By 2050, more than half of all people living in the United States will have skin of color, according to the Skin of Color Society. But the prevalence of certain skin diseases, such as atopic dermatitis, appears to be increasing in this group, especially among Black, Asian and Pacific Islander people. “There are a lot of challenges when it comes to treating skin of color, as diagnoses can be missed, and there can be barriers to getting treatment,” says Valerie Callender, MD, founder and medical director of the Callender Dermatology and Cosmetic Center in Washington, D.C.
Callender spoke on this topic as part of a panel at the American Academy of Dermatology (AAD) annual meeting in March. “There are so many racial disparities in dermatology,” she explained. “Some of that is economic: Patients may not have health insurance or can’t afford the out-of-pocket costs to see a dermatologist. But some of it stems from trust issues, too. People of color are more likely to listen to their doctors when they look like them. Otherwise, they may be wary of taking their advice.”
Here’s a closer look at how racial disparities play out when it comes to common skin conditions such as atopic dermatitis and scarring alopecia.
Managing Pediatric Atopic Dermatitis in Skin of Color
People of African descent are more likely to get atopic dermatitis and to have the disease more severely. But they are also more likely to see delays in care. Black babies with AD have to wait longer to see a dermatologist than white ones, and Black and Hispanic babies end up in the ER for eczema treatment more frequently than White babies, according to a 2024 study published in the British Journal of Dermatology.
Other research has found that kids of color are up to 24% more likely to get AD than white ones and are more than three times as likely to end up in the hospital or at urgent care for treatment. Black children with AD were also up to four times more likely to experience early-onset, persistent disease than White children.
One reason is that it’s simply harder to recognize eczema in darker skin tones. Atopic dermatitis appears differently on skin of color: small bumps that look like goosebumps. It also often looks violet or purple, rather than red.
But socio-economic factors play a role, too. Black children with AD are nearly four times more likely to experience financial hardship than white ones with the condition. Black and Hispanic kids were also more likely to experience delays in care due to transportation problems. As a result, they were also less likely to receive certain AD treatments, see a doctor, undergo allergy testing, and had higher rates of delayed and unfilled prescriptions.
Atopic dermatitis is also more likely to cause skin discoloration in dark skin, which can be more distressing to people of color, noted Callender. It’s been linked to anxiety and depression and impacts quality of life, especially among teenagers.
Thankfully, there are good treatments available for atopic dermatitis in kids. While prescriptionsteroids are often used as the first treatment you try, they should be used carefully in skin of color since they can lighten the skin. Better options may be creams known as topical calcineurin inhibitors (TCIs), like pimecrolimus (Elidel) or tacrolimus (Protopic). Another treatment is the cream crisaborole (Eucrisa). Other treatment options include ruxolitinib (Opzelura) cream and tapinarof (Vtama) cream.
More severe AD in kids can be treated with drugs like biologics or JAK inhibitors. They work very well, but people of color have less access to them. A 2024 study published in the Journal of Allergy and Clinical Immunology found that Black and Hispanic kids were much less likely to be given the biologic dupilumab (Dupixent) than white children.
It’s important to make sure your child with atopic dermatitis gets treated, to prevent skin infections that could lead to hospitalization, stressed Callender. Some ways parents can work to make sure their kids get the care they need include:
- Look for doctors of color. Some medical centers offer Skin of Color clinics, where providers focus on people of color. You can also look for a provider on the Skin of Color website.
- Find a practice which has evening and weekend hours to make it easier to get to.
- Use telehealth, so you don’t have to travel and take as much time off of school and work.
Importance of Pigment Changes
Misdiagnosis doesn’t just affect the skin of people of color. It can affect their hair and scalp, too. One condition in particular is frontal fibrosing alopecia, a type of hair loss that destroys the hair follicles. “It was first thought to be a condition that mainly affected menopausal White women, but it also occurs in younger premenopausal Black women who may not initially show many signs of hair loss,” Callender says. Research suggests that about half of Black American women diagnosed with FFA aren’t in menopause.
One sign, however, is facial hyperpigmentation. “If a Black patient comes into my office and complains of dark blotches on her face, I know to check her eyebrows and scalp to see if she has frontal fibrosing alopecia,” Callender says.
The most common treatment for FFA are two medications, either dutasteride or finasteride, to prevent further hair loss, Callender says. “Since there aren’t really treatments that help hair to regrow, it’s important to catch FFA early,” she says. Other common treatments for FFA include steroids, anti-inflammatory medications such as doxycycline and hydroxychloroquine, oral minoxidil, platelet-rich plasma injections, excimer laser, immunosuppressants, and hair transplantation.
Callender also cautions patients to avoid chemical sunscreens, as some studies suggest that they may worsen FFA. “I encourage them to use mineral sunscreens like zinc or titanium dioxide, and look for tinted ones that are less likely to leave a white chalky paste on dark skin,” she says. Callender also treats hyperpigmentation with the skin lightener hydroquinone, as well as an over-the-counter skin product that contains an ingredient called melasyl. “It blocks the enzyme in your skin that produces melanin, so the hope is that it will prevent future hyperpigmentation.”
The best way to address unmet needs in skin of color is to encourage people to enroll in clinical trials, Callender says. A 2023 review published in the Journal of the American Academy of Dermatology found that while Black people make up almost 14% of the population, they make up less than 8% of people in skin clinical trials. “It’s the only way we’ll ever level the playing field,” Callender says.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Valerie Callender, MD, founder and medical director, Callender Dermatology and Cosmetic Center, Washington, D.C.
Skin of Color Society: “Color Me Healthy.”
Journal of the American Academy of Dermatology: “Racial and Ethnic Underrepresentation in Dermatology Clinical Trials,” “The Association Between Frontal Fibrosing Alopecia, Sunscreen,” “Moisturizers: A Systematic Review and Meta-Analysis.”
American Academy of Dermatology: “Hair loss types: Frontal fibrosing alopecia overview.”
American College of Allergy, Asthma and Immunology: “Black and Hispanic children in the U.S. have more severe eczema than white children.”
Journal of Allergy and Clinical Immunology: “Racial and ethnic disparities in dupilumab for pediatric atopic dermatitis in Florida.”
Eczema in Skin of Color: “Diagnosis and Treatment.”
British Journal of Dermatology: “Examining racial and ethnic disparities in diagnosis and access to care in infantile atopic dermatitis in the USA: a retrospective cohort study”
Pediatric Dermatology: “An Updated Scoping Review of Disparities in Pediatric Atopic Dermatitis - Gottlieb - Pediatric Dermatology - Wiley Online Library.”
