Darker Skin Means Different Presentations of Skin Diseases, Explains Dr James Song

You can also watch the interview with James Song, MD.

James Song, MD

Diverse patients with darker skin tones will show different presentations of skin diseases such as atopic dermatitis, psoriasis, and hidradenitis suppurativa (HS), said James Song, MD, director of clinical research and associate chief medical officer at Frontier Dermatology.

If clinicians are not aware of how these skin conditions may look different on skin of color, it could lead to delays in diagnosis and, ultimately, delays in treatment.

In an interview with The American Journal of Managed Care^®, Song discussed his session at the 2023 Fall Clinical Dermatology Conference.

This transcript has been lightly edited for clarity.

Transcript

What are some key insights from your session on treating 3 major skin conditions across varying severities and skin tones?

So, this talk that we did, it was a symposium on 3 inflammatory conditions, some of the most common ones that we see: atopic dermatitis, psoriasis, and hidradenitis suppurativa [HS]. I co-presented this with Andrew Alexis, MD, MPH, and Linda Stein Gold, MD. The theme here is that there are different presentations in patients who have darker skin types in all of these diseases, which can lead to maybe a delay in diagnosis and, ultimately, a delay in treatment. We also talk about how the burden of disease is much higher in our patients with skin of color, and the fact that they present often with more advanced disease, which does make it more difficult to treat.

I speak, particularly, on the hidradenitis suppurativa section, and the difference with HS compared to maybe atopic dermatitis or psoriasis is that patients that present later or [with] more advanced disease, they're much, much more difficult to treat compared to psoriasis, for example. Or even if they present pretty advanced, because we have so many wonderful therapies in psoriasis, we could still clear the vast majority of those patients, it doesn't really matter at this point. With HS, what we've consistently seen with all of our medications is they simply just don't work when patients start to develop tunnels or scarring.

The call to action here is that we need to find a way to get our patients of skin of color earlier into the dermatologist's office when we have that window of opportunity to still intervene and give them the best treatment response. Otherwise, I really think we're just not going to be able to treat our patients as effectively as we are with maybe some of the other conditions.

Are certain patient demographics disproportionately affected by these 3 conditions?

When HS presents in its more advanced stages, I would say it doesn't matter whether you're White, Asian, or Black, it's the same for the most part, it's just that we have a disproportionately higher number of severe patients that are of skin of color. And a lot of that is tied to various social determinants of health where they may not have access to specialists, access to these newer medications, they may have lower health literacy, or just culturally, they may be a little bit more distrustful of the medical system because they may have been hurt in the past.

So, all of that kind of goes into it. But I would say that, for our Black and Latinx patients in particular, HS is much more common in those patients, and in those who do have it, they tend to be, again, more on that moderate to severe side than maybe another patient that was maybe Asian or White.