Disparities in Atopic Dermatitis Prevalence and Determinants in Southern Texas: A Systematic Review

Atopic dermatitis (AD) is a chronic inflammatory skin condition that disproportionately affects Black and Hispanic populations in the United States, with Southern Texas bearing a heightened burden due to intersecting environmental exposures, socioeconomic inequities, and systemic healthcare barriers. This systematic review aimed to synthesize current evidence on the prevalence, recurrence, complications, and environmental and socioeconomic determinants of AD in Southern Texas and comparable U.S. populations to inform targeted, equity-focused interventions. A structured PubMed search using comprehensive terms related to AD, Southern Texas, race and ethnicity, socioeconomic and environmental factors, and the United States was conducted, applying strict inclusion criteria to identify studies published between 2004 and 2024 in peer-reviewed journals with sample sizes of at least 100 participants, focusing on prevalence, recurrence, complications, and determinants of AD while using validated diagnostic criteria. Studies consistently demonstrated higher prevalence and severity of AD among Black and Hispanic populations, with Black children showing the highest rates and persistence into adolescence and Hispanic children exhibiting increased prevalence during adolescence. Complications of AD in these populations included impaired sleep, chronic pruritus, increased healthcare utilization, and reduced quality of life, which were exacerbated by environmental exposures such as air pollution, urban living conditions, and inadequate housing. Lower socioeconomic status correlated with increased disease burden but did not fully account for disparities, underscoring the role of structural racism and systemic barriers in healthcare access and quality, which further perpetuate AD-related disparities. The review found that while genetic factors, including filaggrin mutations, contribute to individual risk, they do not explain the disparities across racial and ethnic groups, emphasizing the importance of addressing environmental, socioeconomic, and structural determinants. Addressing these disparities requires community-engaged research, policy changes targeting upstream determinants such as housing and pollution, and equitable healthcare delivery models to improve outcomes for affected populations in Southern Texas and similar settings.