Efficacy and Safety of Topical and Systemic Therapies for Atopic Dermatitis in Patients With Skin of Colour: A Systematic Review.

Atopic dermatitis (AD) is more common and often more severe in people with skin of colour, yet the trials that shaped modern treatment enrolled mostly White participants. The disease can look different in darker skin, and erythema-based severity scores may miss active inflammation. Whether current topical and systemic drugs work as well, and are as safe, across racial, ethnic, and Fitzpatrick skin-type groups, is still uncertain. This review brought together the evidence on AD treatment outcomes reported by skin colour. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 and the Synthesis Without Meta-analysis (SWiM) guidance were followed, and PubMed and Scopus were searched from 2015 to March 2026. Randomised controlled trials, their pre-specified or post hoc subgroup analyses, and prospective cohort or registry studies were included if they reported efficacy or safety of any topical or systemic AD drug either stratified by race, ethnicity, or Fitzpatrick skin type, or in a dedicated skin-of-colour population. Two reviewers independently screened studies and extracted data. A meta-analysis was not feasible due to substantial heterogeneity in study designs, interventions, outcome measures, and reporting methods, as well as insufficient quantitative data for statistical pooling. Fifteen studies met the criteria, covering topical agents (tapinarof, crisaborole, roflumilast), interleukin-targeted biologics (dupilumab, tralokinumab, lebrikizumab), Janus kinase inhibitors (abrocitinib, upadacitinib, baricitinib), and conventional systemics in a registry cohort. Across drug classes, response rates among patients with skin of colour were clinically meaningful and broadly consistent with those in lighter-skin strata. Tapinarof reached the primary endpoint in Asian, Black or African American, and White patients and across Fitzpatrick I-III and IV-VI groups. Tralokinumab achieved Eczema Area and Severity Index (EASI-75) rates of 78%, 88%, and 83% in Asian, Black, and White patients after up to two years. Signals of possible difference were small and imprecise, mostly in Black or African American subgroups, which were consistently the smallest, and safety profiles matched those in the wider trial populations. A recurring limitation was that erythema-based tools may underestimate severity in dark skin. Topical and systemic AD therapies are effective and well tolerated in patients with skin of colour, with no clear evidence of reduced benefit. The evidence is limited by small, often untested subgroups, especially Black or African American and Fitzpatrick V-VI patients, and by measurement tools that were not built for darker skin. Dedicated trials and skin-tone-valid outcome measures are needed.