A recent study published by JAMA Dermatology found that race and ethnicity play a role in the prevalence of pediatric skin diseases and the use of dermatology in children. Despite having higher overall rates of skin diseases such as atopic dermatitis (AD), which is a common form of eczema, Black children were found to have less dermatology use than other children.
The cross-sectional study analyzed the health records of 536,776 children from eight children’s hospitals across the U.S. These hospitals were participants in the PEDSnet system. Each child had at least one (or more) dermatology clinic visits or two (or more) non–dermatology clinic visits for AD, acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa (HS). The data for this study spanned nearly 14 years, from January 2009 to July 2022. The data itself was analyzed from January 3 to March 26, 2024.
The average age of a child in this study was 6 or 6.4 years. Roughly half (51.5 percent) of the children were female. While 44.3 percent of the children were white, 27.9 percent were Black, 14.1 percent were Hispanic, 6.4 percent were Asian, 0.2 percent were American Indian or Alaska Native, and 0.3 percent were Native Hawaiian or Other Pacific Islander. There were 377,970 cases of AD, 139, 632 of acne, 54,305 of infantile hemangioma, 11,339 of psoriasis, and 5,722 of HS.
Within the pediatric dermatology care at those eight U.S. hospitals, Black children had higher rates of disease but lower proportions of dermatology use. These children experienced high frequencies of conditions like AD, acne, and HS.
The study found that there were 10,469 cases of AD per 100,000 Black children, while there were only 3,099 cases of AD per 100,000 white children.
According to the findings of this study, dermatologic disease frequencies and dermatology use do, in fact, vary by race and ethnicity. The study noted that additional data needs to be collected on the subject.
“Further research is required to determine whether these patterns represent appropriate specialty care use or reflect gaps in care,” wrote the study’s authors.
According to the National Eczema Association, eczema affects 20 percent of Black children, followed by 16 percent of white children and 8 percent of Hispanic children. Children of color also tend to have more severe cases of eczema than white children.
Black children are 30 percent less likely to see a clinician for eczema treatment than white children. In general, children of color experience worse healthcare than other children across the U.S., including emergency room visits, prescriptions for painkillers, and health complications.
While acne is a common dermatologic condition for children and teens, it can be harder to diagnose in children with darker skin. According to Andrew Alexis, MD, MPH, the chair of dermatology and director of the Skin of Color Center at Mount Sinai, there are major differences in treating patients with SOC (skin of color, typically skin types IV through VI).
“The severity of eczema in SOC can be easily underappreciated since we do not really see the bright red color associated with eczema in white skin; the colors can range from gray to reddish brown to purple or purplish gray,” Dr. Alexis told the NEA. “Beyond color, another example is called the follicular pattern – tiny bumps which are extremely itchy and might correspond with hair follicles. Eczema in SOC may also appear as other types of skin diseases, leading to misdiagnosis.”
Black families are also less likely to participate in clinical trials, given many factors, including medical mistrust and an overall lack of health information. It should be noted that Black families often face higher out-of-pocket healthcare costs for dermatology care.
Pediatric providers must understand the different needs of various skin types and dermatologic disorders, specifically the ones that affect the Black community. This includes AD, acne, and pigmentation disorders. Providers can prioritize supporting patients of color and encouraging clinical trial participation, as most dermatology research is based on white individuals.
Providers should also be aware of how symptoms can present differently in children. Black children are less likely to exhibit erythema or follicular prominence. When it comes to pediatric skin diseases, Black children are more likely to present specific symptoms, including visible symptoms on their legs, arms, and stomach. Some researchers encourage the use of dermoscopy in children of color, which can help improve diagnostic accuracy.
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