Cultural and genetic factors shape skin conditions in Asian children | AAD 2026

Clinicians should consider both cultural practices and genetic factors when diagnosing and treating pediatric skin conditions in Asian populations, according to Joseph Lam, M.D., of BC Children's Hospital, who spoke at the American Academy of Dermatology (AAD) Annual Meeting in Denver.

Lam shared with Managed Healthcare Executive that some conditions are not biologically driven but instead stem from cultural practices. He gave the example of traction alopecia, which can occur commonly in children from Sikh families who wear their hair tightly braided as part of religious tradition. This hair loss is caused by repeated, prolonged tension on hair follicles, often common with tighter hairstyles such as braids, ponytails or weaves. Due to the hair typically being covered, the condition could go unnoticed unless clinicians specifically look for it or families raise concerns.

Other conditions are tied more closely to genetics. Lam mentioned the severe drug reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS syndrome, which have been linked to specific genetic markers more common in certain Asian populations. These reactions can be triggered by medications such as the seizure and nerve pain drug carbamazepine (Tegretol) in those with particular human leukocyte antigen (HLA) subtypes, especially in people of Han Chinese descent. This demonstrates the need for careful medication screening in at-risk groups.

Lam also noted that some conditions remain less understood. For example, prurigo pigmentosa appears more frequently in Asian populations, particularly females, though its exact cause is unclear. Prurigo pigmentosa is a rare skin condition that causes very itchy red bumps. These bumps usually form a net-like pattern on the back, neck or chest. However, its link with the ketogenic diet, sometimes referred to as “keto rash,” could explain what causes the condition.

Lam explained that many factors, from genetics to cultural practices, help researchers understand why certain conditions appear in specific populations. He noted that while some causes are clearer, others remain uncertain.

“We don't really know why it happens more in Asians, particularly Asian females, but it's something that happens consistently,” Lam said.

Diagnosis can also be challenging due to longstanding clinical tools developed primarily using lighter skin populations. For example, redness, a key measure in eczema severity scoring, could be less visible in darker skin tones, potentially leading to underassessment. Lam stressed the need for greater awareness and updated diagnostic methods to improve care across diverse patient populations.