Peter A. Lio, MD: Treating Mild-to-Moderate Atopic Dermatitis in Skin of Color

At the 2023 Fall Clinical Dermatology Conference in Las Vegas, Peter A. Lio, MD, spoke with the HCPLive editorial team about updates on treating atopic dermatitis (AD) in patients with skin of color or richly pigmented skin.

Lio is known for his work as clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine, as well as a Fellow of the American Academy of Dermatology.

“(In my presentation) I was talking about skin of color with atopic dermatitis, how it's more prevalent, and how it may be even a little more severe,” Lio said. “And at the same time, it's harder to diagnose and sometimes is under-diagnosed. Because of melanin-rich skin it is harder to actually appreciate some of the erythema. So we have to be particularly guarded and really proactive about making sure that we have the right diagnosis, the right severity and get the right treatments for those patients.”

Lio went into the topic of diagnosing AD in this patient population, noting that the diagnosis of atopic dermatitis can be somewhat tricky.

“Usually we know when we see it, but in particular with darker skin types, we have different morphologic presentations,” he said. “So a greater tendency towards lichenification, more follicular lesions, sometimes more prurigo-type appearance, so that can be confusing. But then we also have more difficulty trying to perceive the redness, the erythema, because the melanin absorbs some of that. So we have these two pieces of the puzzle that we have to make sure, and it can be difficult.”

Later, Lio commented on the prevalence and characteristics of AD in different ethnic groups and skin types.

“We know that it's an incredibly common disease,” he said. “It affects people from all walks of life. But it turns out that the numbers may be slightly higher and Black patients and potentially patients of Asian extraction. So there, there may be these certain groups that have a higher tendency, and maybe even higher severity of disease. Some of the problem is that because the studies have not always been the most inclusive, we don't have as much data in some groups.”

Lio added that there has been a push among dermatologists to learn more and to understand why the burden may be higher in some patients, as well as why the overall disease may be more severe in some groups.

Lio was asked about specific treatment considerations or approaches for managing the skin disease in skin of color, and the ways they may differ from treatment in lighter skin tones.

“I think by and large, the approach is pretty similar,” he said. “And I would say that it is ultimately similar no matter what color, no matter what age, and to some degree, even no matter what type or morphologic pattern of eczema. We kind of go through the same therapeutic ladder. But certainly if you have very thick like halophyte areas, you might have to use something a little stronger to get through that. If you have very dark skin, then using phototherapy at a low level, it's going to waste everybody's time. Conversely, if you have very light skin, then if you use too much phototherapy, you're more likely to burn or cause photoaging and damage.”

Lio concluded, however, that the therapeutic ladder is essentially very similar between all skin types.

He was then asked about future treatments and clinical data, going into specifics and broadly addressing the potential of the treatments.

“Over 100 new treatments are in development for atopic dermatitis,” Lio said. “It is unbelievable. We are all going to be very busy in the next few years. Obviously all of them probably won't make it to market. But even if a handful make it to market, our patients benefit. We benefit as clinicians to learn more about them and have more tools in our toolbox. But there are a couple that are very, very close to coming out.”

For more information provided by Lio, view the full interview listed above.

The quotes contained in this description were edited for clarity.