JAMA Study: Pediatric Skin Disease Rates Differ Sharply by Race

A new analysis of more than half a million children's medical records, published online May 6 in JAMA Dermatology, found large differences in the recorded frequencies of common pediatric skin diseases across racial and ethnic groups, along with consistently low dermatology specialty care use among Black children. The study, drawing on electronic health records from eight US children's hospitals participating in the PEDSnet research network, recorded atopic dermatitis at 10,469 cases per 100,000 Black children compared with 3,099 per 100,000 White children, a 3.4-fold difference that reframes how prevalence data on the most common inflammatory skin condition in childhood is understood. **Key Takeaways** - Atopic dermatitis was recorded at 10,469 cases per 100,000 Black children versus 3,099 per 100,000 White children across eight US children's hospitals from 2009 to 2022. - Infantile hemangioma showed the inverse pattern, with 290 cases per 100,000 Black children compared with 764 per 100,000 White children. - Across all five conditions studied (atopic dermatitis, acne, infantile hemangioma, psoriasis, hidradenitis suppurativa), Black children had a low proportion of dermatology specialty care use despite high recorded frequencies of AD, acne, and HS. - The cross-sectional analysis drew on 536,776 patient records from PEDSnet, a multicenter clinical research network spanning eight US children's hospitals. The study, led by Nicolas G. Quan, BS, of the University of Colorado Department of Dermatology with senior author Lucinda L. Kohn, MD, MHS, examined records of 536,776 children seen between January 2009 and July 2022 across eight institutions: Children's Hospital Colorado, Seattle Children's, Nationwide Children's, Lurie Children's, Stanford, Washington University in St. Louis, Nemours Children's Health, and Children's Hospital of Philadelphia. The cohort included children with at least one dermatology visit or two non-dermatology visits coded for atopic dermatitis, acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa. ## How Atopic Dermatitis Frequencies Map Across Racial Groups Atopic dermatitis was the most common condition in the cohort, with 377,970 recorded cases. Per 100,000 children, the recorded frequency was 10,469 in Black children (95% CI, 10,414–10,524) and 3,099 in White children (95% CI, 3,083–3,114). Acne (139,632 cases) and hidradenitis suppurativa (5,722 cases) also showed elevated recorded frequencies in Black children. Psoriasis case counts (11,339) were lower overall. Infantile hemangioma reversed the direction. Recorded at 290 cases per 100,000 Black children (95% CI, 280–300) versus 764 per 100,000 White children (95% CI, 756–772), the vascular birthmark followed a pattern long noted in single-center clinical series, now quantified across a multi-institution cohort. The authors do not assert these reflect true biological prevalence, only what was captured in the electronic health record at participating hospitals. ## What Does This Mean for How Skin Conditions Are Recognized in Pigmented Skin? The recorded frequencies cannot, on their own, separate true prevalence from recognition and referral patterns. Recorded atopic dermatitis cases reflect both the underlying disease and what clinicians coded; recorded infantile hemangioma cases reflect both the lesion and whether it was identified, documented, and referred. In pigmented skin, atopic dermatitis often appears as follicular accentuation, lichenification, and post-inflammatory hyperpigmentation rather than the visible erythema textbooks describe in lighter skin, while early infantile hemangiomas can be subtle on darker skin tones in their initial weeks. Both observations have been documented in clinical literature for decades but rarely quantified at this scale. The authors note that the patterns may reflect underdiagnosis in some directions and underreferral in others. Recorded AD frequencies were high in Black children, yet the proportion using dermatology specialty care for AD was low. The authors flag this combination as needing further study to determine whether it represents appropriate primary care management or unmet specialty need. ## When Will Population-Scale Data Like This Reshape Pediatric Skincare Recommendations? PEDSnet, the research infrastructure behind the study, has been growing as a source of pediatric epidemiology data in dermatology and other specialties. Studies like this one tend to feed both pediatric dermatology training (where curriculum updates on skin-tone-specific presentation are accelerating) and consumer-facing skincare guidance, where ingredient recommendations for atopic dermatitis in children (gentle cleansers, ceramide-replenishing emollients, topical corticosteroids when appropriate) are increasingly being framed with awareness that the visual cues for a flare differ across skin tones. For caregivers of Black children with atopic dermatitis, the practical takeaway is that what looks like dryness, hyperpigmentation, or follicular bumps on the skin may be the same underlying inflammatory process clinicians treat as eczema, and the [atopic dermatitis biology behind a flare-resistant regimen](/science/eczema-skincare-routine-atopic-dermatitis-biology/) applies equally regardless of how the condition presents visually. The next wave of pediatric dermatology guidelines, building on the 2026 [AAD pediatric atopic dermatitis update that backed dupilumab from 6 months](/science/aad-pediatric-atopic-dermatitis-guidelines-2026/), is expected to incorporate skin-tone-specific recognition criteria more explicitly. Whether the recorded disparities in this study reflect biology, environment, recognition patterns, or care access (likely some combination of all four), the data give pediatric dermatology a population-scale baseline to measure against as those updates roll out.