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Sessions

Jun 12
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The Role of JAK Inhibitors in Treating Patients With Skin of Color

By Sessions

JAK inhibitors

At the 2025 Skin of Color Update conference, Brett King, MD, PhD, FAAD, delivered a thought-provoking presentation focused on knowledge gaps in JAK inhibitor use among patients with skin of color. Moving away from a case-based approach, Dr. King emphasized the need for inclusive clinical data and nuanced understanding of the efficacy of JAK inhibitors across different patient populations.

The Expanding Landscape of JAK Inhibitors

Over the past decade, eight JAK inhibitors have received FDA approval across a wide range of indications from dermatologic diseases to hematologic malignancies. With over 50 cytokines signaling through the JAK-STAT pathway, it’s no surprise that these agents have revolutionized inflammatory skin disease management. Key cytokines driving dermatologic conditions include IL-4, IL-13, and IL-31 (atopic dermatitis and itch), IL-12 and IL-23 (psoriasis), and IFN-γ (alopecia areata, vitiligo, sarcoidosis, lichen planus, and granuloma annulare).

Atopic Dermatitis: Evidence Across Diverse Populations

Dr. King highlighted several post-hoc analyses of pivotal JAK inhibitor trials analyzing efficacy across racial and ethnic groups.

  • Abrocitinib trials included nearly 9% Black and 22% Asian participants and showed comparable improvements in IGA and itch scores across racial groups and Fitzpatrick skin types.
  • Upadacitinib studies demonstrated a dose-dependent difference: at 15 mg daily, Black patients achieved EASI90 at slightly lower rates than White patients, a gap that disappeared at the higher 30 mg daily dose.  Black patients also experienced a numerically lower itch reduction compared with Asian and White patients at 15 mg, with this difference also seen at the 30 mg daily dose.
  • Ruxolitinib cream analyses showed somewhat lower IGA success rates in Black patients (26.6%) versus Asian (51.3%) and White (45%) participants, though the differences were modest.

Overall, these findings affirm that JAK inhibitors are effective across populations but underscore the need for larger datasets to confirm consistency and optimize dosing strategies in skin of color. Dr. King also raised the question of whether some of the differences seen may be due to challenges with grading disease severity in Black patients with atopic dermatitis.

Vitiligo: Reassuring Efficacy in Patients with Skin of Color

  • In pooled phase 3 data of ruxolitinib cream for vitiligo, the proportion of Black and Asian participants was similar to that in atopic dermatitis studies. Interestingly, efficacy appeared numerically higher in Black patients, possibly due to easier visualization of repigmentation in darker skin.
  • Multiple oral JAK inhibitors are currently in development for vitiligo, which could expand treatment options further.

Alopecia Areata: Diagnostic Nuances in Black Patients

With three JAK inhibitors (ritlecitinib, baricitinib, and deuruxolitinib) now approved for alopecia areata (AA), Dr. King emphasized the complexity of diagnosing AA in patients of African descent. In an addendum to the BRAVE-AA1 trial, external expert reviewers assessed scalp photographs from 36 self-identified Black participants who were screened for enrollment in the study. Strikingly, 33% were determined to have central centrifugal cicatricial alopecia (CCCA) or traction alopecia rather than alopecia areata. This provocative dataset highlights the need for accurate diagnosis and culturally competent assessment in both research and clinical practice.

Hidradenitis Suppurativa and Sarcoidosis: Emerging Data

For hidradenitis suppurativa (HS), the phase 2 trial of povorcitinib included nearly 25% Black participants.  This is an encouraging step toward representation but is also likely a function of the high incidence of HS in these patients. While there are no subgroup analyses at this time, phase 3 trials of povorcitinib and deucravacitinib are underway.

In sarcoidosis, inhibition of type 1 immunity with tofacitinib has shown marked improvement in both cutaneous and systemic disease. Notably, 6 of 10 patients in this study were Black, making this an exciting finding for a condition that disproportionately affects patients with skin of color. Results from an open-label abrocitinib trial are expected soon.

Safety of JAK inhibitors

  • Common adverse events include upper respiratory infections, headache, nasopharyngitis, nausea, and acne.
  • Boxed warnings for JAK inhibitors include serious infection, mortality, malignancies, major cardiovascular events, and thrombosis. Dr. King highlighted the need for dermatologists to understand these boxed warnings in order to be comfortable using these medications. Many of these warnings come from older patients with rheumatoid arthritis treated with tofacitinib, and data from baricitinib and upadacitinib have shown the safety profile is better in patients with skin diseases versus other diseases.
  • JAK inhibitors should be used with caution in older or obese patients, current or past smokers, patients with a history of diabetes or past history of thrombotic events (stroke, deep venous thrombosis, pulmonary embolism).
  • These medications require baseline and period lab monitoring.

