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Skin of Color Update 2024

Aug 28
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Spotlight on STDs in Skin of Color

By Sessions

STDs in skin of color

At the 2024 Skin of Color Update, Theodore Rosen, MD, FAAD, highlighted the critical role dermatologists play in recognizing and treating sexually transmitted diseases (STDs), many of which present with skin findings. His talk focused on the disproportionate burden of STDs in patients with skin of color, the unique clinical presentations of STDs, and the importance of early detection and equitable access to care.

  • Epidemiology & Disparities: In the U.S., 2.5 million STDs are diagnosed annually. African American, Hispanic, American Indian, and Alaska Native populations experience disproportionately high rates of STDs likely due to barriers in healthcare access and lack of knowledge of STD care.
  • Syphilis: Cases of primary, secondary, and congenital syphilis continue to rise, with a record number of congenital cases in 2022. Secondary syphilis in patients with skin of color may mimic psoriasis or appear as nodular or annular lesions. Early recognition is essential to reduce congenital syphilis.
  • Monkeypox (Mpox): Rates have declined since 2022, but Black and Hispanic men who have sex with men remain disproportionately affected. Full vaccination is underutilized due to lack of availability, and resistance to tecovirimat is emerging.
  • HSV (Herpes Simplex Virus): Overall rates are declining, but non-Hispanic Black individuals remain disproportionately affected. Hypertrophic/vegetative HSV-2, more common in immunocompromised patients with skin of color, requires biopsy, appropriate immunostaining, or viral culture (PCR) to make a diagnosis. Treatment requires multimodal therapy.
  • Other STDs: Chancroid, donovanosis, and lymphogranuloma venereum are now rare in the U.S., and mostly limited to specific populations.
  • Testing & Resources: Patients can access free or at-home STD testing through CDC resources.

Key Takeaway: Rising STD rates, especially syphilis, highlight the urgent need for targeted screening, culturally competent care, and better education and prevention strategies for patients with skin of color.

This session summary was written by Dr. Olive Osuoji and published on Next Steps in Derm.

Register for Skin of Color Update for more medical dermatology updates.

Aug 05
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Understanding Psoriasis at SOCU with Dr. Amy McMichael

By Medical Dermatology, Sessions

diagnosing and treating psoriasis in skin of color

August is Psoriasis Awareness Month. At Skin of Color Update 2024, Amy McMichael, MD, FAAD, delivered a comprehensive presentation on the unique challenges of diagnosing and treating psoriasis in patients with skin of color. She emphasized the importance of early recognition, tailored treatment plans, and addressing racial disparities in clinical research.

Unique Presentation in Skin of Color
Psoriasis often appears differently in darker skin tones, with violaceous or hypertrophic plaques, hyperpigmented thin plaques, or guttate (raindrop-like) lesions rather than the classic red, scaly plaques seen in lighter skin. Dr. McMichael recommended biopsy confirmation, especially since the appearance may evolve during treatment.

Treatment Strategies

  • Topicals: Ultrapotent topical steroids are often first-line, but non-steroidal alternatives (e.g., calcipotriene, roflumilast, tapinarof) may be used to reduce steroid-related side effects.
  • Systemics: For more severe cases, systemic treatments like methotrexate, cyclosporine, and acitretin can be effective, particularly in hypertrophic lesions.
  • Biologics: Although effective across all skin types, biologics are underutilized in patients of color due to limited representation in clinical trials.
  • JAK inhibitors and UV phototherapy were also discussed as viable options, especially for refractory disease or patients seeking non-biologic treatments.

Special Considerations
Treating areas like the scalp or groin requires attention to hairstyling practices and vehicle compatibility. Post-inflammatory hyperpigmentation (PIH) is a frequent concern in patients of color, often lingering after psoriasis clears. Dr. McMichael stressed setting realistic expectations and suggested adjunctive use of retinoids or skin-lightening agents alongside psoriasis treatments.

Addressing Disparities
Despite the broad availability of effective therapies, patients of color remain underrepresented in psoriasis research. Dr. McMichael pointed to the VISIBLE trial, which enrolled a racially diverse patient group, as a model for more inclusive studies.

Conclusion
Dr. McMichael underscored the importance of aggressive early treatment, cultural and clinical sensitivity, and diversifying clinical research to improve outcomes for patients of color. Education on pigmentary changes and tailored treatment strategies are key to managing both the physical and psychological impacts of psoriasis in diverse populations.

This session summary was written by Dr. Nidhi Shah and published on Next Steps in Derm.

Jul 02
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Laser End Points at SOCU with E. Victor Ross, MD

By Sessions

laser procedures in patients with skin of color

Safety in using lasers and other procedural treatments is a key educational focus of Skin of Color Update. At the 2024 conference, Next Steps in Derm interviewed E. Victor Ross, MD, FAAD, about his session on laser end points.

Watch as Dr. Ross shares end points for a few laser procedures and what you don’t want to see. Learn what tool Dr. Ross uses even in standard procedures to help with recognizing end points. Find out how a cooling device can be used in safely treating patients with skin of color. Hear how to protect surrounding skin when treating a lentigo. What happens if a laser doesn’t have an end point? Find out Dr. Ross’s tips on how to ensure safety and effectiveness in these situations.

Register for Skin of Color Update 2025 for more pearls in procedural treatments in patients with skin of color.

Jun 24
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Advancing Vitiligo Treatment: Highlights from SOCU 2024

By Sessions

overview of vitiligo

June is Vitiligo Awareness Month. At the 2024 Skin of Color Update, Rebecca Vasquez, MD, FAAD, of UT Southwestern Medical Center, shared a comprehensive overview of vitiligo, highlighting its significant psychological and medical impact.

Affecting 0.5% to 2% of the global population, Dr. Vasquez detailed the role of immune-mediated destruction of melanocytes, which is primarily driven by autoreactive CD8+ T cells. Environmental triggers, like sunburn or phenolic compounds, can trigger or exacerbate the condition, which often appears in areas prone to friction or trauma, such as the elbows and hands.

Clinical Types:

  • Nonsegmental Vitiligo (NSV): Most common, progressive, and often associated with autoimmune conditions.
  • Segmental Vitiligo (SV): Less common, typically stabilizes after rapid early progression.

Dr. Vasquez emphasized the emotional burden of the disease, especially in patients with skin of color, and the need to address psychological health alongside physical symptoms.

Treatment Options:

  • Topical Therapies: Corticosteroids and calcineurin inhibitors.
  • Phototherapy: Narrowband UVB (NbUVB) promotes repigmentation, especially when combined with topicals.
  • JAK Inhibitors: Topical ruxolitinib has shown strong results in trials; oral versions are in phase 3.
  • Surgical Treatments: Autologous skin cell suspension shows high repigmentation success in stable cases.
  • Combination Therapies: Approaches like ruxolitinib + NbUVB yield better outcomes.

Emerging Research:

  • Oral JAK inhibitors (ritlecitinib, povorcitinib, upadacitinib) show promise.
  • Targeting IL-15 as a way to go after tissue-resident memory T cells may offer long-term remission.

Conclusion:
There is no cure, but treatment is advancing. A personalized, multidisciplinary approach is essential to effectively manage both the physical and emotional aspects of vitiligo.

This session summary was written by Dr. Nidhi Shah and published on Next Steps in Derm.

Register for SOCU 2025 for more education on pigmentary disorders, including vitiligo.

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