Disparities in diagnosing and treating people with skin color may arise due to clinicians’ inaccurate diagnoses, insufficient knowledge, and gaps in knowledge among other healthcare providers and patients, according to a presentation at Medscape Live’s annual Las Vegas Dermatology Seminar.
The panel explored skin disorders in people of color, including atopic dermatitis (AD), acne, rosacea, psoriasis, and melanoma.
During the panel discussion on treatment tips for common dermatologic conditions in patients of color, Dr. Susan C. Taylor of the Department of Dermatology at the University of Pennsylvania, Philadelphia, noted that gaps in healthcare access might lead to disparities in the diagnosis and treatment of such conditions.
Dr. Valerie Callender of Howard University, Washington, explained that when Black patients present with AD, “you may not see the erythema.” However, she noted that follicular and papular presentations might be more common in Black patients. In addition, in patients with rich skin tones, erythema and erythroderma can appear as violet, gray, or dark brown shades. She further added that disease severity could be misinterpreted, as scoring systems such as the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD) underestimate AD severity in dark skin.
The appearance of acne might be different in people of color, according to Dr. Andrew Alexis, Vice-Chair for Diversity and Inclusion in the Dermatology Department and professor of Clinical Dermatology at Weill Cornell Medicine. For example, acne might not appear red but in a darker tone.
The panelists also addressed common misconceptions about melanoma in people of color. According to Dr. Taylor, a common misperception about melanoma among skin-of-color patients is that they don’t think they can get it. She noted that this could lead to undetected cases.
Dr. Nada Elbuluk, the founder and director of the University of Southern California Skin of Color Center and Pigmentary Disorders Clinic, Los Angeles, emphasized that educating skin-of-color patients about melanoma is essential. Dr. Elbuluk also called on dermatologists not to skip black patients’ total body skin exams. She also noted that many patients would only partially undress and miss areas such as toes.
For rosacea, the panelists emphasized that in patients with skin of color, clinicians need to look for different signs of rosacea than those typically seen in white patients. “The most common presentation of rosacea in skin of color is papulopustular,” and the granulomatous variant. “These patients will often give you a history of sensitivity to products,” Dr. Elbuluk added. In addition, she noted that people of color may not always have the hallmark of flushing, but they may report warmth, itching, and product sensitivity.
The panel also discussed disparities in the management of psoriasis in patients of color. Dr. Alexis pointed out that psoriasis in skin-of-color patients was once considered a rare occurrence, but that is far from the truth. She stated that many psoriasis cases remain undiagnosed or there is a delay in diagnosis among these patients.
The panelists highlighted that current psoriasis treatment guidelines are based on clinical trials mainly involving White patients and lack specific recommendations for people of color. They also noted that psoriasis lesions might appear differently in patients with darker skin, with thicker plaques and more scaling over larger areas, and may result in long-lasting dyspigmentation.
To develop an effective psoriasis treatment strategy for people of color, the panelists suggested considering factors such as comorbidities, medications, prior treatment response, patient preferences, quality of life, and disease severity.