Summary

While JAK inhibitors are transforming dermatologic care, clinical trials should prioritize inclusive data collection and accurate disease recognition in patients with skin of color. Understanding diagnostic nuances, optimizing dosing, and interpreting clinical endpoints across diverse populations will be essential to ensure equitable and evidence-based use of these diverse and highly effective medications.

This information was presented at the 2025 Skin of Color Update conference by Brett King, MD, PhD, FAAD. The above highlights from this lecture were written and compiled by Riyad N.H. Seervai, MD, PhD. Visit Next Steps in Derm to watch a video interview with Dr. King about this topic.

Jun 02
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Vitiligo Treatment Breakthroughs: Optimizing Outcomes for Patients With Skin of Color

By Sessions

vitiligo treatment

At Skin of Color Update, Pearl E. Grimes, MD, FAAD, shared the latest breakthroughs in vitiligo treatment.

Vitiligo remains one of the most emotionally and therapeutically challenging conditions in dermatology. It’s a disease that patients cannot hide, making its impact deeply personal and public. Contrary to common misconceptions, vitiligo affects all racial groups equally, not just African Americans.

A recent international survey highlighted the profound psychological burden of vitiligo. Patients reported increased rates of anxiety, depression, eating disorders, and PTSD. The burden is especially high among African American patients, those with facial involvement, and those with more than 5% body surface area affected.

Dr. Grimes discussed factors that influence the success of repigmentation:

  • Body Site: The face and neck respond best to treatment, while the hands remain the most resistant.
  • Age: Children tend to have better outcomes.
  • Duration of Therapy: Patients should be counseled that treatment requires several months of commitment. Be patient!
  • Lesional White Hairs: Areas with white or gray hairs are less likely to respond.
  • Trichrome Lesions: These are more resistant to therapy.

Vitiligo management should focus on three main goals: reducing oxidative stress, modulating the immune response, and stimulating melanocyte growth. Dr. Grimes discussed multiple treatment approaches:

  • Oral Minipulse Dexamethasone: 2–4 mg for two consecutive days every week, typically for about six weeks.
  • Narrowband UVB (NB-UVB): Administered 2–3 times per week, effective for both stabilization and repigmentation.
  • Vitamin D: Deficiency is common, especially in African American patients and those with vitiligo. Dr. Grimes recommends screening and supplementing all patients.
  • Emerging Therapies: These include JAK inhibitors (alone or combined with NB-UVB), afamelanotide, aryl hydrocarbon receptor agonists, WNT pathway agonists, and even metformin.
  • Topical therapies: Both topical corticosteroids and calcineurin inhibitors are equally effective, with tacrolimus offering a favorable side-effect profile. Topical ruxolitinib can be considered a first-line agent. Dr. Grimes emphasized that patients may continue to see improvement beyond 24 weeks, so persistence is key!
  • At-home NB-UVB devices have been available for over 20 years and are effective alternatives to in-office treatments.

As far as new medications:

  • Ritlecitinib, Povorcitinib, Upadacitinib, Baricitinib: There is significant positive data to support the use of these oral JAK inhibitors.
  • Combination Therapy: Best results are seen when oral agents are combined with NB-UVB.
  • Afamelanotide + NB-UVB: This combination accelerates repigmentation compared to NB-UVB alone.

Dr. Grimes predicts that the future of vitiligo treatment will rely on combination therapies. For example, using JAK inhibitors to control inflammation and agents like afamelanotide to stimulate melanocyte growth.

Vitiligo management is rapidly evolving, with new therapies offering hope for better outcomes, especially for patients with skin of color. A personalized, persistent, and multi-modal approach is key to optimizing results.

This information was presented at the 2025 Skin of Color Update conference by Pearl E. Grimes, MD, FAAD.  The above highlights from this lecture were written and compiled by Jay Nguyen, DO.

