Ester Del Duca, MD: Molecular Phenotype Differences in African Eczema Patients

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The Icahn investigator reviews new data suggesting ethnicity-based differences in molecular phenotype of atopic dermatitis, which may better inform treatment strategies for different populations.

New late-breaking data presented at the American Academy of Dermatology (AAD) 2023 Annual Meeting in New Orleans this weekend showed further uniquities of atopic dermatitis molecular phenotype among patients from African and African-American ethnicities.

The findings, presented by study author Ester Del Duca, MD, of the Laboratory of Inflammatory Skin Diseases at Icahn School of Medicine at Mount Sinai, showed patients with eczema from East Africa did not present with an upregulation of genes related to innate immune nor Th1 pathways, compared to African-American and European-American patients with these disease. What’s more, European-Americans showed a particularly greater upregulation of Th17-related markers, while East Africans showed a significant downregulation of lipid metabolism markers.

The data may present investigators with more nuanced and patient background-specific avenues of routine and biologic therapy research and development.

In an interview with HCPLive during AAD 2023, Del Duca discussed the significance of characterizing chronic skin disease at a molecular phenotype scale—especially based on patients’ backgrounds. She pointed to the observed downregulation of lipid metabolism markers among East African patients as an example of where the research could lead to next.

“This is going to impact the future of new treatments, including moisturizers and even more, small molecules and biologic therapies that can better target this feature of the atopic dermatitis—compared to the inflammation, which might be a better target in other populations or ethnic groups.”

Del Duca additionally discussed her team’s relevant research in other chronic skin diseases including alopecia areata, as well as ongoing trials into dose-adjusted treatment strategies informed by ethnicity-related molecular phenotypes.

At a time when drug classes are rapidly developing across dermatology and particularly for atopic dermatitis, these relevant findings may give clinicians as accurate a target as they’ve had to treat the individual patient’s disease.

“What we really need to do is larger-scale trials, and maybe a bigger collaboration would be ideal…that could lead to stronger results,” Del Duca said. “A cohesive march of science toward better results for the entire population would be my biggest hope.”


Del Duca E, Liu D, Dahabreh D, et al. Skin characterization of the African and African American atopic dermatitis molecular phenotype. Paper presented at: American Academy of Dermatology 2023 Annual Meeting; March 17 – 21. New Orleans, LA. Accessed March 18, 2023.