Improving Social Determinants of Health Essential for Better AD Outcomes in Pediatric Patients of Color

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Addressing social determinants of health is necessary to improve outcomes for pediatric patients with skin of color and atopic dermatitis (AD), an expert emphasized during a Saturday morning session at the 2025 American Academy of Dermatology Annual Meeting in Orlando, Florida.

Amid limited access to pediatric dermatologists nationwide, pediatric patients of color with atopic dermatitis are particularly affected by social determinants of health, further impacting their outcomes. | Image Credit: fizkes - stock.adobe.com

Candrice R. Heath, MD, FAAD, of Howard University, an adult and pediatric dermatologist, began her presentation, “Bridging the Gaps: Pediatric Atopic Dermatitis (AD) in Diverse Skin Tones,” during the session, “Addressing Unmet Needs in Diverse Populations: Therapeutic, Aesthetic, and Investigational Approaches,” by highlighting that AD affects about 25% of US children, with a higher prevalence and severity in children with skin of color, especially non-Hispanic Black and Hispanic children. She noted that this is particularly concerning, as over 50% of US children are now people of color, underscoring the need for better AD solutions moving forward.

These disparities persist despite the many available treatments for pediatric patients with AD, with hospitalization rates higher among non-White children and Medicaid recipients. Heath explained that factors that may contribute to worse outcomes among these groups include delayed presentation, reliance on emergency care, and social determinants of health.

More specifically, AD severity in these groups is linked to socioeconomic factors, like housing instability, environmental exposures, and lower household income and parental education. She added that structural racism and historical inequalities affect health care access and literacy among patients with skin of color. Heath explained that, in generations past, patients with skin of color faced racism that limited, for example, where they could live or what jobs they could hold.

She said that these factors “trickle down,” contributing to disparities in quality care access, increased pollution exposure, and beyond in patients with skin of color today. Heath emphasized that understanding this history could help dermatologists better understand the patterns seen in pediatric patients with skin of color and AD.

“Race is really a made-up thing," Heath said. "It’s what we call a social construct, but it can have devastating side effects that can last for generations."

The issue of access in pediatric dermatology was discussed more broadly in the session, “The Future of Dermatology: What Changes are Coming and How Can We Prepare?,” by Thy N. Hyunh, MD, FAAD, of the University of Mississippi Medical Center.1 She stressed the importance of growing the pediatric dermatology field, which only consists of about 300 board-certified dermatologists nationwide.

Many specialists are concentrated in Massachusetts and Illinois, limiting access for most of the US. This issue is further exacerbated by the lack of pediatric dermatologists in Delaware, Louisiana, Maine, Montana, Nevada, North Dakota, and South Dakota. Despite the high demand, Huynh noted that her no-show rates range from 25% to 45%, with higher rates occurring among Medicaid-insured patients who live in lower socioeconomic areas.

To handle these broader access and no-show issues among pediatric patients, she suggested providers save 2 spots, particularly an early morning and an early evening appointment, for up to 2 weeks in advance to accommodate acute cases. Since most pediatric cases are time-sensitive, Hyunh emphasized that rapid access is “crucial.” She also claimed this strategy can increase patient show rates by 30% to 40%.

Similarly, Heath emphasized that addressing social determinants of health is key to improving outcomes for pediatric patients with skin of color and AD. Possible solutions to the generational factors and hidden barriers impacting outcomes, such as inconsistent care, limited treatment availability, and financial constraints, include embracing telemedicine and community clinics, which can help expand care access.

Lastly, like Hyunh, Heath recommended that pediatric dermatologists adopt more flexible appointment strategies. To improve care coordination, Heath suggested more flexible appointment times and direct calls to caregivers to enhance patient accessibility and consistency.

“Some people are going through things that may not look like the picture that pops into your mind of someone who needs help outside of the office, so it’s important to really have conversations with your patients,” Heath concluded.

Reference

1. McCormick B. Shaping dermatology's future by increasing access, data, and advocacy. AJMC®. March 7, 2025. Accessed March 8, 2025. https://www.ajmc.com/view/shaping-dermatology-s-future-by-increasing-access-data-and-advocacy