Patients with dark skin and scleroderma, also known as systemic sclerosis (SSc), experience significant differences in diagnosis and treatment outcomes due to differences in skin manifestations, according to a study published in Journal of the European Academy of Dermatology and Venereology.1
The researchers hope that the study will stimulate further studies aimed at improving diagnostic and treatment needs for this patient group.
Image source: © Юля Бурмистрова – stock.adobe.com
Background and methods
SSc occurs more frequently in African-American populations than in European-Americans. To further complicate this disparity, it has also been documented that African-American populations with SSc also have an earlier average age of disease onset with an increased risk of skin involvement and lung disease.2
The authors of the present study also noted that the diagnosis and treatment of SSc may be complicated by physicians’ failure to recognize the disease in darker skin types. Despite the prevalence of SSc in the African-American population, the disease may be underdiagnosed or misdiagnosed in some cases.3
The systematic review included a search of databases such as PubMed and SCOPUS for studies on SSc in patients with dark skin published between 2013 and 2023. It included primary data studies addressing the presentation, diagnosis and outcomes of SSc.
Results
The review initially included 82 studies, which were narrowed down to 9 relevant articles based on inclusion criteria and exclusion of duplicate materials. These studies were of diverse designs, including cross-sectional, retrospective, and longitudinal, and focused on various ethnic groups, including African Americans, Afro-Brazilians, and other populations of color.
The review studies show significant differences in the occurrence of SSc in black populations compared to white patients.
For example, African-American and Afro-Brazilian patients had higher mean modified Rodnan skin scores, indicating more severe skin disease. In addition, the prevalence of diffuse skin disease was higher in African-American patients (57%) than in white patients (37%). Diffuse skin disease was also common in Afro-Brazilian patients, and Raynaud’s syndrome and digital ulcers were similar in frequency to white patients.
Several studies have also highlighted ethnic differences in the manifestation of SSc. In most Afro-Caribbean patients, the incidence of diffuse skin disease and certain complications such as pulmonary disease was higher.
Black patients in the EUSTAR database had significantly higher rates of diffuse skin involvement but a lower prevalence of telangiectasia compared to white patients. In addition, black patients had a higher frequency of severe lung disease and higher mortality rates.
A cross-sectional study highlighted the significant psychosocial impact of SSc on African-American patients. Black patients showed greater body image disturbances and dissatisfaction related to finger ulcers, pigmentary changes, and pruritus.
Conclusions
The researchers noted that this study clarifies and highlights the differences between patients with scleroderma and dark skin. Limitations of the study may include potential bias in the reported data and subjective differences in the definition of dark skin.
“Different clinical manifestations such as atypical skin symptoms, antibody profiles and disease severity underline the complexity of diagnosing SSc in SOC populations,” said Podwojniak et al. “However, many uncertainties remain and require further research.”
The study authors stressed that this research needs to be further explored in future studies. They noted that patients with dark skin often have more severe clinical manifestations of SSc and are at higher risk for disease-related complications. Therefore, physicians and researchers should consider these factors when treating and researching patients with dark skin.
References
- Podwojniak A, Tan IJ, Leiter A, Ghani H, Cohen BA. Cutaneous manifestations of systemic sclerosis in people of color: a systematic review. J Eur Acad Dermatol Venereol. August 15, 2024. https://doi.org/10.1002/jvc2.527
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Scleroderma. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved August 21, 2024. https://www.niams.nih.gov/health-topics/scleroderma#:~:text=The%20disease%20is%20more%20common,when%20compared%20with%20other%20groups
- Shanmugavadivel D, Liu JF, Buonsenso D, Davis T, Roland D. Assessment of healthcare professionals’ recognition of pediatric dermatologic conditions in darker skin tones. Children. 2022; 9(11):1749. https://doi.org/10.3390/children9111749
