Advanced Systemic Therapies for Pediatric Atopic Dermatitis and Skin of Color: A Review and Strategies for Improving Trialist Involvement

Atopic dermatitis (AD) is a leading dermatological condition presenting in children and adolescents. Nearly one-fifth of children globally are diagnosed with AD, with higher prevalence and increased disease burden observed among racial minority groups, particularly children of African and Asian descent. Systemic therapies are a key component of managing moderate-to-severe atopic dermatitis; however, their safety and efficacy profiles may vary among pediatric patients with skin of color due to differences in disease phenotype, immune response, and underrepresentation in clinical trials. We aimed to investigate the literature for ethnic and racial representation of pediatric patients with AD in clinical trials of advanced systemic therapies. A rapid review was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 16 studies representing 21 clinical trials and 3148 patients were included. White patients represented over half of the total participant population investigated across all studies. Asian and Black demographics were the least represented at 16.7% and 9.4%, respectively. None of the clinical trials that were analyzed conducted a subset analysis of therapy outcomes for racial and/or ethnic variability. Although Black and Asian populations are disproportionately affected by atopic dermatitis, our review provides strong evidence of their continued underrepresentation in pediatric dermatological AD clinical trials. Adequate representation may be achieved by addressing frequent barriers, including mistrust in healthcare research, language barriers, lack of trial awareness, and logistical challenges of clinical trial participation.