Scorecard improves atopic dermatitis identification in varied skin tones among infants
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Key takeaways:
- There is no gold standard for evaluating atopic dermatitis among infants with different skin tones.
- Photographs used in the scorecard included white, Black, mixed race and Hispanic/Latino infants.
A picture-based scorecard with multiple skin tones facilitated the assessment of atopic dermatitis among infants, according to a study published in Annals of Allergy, Asthma & Immunology.
By improving diagnosis and characterization of AD among infants, providers may be able to prevent peanut allergy, Waheeda Samady, MD, associate professor, pediatrics, Northwestern Feinberg School of Medicine, and colleagues wrote.
AD affects up to 20% of children, the researchers wrote, whereas a third of children who have moderate or severe AD also have a documented food allergy.
By diagnosing AD in a timely manner, the researchers wrote, providers can better manage and treat the disease, improving sleep and quality of life while minimizing risks for food allergy, environmental allergy and asthma.
There is no gold standard for evaluating AD, which is heterogenous with differences across skin tones, the researchers wrote, prompting them to develop a picture-based, infant validated Investigator Global Assessment scale for AD (vIGA-AD) scorecard that focuses on diverse skin tones.
The researchers recruited 13 infants from clinics at Lurie Children’s Hospital between August 2019 and April 2020. Researchers photographed six of these infants, and parents photographed seven. Both groups used a standardized dermatologic photography protocol.
Two dermatologists evaluated 58 of these photographs and determined the severity of AD pictured in each one. They agreed about the severity of the AD in 84% of these photographs during their first pass through them.
The scorecard that resulted from these assessments included photos from two white infants, two Black infants, one mixed race infant, and two Hispanic/Latino infants. They included five mild, five moderate and four severe AD cases. An instructional video on AD identification and classification accompanied the scorecard.
The researchers emailed surveys to 159 pediatricians who used the scorecard for 18 months, and 110 (69.2%) responded between December 2022 and April 2023. Responders were 77.3% white and 7.3% Hispanic/Latino, as well as 85.5% female.
Also, 40% had been practicing for 10 years or less, 31.8% had been practicing for 11 to 20 years, and 48.2% engaged in direct care of children 4 or more days each week.
In the survey, 25.5% of respondents called the picture-based, vIGA-AD scorecard “moderately” helpful and 53.7% said it was “very” or “extremely” helpful.
Responses also included 34.5% who said they “sometimes” used the scorecard for AD evaluation and 10% who said they used it “very often” or “always.”
Respondents further said that the scorecard “moderately” (35.5%), “very” (30%) or “extremely” (7.3%) improved their ability to diagnose and categorize AD.
Based on these findings, the researchers said that their picture-based scorecard including multiple skin tones facilitated identification of AD in infants among pediatricians, improving diagnosis and potentially preventing peanut allergy.
The National Institute of Allergy and Infectious Diseases recommends that infants with severe eczema and/or egg allergy should be introduced to peanut as early as age 4 to 6 months, and infants with mild to moderate eczema should be introduced to peanut around age 6 months, to prevent peanut allergy.
The researchers also said that they are continuing to collect photos of infants with diverse skin tones.
Perspective
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It is absolutely crucial to include different skin tones in diagnostic tools like this. Clinical presentations can vary widely in different skin types, and diagnostic tools are only useful when they encompass the full range of presentations. Also, historically, inclusion of skin of color has been lacking. This tool has the potential to facilitate diagnosis among pediatricians, but further evaluation will be needed in real-world settings. Further work is needed to improve diagnosis of dermatologic conditions in diverse patient populations, but this is a promising effort in that direction.
Perspective
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This was an interesting intervention and exciting to read. It addresses two big issues, the first being supporting pediatricians to increase education on how to classify infant AD to guide early food introductions, and the second being the need for more education on the presentation of AD in skin of color.
There has been more attention to diversity in presentation of AD over the last few years. As we discussed previously, AD is more common among Black, Asian and Pacific Islander patients, especially in children. Black and Hispanic children tend to develop more severe cases of AD compared with white children and are more likely to miss school due to their AD.
In a report released by the American College of Allergy, Asthma & Immunology in 2022 addressing racial disparities in AD and food allergies, two of the recommended solutions were “Increase awareness and understanding among primary care physicians — and leverage community outreach to educate patients” and “Develop a photo library of atopic dermatitis in people of color.” This article addresses both of those needs.
Also, while the Eczema in Skin of Color website has some great images in its image gallery, images in children are lacking. This article is a great step toward addressing this need. I look forward to their ongoing studies.
Reference:
Racial disparities in atopic dermatitis and food allergy: Physician and advocacy experts describe pervasive problems and identify a top 10 solutions agenda. https://acaai.org/wp-content/uploads/2022/11/Racial-disparities-roundtable-white-paper-final.pdf. Accessed July 8, 2024.
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