Tinea capitis, folliculitis, seborrheic dermatitis, and pediculosis capitis are four common scalp conditions. Although tinea capitis and seborrheic dermatitis are found more commonly in patients with skin of color and hi...Tinea capitis, folliculitis, seborrheic dermatitis, and pediculosis capitis are four common scalp conditions. Although tinea capitis and seborrheic dermatitis are found more commonly in patients with skin of color and highly textured hair, all of these conditions have special diagnostic or management considerations in these populations. This article reviews the diagnosis and management of these common scalp conditions.
African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to under...African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.
Keloids are an exuberant response to skin wound healing in which abundant scar tissue grows beyond the boundaries of the inciting insult. Age, race, location, family history and personal history of keloids are relevant f...Keloids are an exuberant response to skin wound healing in which abundant scar tissue grows beyond the boundaries of the inciting insult. Age, race, location, family history and personal history of keloids are relevant factors concerning the risk of developing keloids. Because keloids are prone to recurrence after surgical excision, post-operative management plays an important role in the treatment of keloids. There are many modalities that can be used to treat keloids or prevent their recurrence; a multimodal approach is often necessary in difficult cases.
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance...Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
Skin cancer is often associated with greater morbidity and mortality in skin of color patients because most medical literature and research on skin cancer to date has been predominantly focused on lighter skin types. It...Skin cancer is often associated with greater morbidity and mortality in skin of color patients because most medical literature and research on skin cancer to date has been predominantly focused on lighter skin types. It is crucial that dermatologic providers be able to recognize different presentations of skin cancer in skin of color patients to optimize the early detection of these tumors and ensure equitable outcomes. This article details the epidemiology, risk factors, clinical features, and disparities in the treatment of melanoma, squamous cell carcinoma, basal cell carcinoma, and mycosis fungoides subtype of cutaneous T-cell lymphoma in skin of color patients.
Hidradenitis suppurativa (HS) is a chronic disease characterized by recurrent painful abscesses and chronic sinus tracts in intertriginous areas. In the United States, HS disproportionally affects adults of African-Ameri...Hidradenitis suppurativa (HS) is a chronic disease characterized by recurrent painful abscesses and chronic sinus tracts in intertriginous areas. In the United States, HS disproportionally affects adults of African-American heritage. Depending on the severity of disease, the consequences of HS can be far-reaching, significantly affecting mental health and quality of life. In recent years, concerted research efforts have been made to better understand the pathophysiology of the disease as well as identify emerging new treatment targets. Herein, we discuss the clinical presentation, diagnostic criteria, and treatment approach of HS with a focus on skin of color.
Sarcoidosis is a chronic, multisystem, inflammatory disorder that is characterized by noncaseating granulomas that cause organ dysfunction with various clinical subphenotypes. The incidence and prevalence of sarcoidosis...Sarcoidosis is a chronic, multisystem, inflammatory disorder that is characterized by noncaseating granulomas that cause organ dysfunction with various clinical subphenotypes. The incidence and prevalence of sarcoidosis varies greatly by ethnic background. There are significant racial disparities in prevalence, severity, and outcomes; however, there is a dearth of studies investigating the impact of structural racism. The skin is often the presenting and second most frequently involved organ with significant implications on diagnosis and management in patients with darkly pigmented skin. Workup should be comprehensive given the multisystem involvement. There are many therapies for sarcoidosis, although none is universally effective.
Collagen vascular diseases such as lupus erythematosus and dermatomyositis (DM) occur 2 to 3 times more often among patients with skin of color. In this article, the authors review DM and cutaneous lupus erythematosus, i...Collagen vascular diseases such as lupus erythematosus and dermatomyositis (DM) occur 2 to 3 times more often among patients with skin of color. In this article, the authors review DM and cutaneous lupus erythematosus, including acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and discoid lupus erythematosus. They discuss the distinguishing features between these entities and highlight distinct presentations and management considerations in patients with skin of color to aid in prompt and correct diagnoses in this patient population.
Diagnosing psoriasis in patients of color can pose both diagnostic and treatment challenges. It is important to keep psoriasis on the differential diagnosis with conditions such as lichen planus, tinea corporis, and subc...Diagnosing psoriasis in patients of color can pose both diagnostic and treatment challenges. It is important to keep psoriasis on the differential diagnosis with conditions such as lichen planus, tinea corporis, and subcutaneous lupus for patients of color. Biopsy can help delineate the causes and guide treatment. Although there is no documented difference in efficacy of certain treatments for psoriasis based on racial group, cultural norms, hair washing practices, health literacy, and attitudes toward certain treatment options should be elicited in all patients.
Atopic dermatitis (AD) is a pruritic inflammatory skin disease that disproportionately affects skin of color patients. African American, Asian, and Hispanic patients carry disproportionate disease burdens, with increased...Atopic dermatitis (AD) is a pruritic inflammatory skin disease that disproportionately affects skin of color patients. African American, Asian, and Hispanic patients carry disproportionate disease burdens, with increased prevalence, disease severity, and health care utilization. AD has a unique clinical presentation in skin of color patients, often with greater extensor involvement, dyspigmentation, and papular and lichenified presentations. Erythema is also more difficult to appreciate and can result in an underappreciation of disease severity in skin of color patients. In this review, we highlight the important manifestations of AD across all skin types, including nuances in treatment.
