Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Clinical Features and Management of Inflammatory Dermatologic Conditions in East Asian Patients
Description
The presentation reviewed how inflammatory dermatologic diseases can appear differently in East Asian patients because of genetic, environmental, and cultural factors, and emphasized that these differences matter for diagnosis and treatment. A key example was atopic dermatitis in East Asian patients, which may look psoriasiform with well-demarcated, scaly, extensor-distributed lesions rather than classic flexural eczema; despite this appearance, the underlying type 2 inflammatory pathway remains important and biologics such as dupilumab can be effective. The talk also highlighted dupilumab-associated head and neck dermatitis, noting that it may involve Malassezia and can improve with antifungal treatment plus topical therapy. Other conditions discussed included palmoplantar pustulosis, which is more common in East Asia, often linked to smoking and metal allergy, and may be associated with SAPHO syndrome when joint or chest pain is present. Prurigo pigmentosa was described as a reticulated papular eruption associated with ketosis, fasting, or ketogenic diets, typically treated with tetracyclines such as minocycline. Finally, Behçet disease was reviewed as a Silk Road disease with mucocutaneous findings including oral and genital ulcers, erythema nodosum-like lesions, and sterile papulopustules, with management ranging from colchicine and corticosteroids to immunosuppressants, apremilast, and TNF inhibitors in severe cases. The speaker concluded by stressing the need to recognize ethnic patterns, avoid diagnostic bias, consider post-inflammatory hyperpigmentation in darker skin, and ask about diet and cultural practices.
View moreConclusions
- East Asian patients can show distinctive inflammatory skin disease patterns that differ from textbook descriptions, so ethnicity should be considered in diagnosis and treatment.
- Atopic dermatitis in East Asian populations often presents with more demarcated, psoriasiform, extensor or trunk-predominant lesions, yet still responds well to Th2-targeted therapy such as dupilumab.
- Dupilumab can improve Asian phenotype atopic dermatitis substantially, but clinicians should watch for complications such as head and neck dermatitis that may involve Malassezia and require additional treatment.
- Palmoplantar pustulosis is more common in East Asia, often occurs without classic plaque psoriasis, and is strongly associated with smoking and metal allergy.
- Patients with palmoplantar pustulosis who develop musculoskeletal symptoms should be evaluated for SAPHO syndrome.
- Prurigo pigmentosa should be suspected when a reticulated truncal rash with residual hyperpigmentation occurs, especially with ketosis-related triggers such as fasting or ketogenic diets.
- Prurigo pigmentosa is often treated effectively with tetracyclines, but post-inflammatory hyperpigmentation may persist after inflammation resolves.
- Behçet disease is a Silk Road–associated multisystem disorder with especially high prevalence in Turkey and East Asia and characteristic oral, genital, ocular, and skin involvement.
- Colchicine, corticosteroids, immunosuppressants, and newer targeted agents can be effective for Behçet disease depending on severity and organ involvement.
- A practical clinical takeaway is that awareness of ethnic variation, cultural factors, and common triggers improves recognition, avoids misdiagnosis, and leads to better management of inflammatory dermatologic conditions.
- Kozera, E., et al. Br J Dermatol, 2022, 186(6): 1050-1052.
- KOZERA E, et al. Br J Dermatol, 2022, 186(6): 1050-1052.
- INTERNATIONAL STUDY GROUP FOR BEHCET'S DISEASE. Lancet, 1990, 335:1078-1080.