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Understanding eczema
For her entire life, April has lived with dry, itchy skin, experiencing frequent thinning and scarring of her skin due to insistent itching. Atopic dermatitis, also called eczema, is much more than just a rash. April is one of nearly 16.5 million people in the U.S. who lives with eczema.1
The often-uncomfortable symptoms of eczema can cause severe itchiness, which can lead to more scratching causing skin to crack and bleed, contributing to self-isolation, anxiety and depression.2-4 While the disease can affect anyone, it often appears differently on varying skin tones,5 and on darker skin tones, the signs can be masked due to skin pigmentation and result in delayed diagnosis and care.6
"I wasn't aware of research on skin conditions like eczema in my community, and I spent most of my childhood treating my condition with home remedies, uneducated on the various treatments available to help manage my skin," shared April.
According to research, Black Americans are more likely to develop more severe cases of eczema,7 and more generally, people with skin of color may have a disproportionately higher prevalence of skin conditions.8 Yet people with skin of color, like April, are often underrepresented in care and research. This can unfortunately lead to the people who need care most being less likely to pursue or receive appropriate treatment for their disease.
"There is a lack of knowledge," said April. "I tried working with dermatologists, but it wasn't helpful; I felt judged and observed, instead of helped. We need doctors to have more education on how this disease can affect a patient's mental health...someone that is understanding of the condition and willing to help."
Dr. Maria Jose Rueda, M.D., head of dermatology medical affairs at Eli Lilly and Company (Lilly) and trained dermatologist, has seen firsthand how the lack of education for health care providers can unintentionally lead to a feeling of judgement and mistrust among patients. "The issue is that some people don't trust health care providers and the system and aren't able to find a provider who knows about their type of skin and understands the differences that they may have. Gaps in care have four major root causes including cultural diversity, socioeconomic disadvantages, racial/ethnic biases and inadequate training for health care providers or lack of research including underrepresentation in medical research. At Lilly, we are working with some of the most prominent experts in the field to educate and address some of these gaps."
Making a change
Lilly is focused on creating solutions that strengthen the relationship between health care providers and patients with eczema by advancing treatment conversations and opening the lines of communication between both groups. For example, Lilly is:
- Engaging in impactful research that improves patient care to increase understanding of clinical management from diagnosis to treatment such as conducting a clinical trial specifically for people of color with eczema.
- Supporting health care providers with education on the journey people with skin of color face and the understanding of eczema by collaborating to develop educational webinars and training modules.
- Empowering the patient voice to increase understanding of common care challenges so people can make their needs known and actively partner to find impactful solutions. For example, Lilly surveyed over 1,200 adults with dermatologic conditions to highlight challenges and foster discussion among health care providers, patients, and community members.
There is a lot of work left to be done, but first we need to address the critical health disparities in the field of dermatology for people with eczema and skin of color.
"At Lilly, we strive to be a leader in addressing the health needs of underserved populations. We are dedicated to creating meaningful change and amplifying the voices of these underserved patients and raising awareness of the challenges they face," shared Dr. Rueda.
Resources to help you decide what treatment is right for you
Lilly's website features more information about the company's commitment to health equity and how Lilly is advancing care in dermatology. For more information on eczema, including a list of local health care providers with experience diagnosing and treating this condition, visit the National Eczema Association.
References
1. Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. 2019;139(3):583-590. doi:10.1016/j.jid.2018.08.028
2. Nelson, S. (2023, January 3). Mental health and eczema - seeing the unseen. National Eczema Association. https://nationaleczema.org/blog/mental-health-science/#:~:text=The%20effects%20of%20AD%20on,on%20work%20absenteeism%20or%20productivit
3. Chandan N and Lio P. The shape of atopic dermatitis. Practical Dermatology June 2019:64-78. Available at: https://practicaldermatology.com/articles/2019-june/the-shape-of-atopic-dermatitis
4. Lohman ME and Lio P. Comparison of psoriasis and atopic dermatitis guidelines - an argument for aggressive atopic dermatitis management. Pediatr Dermatol 2017;34(6):739-42.
5. Sangha AM. Dermatological conditions in skin of color-managing atopic dermatitis. J Clin Aesthet Dermatol. 2021;14(3 suppl 1): S20-S22.
6. Adelekun A, Onyekaba G, Lipof JB. Skin color in dermatology textbooks: An updated evaluation and analysis. J Am Acad Dermatol. 2021 Jan;84(1):194-196.
7. National Eczema Association. Eczema in skin of color: What you need to know. Available at: https://nationaleczema.org/skin-of-color/
8. McKenzie S, Brown-Korsah JB, Syder NC, Omar D, Taylor SC, Elbuluk N. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color. Part II: Differences in clinical presentation and disparities in cutaneous disorders in skin of color. J Am Acad Dermatol. 2022 Dec; 87(6):1261-1270.