Skin hypopigmentation and depigmentation disorders are a top concern for patients with skin of color seeking care from a dermatologist. The visual contrast between involved and uninvolved skin in these disorders makes th...Skin hypopigmentation and depigmentation disorders are a top concern for patients with skin of color seeking care from a dermatologist. The visual contrast between involved and uninvolved skin in these disorders makes them particularly burdensome for patients with skin of color. These disorders may have a wide differential of diagnosis, as patients with skin of color may present differently or more frequently than White patients for certain conditions. Clues from a comprehensive history and physical examination with standard lighting and a Wood's light are essential for clinching the diagnosis, although a biopsy may be warranted in special cases.
Disorders of hyperpigmentation are common and challenging conditions which can arise due to a myriad of etiologic factors. Many of them can present across skin types but are more common in skin of color individuals with...Disorders of hyperpigmentation are common and challenging conditions which can arise due to a myriad of etiologic factors. Many of them can present across skin types but are more common in skin of color individuals with Fitzpatrick skin types III-VI. Facial hyperpigmentation, in particular, can have a significant impact on the quality of life of affected individuals due to its increased visibility. This article provides a comprehensive review of disorders of facial hyperpigmentation including epidemiology, pathogenesis, diagnostic considerations, and treatment approaches for these conditions.
Identification of specific patterns, shades, and intensity of erythema in the skin has always been critical and fundamental to diagnostic accuracy in dermatology. Erythema is often less noticeable in darker skin types. T...Identification of specific patterns, shades, and intensity of erythema in the skin has always been critical and fundamental to diagnostic accuracy in dermatology. Erythema is often less noticeable in darker skin types. The interplay of inflammation and variance of skin tone contributes to appreciable differences in the clinical appearance of cutaneous disease in darker complexions. In this article, we discuss common disorders that present with facial erythema in skin of color and offer distinguishing features of each disorder to assist the clinician with diagnosing these conditions in the presence of deeply pigmented skin.
The importance of skin of color and diversity, equity, and inclusion (DEI) started to be recognized in the late 1990s. Since then, because of the advocacy and effort of several highly visible leaders in dermatology, noti...The importance of skin of color and diversity, equity, and inclusion (DEI) started to be recognized in the late 1990s. Since then, because of the advocacy and effort of several highly visible leaders in dermatology, noticeable progress has been achieved. Leadership lessons learned for successful implementation of DEI include the following: (1) commitment by and continued engagement of highly visible leaders; (2) engagement of other societies in dermatology; (3) engagement of dermatology department leaders and educators; (4) education of the next generation of dermatologists; (5) inclusivity in DEI to include gender and sexual orientation; and (6) cultivation of allies and allyship.
Over the past few years, there have been concerted efforts to increase diversity in the field of dermatology. This has been achieved through the creation of Diversity, Equity, and Inclusion (DEI) initiatives in dermatolo...Over the past few years, there have been concerted efforts to increase diversity in the field of dermatology. This has been achieved through the creation of Diversity, Equity, and Inclusion (DEI) initiatives in dermatology organizations that strive to provide resources and opportunities for trainees who are underrepresented in medicine. This article compiles the ongoing DEI initiatives in the American Academy of Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology Society, Society for Investigative Dermatology, Skin of Color Society, American Society for Dermatologic Surgery, The Dermatology Section of the National Medical Association, and Society for Pediatric Dermatology.
Clinical trials are an essential component of research for determining the safety and efficacy of treatments for medical diseases. In order for the results of clinical trials to be generalizable to diverse populations, t...Clinical trials are an essential component of research for determining the safety and efficacy of treatments for medical diseases. In order for the results of clinical trials to be generalizable to diverse populations, they must include participants at ratios that are reflective of national and global populations. A significant number of dermatology studies not only lack racial/ethnic diversity but also fail to report data on minority recruitment and enrollment. Reasons for this are multifold and are discussed in this review. Although steps have been implemented to improve this issue, greater efforts are needed for sustained and meaningful change.
Race and racism are rooted in the man-made belief that the color of a person's skin determines a person's hierarchal rank in humanity. Early scientific theories of polygenics and misleading scientific studies were used t...Race and racism are rooted in the man-made belief that the color of a person's skin determines a person's hierarchal rank in humanity. Early scientific theories of polygenics and misleading scientific studies were used to promote the concept of the inferiority of people of color and to support and maintain the institution of slavery. These discriminatory practices have filtered into society as structural racism, including the field of medicine. Structural racism has led to health disparities in black and brown communities. Dismantling structural racism requires us all to become change agents at societal and institutional levels.
Racial and ethnic disparities exist across a wide range of disease areas and clinical services. Becoming familiar with the history of race in America, and how it has been used to structure laws or policies that drive ine...Racial and ethnic disparities exist across a wide range of disease areas and clinical services. Becoming familiar with the history of race in America, and how it has been used to structure laws or policies that drive inequities in the social determinants of health, even today, is necessary to mitigate these disparities across medicine.
Health disparities are differences in health or disease incidence, prevalence, severity, or disease burden that are experienced by disadvantaged populations. Their root causes are attributed in large part to socially det...Health disparities are differences in health or disease incidence, prevalence, severity, or disease burden that are experienced by disadvantaged populations. Their root causes are attributed in large part to socially determined factors, including educational level of attainment, socioeconomic status, and physical and social environments. There is an expanding body of evidence documenting differences in dermatologic health status among underserved populations. In this review, the authors highlight inequities in outcomes across 5 dermatologic conditions, including psoriasis, acne, cutaneous melanoma, hidradenitis suppurativa, and atopic dermatitis.