For Doctors in a Hurry
- Researchers investigated how pediatric skin disease frequency and dermatology specialty care utilization vary across different racial and ethnic groups.
- This multicenter cross-sectional study analyzed electronic health records from 536,776 children across eight United States pediatric hospitals over thirteen years.
- Black children showed 10,469 cases of atopic dermatitis per 100,000, significantly higher than 3,099 cases per 100,000 in White children.
- The study found that Black children utilized dermatology specialty care less frequently despite higher rates of atopic dermatitis, acne, and hidradenitis suppurativa.
- Clinicians should evaluate whether these utilization patterns reflect disparities in access to specialty care or differences in primary care management.
Racial Disparities in Pediatric Dermatology Access and Disease Burden
Pediatric inflammatory skin conditions often require specialized management to mitigate long-term complications, such as the significant mental health burden associated with atopic dermatitis [1]. While standard-of-care maintenance therapies exist, clinicians frequently face challenges in balancing treatment safety with efficacy in young populations [2]. Furthermore, chronic conditions like hidradenitis suppurativa (a chronic inflammatory disease characterized by painful nodules and scarring) disproportionately affect Black and biracial individuals, yet these groups remain underrepresented in clinical research and specialized care pathways [3]. Disparities in healthcare access are often compounded by suboptimal awareness of clinical guidelines among various provider types [4]. Emerging digital health tools and teledermatology offer potential avenues to bridge these gaps, though technological barriers persist in underserved communities [5]. To better understand these care gaps, a recent multicenter analysis examined how race and ethnicity influence both disease frequency and specialty care utilization across major United States children's hospitals.
Multicenter Analysis of Pediatric Skin Disease Prevalence
The researchers conducted a multicenter cross-sectional analysis utilizing PEDSnet, a national clinical research network of pediatric health systems, encompassing eight United States children's hospitals. The study cohort comprised 536,776 pediatric patients with a mean age of 6.4 years (standard deviation of 6.3 years). Data collection spanned more than a decade, from January 2009 to July 2022, with subsequent statistical analysis performed in early 2024. To ensure diagnostic consistency within the electronic health record data, inclusion required patients to have either one or more visits to a dermatology clinic or two or more visits to non-dermatology clinics specifically coded for one of five target skin conditions: atopic dermatitis, acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa.
The study population was 51.5% female and represented a broad racial and ethnic spectrum. The distribution included 44.3% White, 27.9% Black, 14.1% Hispanic, 8.4% non-Hispanic, 6.4% Asian, 4.3% multiple races, 0.3% Native Hawaiian or Other Pacific Islander, and 0.2% American Indian or Alaska Native participants. Additionally, 16.6% of the cohort had an unknown race and 5.5% had an unknown ethnicity. By tracking these specific diagnoses across a large multi-institutional database, the researchers aimed to establish clear patterns of disease frequency and specialty care utilization. This methodology allowed for a robust comparison of how different demographic groups access specialized dermatologic care for chronic and inflammatory skin conditions, providing a clearer picture of where primary care physicians might need to facilitate stronger referral pathways.
Quantifying the Disconnect in Disease Frequency
The analysis of electronic health record data revealed a substantial clinical burden of pediatric skin disease, with total case counts reaching 377,970 for atopic dermatitis, 139,632 for acne, 54,305 for infantile hemangioma (a common benign vascular tumor of childhood), 11,339 for psoriasis, and 5,722 for hidradenitis suppurativa. The researchers observed that electronic health record-derived frequencies for these five conditions varied significantly across race and ethnicity groups. The study identified a stark disparity in the frequency of atopic dermatitis, which was 10,469 (95% CI, 10,414 to 10,524) cases per 100,000 Black children compared with 3,099 (95% CI, 3,083 to 3,114) cases per 100,000 White children. This indicates that Black children in the study cohort were diagnosed with atopic dermatitis at more than three times the rate of their White peers. Conversely, the frequency of infantile hemangioma was lower in Black children, at 290 (95% CI, 280 to 300) cases per 100,000, while White children showed a higher frequency of 764 (95% CI, 756 to 772) cases per 100,000.
Most notably, despite the high frequencies of atopic dermatitis, acne, and hidradenitis suppurativa among Black children, this population had a low proportion of dermatology specialty care use across all five studied conditions. This disconnect between high disease frequency and low utilization of specialized services suggests that Black children are either primarily managed in primary care settings or face systemic barriers to accessing dermatologists. For the practicing physician, these findings highlight a critical gap in specialty care delivery. The patients with the highest documented disease burden for several severe inflammatory conditions are the least likely to receive care from a dermatology specialist, underscoring the need for primary care providers to actively evaluate their referral patterns and help mitigate barriers to specialty access for at-risk pediatric populations.
References
1. Xie Q, Dai X, Tang X, et al. Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Frontiers in Psychology. 2019. doi:10.3389/fpsyg.2019.01773
2. Siegfried EC, Jaworski JC, Kaiser JD, Hebert AA. Systematic review of published trials: long-term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. BMC Pediatrics. 2016. doi:10.1186/s12887-016-0607-9
3. James JF, Madray V, Salame N, et al. Demographic Gaps and Requirements for Participation: A Systematic Review of Clinical Trial Designs in Hidradenitis Suppurativa. Dermatology. 2022. doi:10.1159/000526069
4. Wang J, Bird JA, Cleary K, et al. Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians. The Journal of Pediatrics. 2024. doi:10.1016/j.jpeds.2024.114218
5. Burshtein J, Buethe MG, Ghias M, Epstein J, Glick SA, Marmon S. Efficacy, perception, and utilization of pediatric teledermatology: A systematic review. JAAD International. 2023. doi:10.1016/j.jdin.2023.03.005
