Suggested criteria added for diagnosing eczema in patients with skin of color
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Key takeaways:
- There may be value to adapt the original major and minor criteria to account for diverse patient populations.
- Suggested diagnostic guidelines include the addition of one major and four minor criteria.
NEW YORK — Speakers at the Skin of Color Update 2023 meeting discussed the additional diagnostic criteria that are necessary to consider in order to properly diagnose eczema in patients with skin of color.
Andrew F. Alexis, MD, MPH, cofounder and cochair of Skin of Color Update, and Shawn G. Kwatra, MD, director of the Johns Hopkins Itch Center and associate professor of dermatology at Johns Hopkins Medicine, participated in an expert panel on diagnosing and treating eczema in patients with skin of color.
In their presentation, the pair referenced a study they published this year in Dermatology Clinic where they addressed the lack of diversity in the standard guidelines for diagnosing eczema, explaining that there may be value to adapt the original major and minor criteria to account for diverse patient populations.
The current major criteria includes four points: pruritus, typical morphology and distribution, chronic or chronically relapsing dermatitis and personal or family history of atopy. Under “typical morphology and distribution” are two sub-criteria: flexural lichenification and extensor eruptions in infants and children.
However, these criteria exclude manifestations often seen in patients with skin of color. Therefore, as another sub-criterion beneath “typical morphology and distribution,” Kwatra and his colleagues suggest the addition of “extensor papular involvement, lichenification or psoriasiform thickening of skin in skin of color patients.”
According to Kwatra, many residents assume that papular involvement can only be in the flexural areas to be considered eczema. However, “this is incorrect,” he said.
“You definitely can have extensor areas, especially in skin of color patients,” Kwatra continued.
Kwatra also suggests the addition of four additional criteria in the minor criteria category, which currently consist of 22 points. The first suggested addition was dyspigmentation including post-inflammatory hypopigmentation and hyperpigmentation followed by psoriasiform scaling, perifollicular accentuation and secondary papular involvement/prurigo nodule formation.
Editor's note: On Oct. 9, the headline and fifth paragraph of this article were corrected to clarify that the researchers suggested criteria changes. The editors regret the error.
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