skin tones. Children with darker skin were approximately six times more likely to develop atopic dermatitis in comparison to children with lighter skin. African American and Asian patients more frequently have atopic dermatitis compared to Caucasian patients. Presentations of atopic dermatitis vary due to duration, age and color of skin. Acute lesions are clinically characterized as ill-defined pruritic, erythematous plaques (raised, >1cm) while chronic lesions are dry, hyperpigmented plaques (raised, >1cm) with lichenification and prurigo nodules. Differential diagnosis includes scabies, seborrheic dermatitis, ichthyoses, and psoriasis. This review article will showcase clinical images with varying presentations of atopic dermatitis in ranging age groups and skin color according to the Fitzpatrick scale.

Case Information

The Fitzpatrick scale provides a classification system for an individual’s skin type based on the ability to burn and/or tan when exposed to ultraviolet light. It is used to approximate the degree of skin pigmentation. This review article focuses on 5 distinct cases of varying ages and skin types to present 5 atypical presentations of atopic dermatitis. Case 1 presents a 40-year-old, Fitzpatrick I, with chronic atopic dermatitis. Case 2 presents a 6-month-old, Fitzpatrick III, with acute atopic dermatitis. Case 3 presents a 11-year-old, Fitzpatrick IV, with subacute atopic dermatitis. Case 4 presents a 21-year-old, Fitzpatrick IV, with chronic atopic dermatitis. Case 5 presents a 3-year-old, Fitzpatrick V, with chronic atopic dermatitis.

Discussion

In the United States, atopic dermatitis affects approximately 11.3 – 12.7% and 6.9 – 7.6% of children and adults, respectively. Presentations of atopic dermatitis can vary due to duration, age and color of skin. Post inflammatory dyspigmentation is observed more in African American patients due to decreased healthcare access and different clinical manifestations, notably with erythema. Atopic dermatitis can have a significant quality of life impairment and disease burden in diagnosed individuals, especially those with darker skin pigmentation. The disease can progress to a systemic disorder, "atopic march” causing allergic conditions including asthma, allergic rhinitis and food allergies. Pruritus, a hallmark symptom of atopic dermatitis, may lead to increased sleep disturbances, fatigue, and mental health symptoms which ultimately affects growth, school performance, attention, and accident rates in children. Atopic dermatitis has been linked to attention-deficit hyperactivity disorder in children and increased rates of depression and anxiety in teengagers and adults. The purpose of this review article is to outline atypical presentations of atopic dermatitis to allow practitioners to gain a better understanding to aid in diagnosing patients with different skin tones.

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