May 27
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Pigmentary Impact of Acne: SOCU Video Interview

By Sessions

pigmentary impact of acne

“Our patients hate these marks. They hate them more than they hated their acne to begin with.”  — Hilary Baldwin, MD, FAAD

Don’t miss this insightful interview on the pigmentary impact of acne, conducted by Next Steps in Derm in partnership with Skin of Color Update. Dr. Baldwin reviews how her management of acne and post‑inflammatory pigmentary changes has evolved. She shares practical, clinic-ready guidance including:

  • Whether to take an acne‑first approach or treat acne and hyperpigmentation simultaneously
  • Why “scars” is often the wrong term for certain post‑acne pigmentary changes
  • How she safely incorporates new over‑the‑counter topicals into patients’ routines to address pigmentary alteration

If you treat acne in patients with skin of color (or anyone troubled by persistent pigmentation), join us in Chicago June 6 and 7 for the Pigmentary Disorders Exchange Symposium. Sessions will address the pigmentary sequelae of inflammatory skin conditions, including acne and atopic dermatitis, as well as the latest in the management of pigmentary conditions, including melasma and vitiligo.

May 15
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Unique Skin Conditions in Asian Patients: SOCU Session Summary

By Sessions

Asian skin dermatology

Here’s a summary of key clinical pearls from the Skin of Color Update lecture by Hye Jin (Leah) Chung, MD, MMSc, FAAD, on managing dermatologic conditions in Asian patients:

  • Asian skin: higher ceramide content but greater propensity for reactivity → prioritize efficacy while minimizing irritation and PIH.
  • Melasma: emphasize photoprotection (tinted sunscreens to block visible/blue light) and gentler topicals (azelaic acid, kojic acid, topical TXA) over irritant triple combinations or cysteamine.
  • Oral tranexamic acid (TXA): Dr. Chung’s protocol — 325 mg BID × 3 months, then 325 mg daily × 3 months, then 6‑month drug holiday. Obtain thorough history and baseline thrombophilia testing (protein C/S, factor V Leiden, lupus anticoagulant, anticardiolipin antibodies) before initiation.
  • Lasers and pigment: low‑fluence Q‑switched or picosecond Nd:YAG for subcellular photothermolysis; consider picosecond/Q‑switched for deep dermal pigment (ABNOM). 1927 nm can help PIH via controlled epidermal/papillary dermal coagulation.
  • Scars: CROSS with TCA for ice‑pick scars; consider ablative CO₂ for papular scars (or needle + electrosurgery where laser unavailable).
  • Device safety: favor microneedling, fractional RF microneedling, and fractional picosecond modalities; use high‑energy/low‑density settings if performing fractional ablative/nonablative treatments to reduce PIH risk.

The write-up was written by Jay Nguyen, DO, and posted to Next Steps in Derm.

May 07
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Atopic Dermatitis in Skin of Color: SOCU Video Interview

By Sessions

atopic dermatitis in skin of color

Next Steps in Derm, in partnership with Skin of Color Update, sat down with Raj J. Chovatiya, MD, PhD (associate professor, Rosalind Franklin University/Chicago Medical School), to discuss diagnosing and treating atopic dermatitis in patients with darker skin tones.

Watch to learn:

  • Practical tips Dr. Chovatiya shares with trainees for recognizing AD in skin of color
  • How differences in presentation can influence treatment choice
  • His patient-centered approach (“Patients aren’t textbooks!”)
  • How to interpret the latest AD research for clinical care

Whether you teach, consult, or see a diverse clinic population, this conversation will sharpen diagnostic skills and therapeutic decision‑making.

Apr 21
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Scarring Alopecias: SOCU Interview with Dr. Susan Taylor

By Medical Dermatology

scarring alopecias

Scarring alopecias require early, effective treatment to stop progression and prevent further permanent hair loss. In an interview with Next Steps in Derm, in partnership with Skin of Color Update, Susan C. Taylor, MD, FAAD, shares the latest research in the understanding of scarring alopecias and how that’s influencing the therapeutic pipeline. Dr. Taylor, the Bernett Johnson Endowed Professor of Dermatology at the University of Pennsylvania Perelman School of Medicine, outlines current and future treatments, including JAK inhibitors, metformin, and vitamin D.

For more on hair loss, join us on Saturday, June 27, for Hair and Scalp Disorders: The Rx Pad and Beyond, a virtual, one-day conference. The program provides a full-spectrum perspective on hair and scalp management, from diagnosis to therapeutics to nutrition and lifestyle factors. Led by co-chairs Adam Friedman, MD, and Amy McMichael, MD, every session emphasizes practical tools, decision-making, and real-world implementation. Register today!

