Skin of Color Literature Review 2019 Panel
Featuring Ginette Okoye, MD and Temitayo Ogunleye, MD
Saturday morning began with an enlightening conversation with Dr. Ginette Okoye and Dr. Temitayo Ogunleye reviewing medical literature on skin of color. While this is improving, Dr. Okoye mentioned “ there is not a lot of great research in skin of color”.
Dr. Ogunleye presented a review of alopecia. In patients of color who present with frontal fibrosing alopecia (FFA) , they often lack the perifollicular scale and erythema. Common presentations of FFA in these patients include complete absence of the frontal hairline with or without proximal skin hyperpigmentation. Patients of color who present with FFA have a 54% concomitant presentation with lichen planus pigmentosus. Additional features of FFA in patients of color include facial papules and loss of overall body hair. Both Dr. Ogunleye and Dr. Okoye report many of their patients who have FFA are misdiagnosed with traction alopecia for years prior to presenting to their office. Dr. Ogunleye emphasized the importance for providers to ‘widen your differential’ when examining these patients.
Patients of color who present with FFA have a 54% concomitant presentation with lichen planus pigmentosus. Additional features of FFA in patients of color include facial papules and loss of overall body hair.
Next, Dr. Okoye discussed the presentation of rosacea in patients of color. Though it is reported less frequently, it is still not rare and may be underreported or underdiagnosed in this population. Since facial erythema may be more difficult to discern in patients of color, Dr. Okoye recommends to ask these patients about their redness rather than trying to decide if the patient is red. Additional clues to discern erythema in patients of color include using dermoscopy to look for telangiectasia, use of diascopy with a glass slide to assess for blanching or photography of patients in a dark blue background which can accentuate erythema.
The data in regards to skin cancer in patients of color was reviewed by Dr. Ogunleye. In contrast to Caucasians, skin cancer in people of color is not common. Basal cell cancers are more common in Asian and Hispanic patients who present with pigmentation in more than 50% of their tumors. Squamous cell cancers are the most common skin cancer presentation in African Americans with 80% of their tumors presenting in partially or fully covered skin such as the groin and anogenital region. There is a 20-40% risk of metastatic disease when squamous cell skin cancers present in chronic scars, such as in discoid lupus lesions. Finally, while melanoma is much less frequent in African Americans, their melanomas tend to be deeper at diagnosis and they are 1.5 x more likely to die of malignant melanoma.
Squamous cell cancers are the most common skin cancer presentation in African Americans with 80% of their tumors presenting in partially or fully covered skin such as the groin and anogenital region.
Dr. Okoye discussed racial differences in atopic dermatitis presentations and treatment. Atopic dermatitis is more prevalent in patients with skin of color—especially people of African and Asian ancestry. Patients of color are more likely to have treatment resistant disease. Of note, black and Hispanic children are three times less likely than white children to receive medical care for their atopic dermatitis. African Americans are more likely to present with extensor involvement, diffuse xerosis, Dennie-Morgan lines and papular eczema. Finally, Dr. Okoye emphasized the need for more representation of all racial groups in clinical trials in the US as well as an increased global reach.
Byline: Sarah Patton, MSHS, PA-C
Posted: June 8, 2019