Managing Inflammatory Skin Diseases in Patients With Skin of Color

On the third day of Fall Dermatology Week 2023, Hilary Baldwin, MD, and Shawn Kwatra, MD, presented on keloid scarring, acne, and rosacea and their impact on patients with skin of color during the session, “Inflammatory Skin Diseases in Skin of Color Patients,” with the objective to evaluate treatment options for all the diseases that avoid skin irritation and the possibility of resultant iatrogenic hyperpigmentation.

Dr Baldwin started the session with the question, is there a racially dependent variation in either acne or rosacea?

“Data does not support that either disease has racial differences in terms of morphology, etiology, or response to therapy. I think the major differences that we see clinically in acne are an increased risk of the sequelae of hyperpigmentation, of keloidal scarring, as well as an increased risk of iatrogenic hyperpigmentation, and also, of course, pomade acne,” she stated.

She added that the major differences in rosacea include missing the diagnosis altogether because of a low index of suspicion, and an increased risk, again, of iatrogenic hyperpigmentation if the topical medications physicians choose cause irritation.

For his part, Dr Kwatra looked at isotretinoin, stating, “A few years ago, we looked in terms of the prescribing patterns of isotretinoin. We found that Black patients in particular were prescribed isotretinoin less frequently than Caucasian patients.”

He stressed that postinflammatory hyperpigmentation is just as important as the erythematous lesions of acne and awareness is important to initiate early treatment.

Next, Dr Baldwin noted that erythema is one of the signs of rosacea in patients with darker skin tones. She shared that it may be more difficult to identify, therefore compression is sometimes helpful by utilizing a glass slide or blood tube. In this way, physicians can appreciate that the color has changed when they press on the skin. She added that telangiectasias, another sign of rosacea, may be easier to see with dermoscopy. Papules and pustules can also be viewed with dermoscopy.

Regarding treatment of rosacea in patients with skin of color, Dr Bladwin noted that the most important thing is to listen to patients’ symptoms.

“I like to hand them a mirror, and then while they're looking at themselves, I'm pointing out all the salient features of their rosacea. And then I say, ‘Of all the things I just pointed out to you, what do you care about?’ And then we discuss options for treatment because what would bother me is often not what bothers them,” she stated.

She concluded by stressing that physicians should manage patient expectations because rosacea is a long-term chronic condition requiring long-term chronic commitment.

For more meeting coverage, visit the Fall Dermatology Week 2023 newsroom.

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Reference
Baldwin H, Kwatra S. Inflammatory skin diseases in skin of color patients. Presented at: Dermatology Week 2023; September 20-23, 2023; Virtual.