Apr 13
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The AD, HS, and CHE Treatment Landscape

By Sessions

dermatology drug approvals

Unprecedented momentum in dermatology: The past 18 months have brought a wave of FDA approvals that meaningfully expand options for inflammatory skin disease—many supported by trials with substantial representation of patients with skin of color.

At Skin of Color Update, Conference Co-Chair Andrew F. Alexis, MD, MPH, FAAD, highlighted several advances that matter for clinical care and health equity.

Key updates include:

  • Tapinarof 1% cream for atopic dermatitis (now approved for ages ≥2) with diverse trial cohorts and comparable efficacy across racial groups.
  • Roflumilast 0.3% foam for plaque psoriasis (scalp/body) with rapid itch relief.
  • Ruxolitinib extended to children ≥2 years for mild-to-moderate AD.
  • Delgocitinib cream approved for moderate-to-severe chronic hand eczema.
  • Lebrikizumab showing improvement in post-inflammatory hyperpigmentation in Fitzpatrick IV–VI patients.
  • Nemolizumab approved for AD ≥12 years.
  • Bimekizumab for moderate-to-severe hidradenitis suppurativa.
  • Dupilumab gains indications for chronic spontaneous urticaria and bullous pemphigoid.

These approvals are already shaping updated AD guidelines, which strongly recommend new topicals, biologics, and JAKs for moderate-to-severe disease. Read the full session summary written by Dr. Riyad Seervai to explore the data and subgroup findings.

Apr 07
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CSU in Patients With Skin of Color: SOCU Video Interview

By Sessions

chronic spontaneous urticaria in skin of color

Chronic spontaneous urticaria (CSU) is deceptively intermittent — and that can mean missed or delayed diagnoses, especially in patients with darker skin where subtle changes are harder to spot.

In a Next Steps in Derm interview at Skin of Color Update, Dr. Mona Shahriari (Yale) calls CSU “the rash that ghosts you” and shares practical tips for recognizing CSU in patients with skin of color.

Watch and learn:

  • How CSU can present differently on darker skin and what to look for
  • What’s new in the CSU toolbox — diagnostic approaches and emerging management strategies
  • Clear, pragmatic recommendations for antihistamine use and when to escalate care

This is essential for those who want to reduce diagnostic delays and improve outcomes in diverse patient populations. Tune in to hear Dr. Shahriari’s insights and actionable takeaways.

Mar 26
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Traction Alopecia in Children: SOCU Video Interview

By Sessions

traction alopecia

Traction alopecia is a common subtype of alopecia in children and one that requires culturally sensitive care, according to Brandi Kenner-Bell, MD, FAAD. In this Next Steps in Derm video interview from Skin of Color Update, Dr. Kenner-Bell says clinicians should first understand a child’s haircare practices and cultural styling preferences before offering recommendations.

In the video, Dr. Kenner-Bell shares ways for dermatology clinicians to work collaboratively with children and their parents to protect hair health while respecting cultural practices. She shares tips she’s learned in her own practice at the Ann and Robert H. Lurie Children’s Hospital of Chicago, including questions to ask at a traction alopecia office visit.

Mar 12
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Diet and HS: JDD Buzz

By Medical Dermatology

Diet and HS

A review in the Journal of Drugs in Dermatology highlights diet as a promising adjunct in hidradenitis suppurativa (HS) management, with emerging evidence that targeted dietary changes may reduce inflammation and disease severity.

In this interview with Next Steps in Derm, the study’s authors outline the main takeaway: Several dietary strategies may benefit some patients. Avoiding dairy and brewer’s yeast has been associated with symptom improvement, likely by reducing hormonal and immune triggers linked to follicular plugging and inflammation. Diets that lower systemic inflammation—such as the Mediterranean diet and very-low-calorie ketogenic diet—have shown encouraging results in small studies. Limiting leucine-rich foods (e.g., meat, eggs, and dairy) may also help by reducing mTOR-driven pathways involved in HS lesion formation.

Addressing micronutrient deficiencies is another low-risk strategy. Supplementation with vitamin D or zinc in deficient patients has produced clinical improvement in some cases. In addition, intermittent fasting, including Ramadan-style fasting, has been associated with reduced inflammatory markers and lesion severity in a subset of patients.

Although most studies are small and further research is needed, the findings support diet as a personalized, noninvasive adjunct to medical therapy. Clinicians should move beyond general advice and consider discussing specific dietary patterns—such as Mediterranean, dairy-free, or brewer’s yeast–free approaches—with patients seeking to optimize HS control or reduce reliance on systemic medications.

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