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Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

Lookup NU author(s): Professor Nick ReynoldsORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 American Academy of Dermatology, Inc. Background: Few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types. Objective: To investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type. Methods: In an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL ( and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; registries, data on morphological phenotypes and treatment outcomes were investigated. Results: A total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05). Limitations: Unblinded, non-randomized. Conclusion: Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

Publication metadata

Author(s): Bosma AL, Ouwerkerk W, Heidema MJ, Prieto-Merino D, Ardern-Jones MR, Beattie P, Brown SJ, Ingram JR, Irvine AD, Ogg G, Patel P, Reynolds NJ, Hearn RMR, Wan M, Warren RB, Woolf RT, Hyseni AM, Gerbens LAA, Spuls PI, Flohr C, Middelkamp-Hup MA

Publication type: Article

Publication status: Published

Journal: JAAD International

Year: 2023

Volume: 10

Pages: 14-24

Print publication date: 01/03/2023

Online publication date: 10/11/2022

Acceptance date: 18/09/2022

Date deposited: 28/11/2022

ISSN (electronic): 2666-3287

Publisher: Elsevier BV


DOI: 10.1016/j.jdin.2022.09.006


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Funder referenceFunder name
Manchester NIHR Biomedical Research Centre
NIHR Newcastle Biomedical Research Centre