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Common Chief Concerns in Skin of Color Populations and Advancements in Diagnostics and Therapeutics

Author(s)
Noelle Desir, BA
Iain Noel Encarnacion, MS
Susan C. Taylor, MD

The umbrella term skin of color (SOC) includes individuals identifying as Black/African, Hispanic, Asian, Native American, Middle Eastern, and Mediterranean as well as multiracial groups. While the Fitzpatrick skin typing system is not an accurate proxy for describing skin tone, SOC populations typically correspond to Fitzpatrick skin types IV to VI, and clinical researchers often report the Fitzpatrick skin type of their study populations.1

Over the past several decades, the underrepresentation of diverse skin tones in educational resources has limited clinical training.2 For example, only 10.3% of conditions featured in contemporary dermatology textbooks are shown in darker skin tones.3 This educational resource gap has spurred a transformative movement toward inclusivity in dermatologic education, research, and clinical practice. Notable examples include VisualDx4 and Dermatology for Skin of Color.5 In addition, Cutis began publishing the Dx Across the Skin Color Spectrum fact sheet series in 2022 to highlight differences in how cutaneous conditions manifest in various skin tones (https://www.mdedge.com/cutis/dx-across-skin-color-spectrum).

These resources play a critical role in advancing dermatologic knowledge, ensuring that dermatologists and other health care professionals are well equipped to diagnose and treat dermatologic conditions in SOC populations with accuracy and cultural humility. These innovations also have enhanced our understanding of how common dermatologic conditions manifest and respond to treatment in SOC populations. Herein, we highlight advances in diagnostic and therapeutic approaches for the most common concerns among SOC populations in the United States, including acne vulgaris, atopic dermatitis (AD), seborrheic dermatitis (SD), melasma, postinflammatory hyperpigmentation, psoriasis, and seborrheic keratosis.

Chief Concerns Common Among SOC Populations in the United States

Acne Vulgaris—In patients with SOC, acne frequently results in pigmentary changes and scarring that can manifest as both hypertrophic and keloidal scars.6 Clinical evidence from randomized controlled studies supports the use of topical dapsone gel as a safe and effective frontline treatment for acne in patients with SOC.7,8 Notably, the US Food and Drug Administration–approved 1726-nm laser with a contact-cooling sapphire window has demonstrated safety and efficacy in the management of acne across Fitzpatrick skin types II to VI.9-11 To manage atrophic acne scars, cutting-edge laser and radiofrequency devices including erbium-doped yttrium aluminum garnet, fractional CO2, and picosecond lasers have been effectively employed in SOC populations. When these energy-based treatments are combined with cooling systems, they substantially reduce the risk for thermal damage in darker skin tones.12,13

Atopic Dermatitis—While epidemiologic data indicate that Black patients experience a higher prevalence (19.3%) of AD than Asian (17.8%), White (16.1%), or Hispanic (7.8%) groups in the United States, this disparity may be influenced by factors such as access to care and environmental stressors, which require further study.14-16 The pathogenesis of AD involves a complex interaction between skin barrier dysfunction, immune dysregulation, and environmental triggers, with patients with SOC exhibiting distinct endotypes.14,17 For example, East Asian individuals have elevated TH17-related cytokines and a blended TH17/TH2 AD-psoriasis endotype,14,18 while Black individuals have greater TH2 skewing and filaggrin variations and higher serum IgE levels.17 Diagnostic advancements, including a modified Eczema Area and Severity Index using grayscale rather than erythema-based assessments for patients with SOC as well as a novel SOC dermatology atlas that includes AD have increased equity in disease evaluation.19,20 Recent clinical trials support the efficacy of topical crisaborole, topical ruxolitinib, and biologics such as dupilumab, tralokinumab, lebrikizumab, and fezakinumab for AD in SOC populations, with dupilumab also improving postinflammatory hyperpigmentation.20-22

Seborrheic Dermatitis—Seborrheic dermatitis is common in patients with SOC, though its manifestations vary by racial/ethnic background.23 In Black patients, petaloid SD is more prevalent and can resemble secondary syphilis, making accurate diagnosis essential to rule out potential mimickers.24 Effective treatments remain limited, as current therapies often fail to address both the underlying yeast-driven inflammation and the resulting pigmentary changes that commonly affect SOC populations.25 Roflumilast foam 0.3%, a phosphodiesterase 4 inhibitor, has emerged as a promising option, offering both anti-inflammatory benefits and improvements in pigmentary alterations—making it particularly valuable for treatment of SD in patients with SOC.26

Melasma—Melasma is more prevalent in women with darker skin types, particularly those of African descent and those from East and Southeast Asia or Latin America.27,28 Standard treatments including hydroquinone, retinoids, azelaic acid, kojic acid, ascorbic acid, arbutin, alpha hydroxy acids, niacinamide, and the Kligman formula (5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone) remain therapeutic foundations in patients with SOC.29 Newer alternatives that are effective in SOC populations include topical metformin 30%30; topical isobutylamido thiazolyl resorcinol or thiamidol31; and tranexamic acid cream 5%, which has comparable efficacy to hydroquinone 4% with fewer adverse effects.32 Laser therapies such as the 675-nm and 1064-nm Q-switched neodymium-doped yttrium aluminum garnet lasers, offer effective pigment reduction and are safe in darker skin tones.33,34

Postinflammatory Hyperpigmentation—Postinflammatory hyperpigmentation, often triggered by acne in SOC populations,23 manifests as brown, tan, or gray discoloration and is managed using similar topical agents as melasma, with the 1927-nm laser providing an additional treatment option for patients with SOC.27,35,36

Psoriasis—In patients with SOC, psoriasis often manifests with thicker plaques, increased scaling, and greater body surface area involvement, leading to considerable quality-of-life implications.37 Although prevalence is highest in White populations (3.6%), Asian (2.5%) and Hispanic/Latino (1.9%) patients experience increased disease severity, potentially explaining why psoriasis is among the top chief complaints for these racial/ ethnic groups in the United States.23,38 Greater diversity in clinical trials has improved our understanding of the efficacy of biologics for psoriasis in SOC populations. The VISIBLE trial—the first SOC-exclusive psoriasis trial—demonstrated a Psoriasis Area and Severity Index 90 response in 57.1% (44/77) of participants receiving guselkumab vs 3.8% (1/26) of participants receiving placebo by week 16 (P<.001).39 Other biologics such as risankizumab, secukinumab, and brodalumab also have shown efficacy in SOC populations.40-42 Additionally, topical therapies such as calcipotriene-betamethasone dipropionate cream/aerosol foam and halobetasol propionatetazarotene lotion have proven effective, with minimal adverse effects and low discontinuation rates in patients with SOC.43-46

Seborrheic Keratosis—In SOC, seborrheic keratosis (SK) often appears as a variant known as dermatosis papulosa nigra (DPN), manifesting as small, benign, hyperpigmented papules, particularly on the face and neck.47 Dermatosis papulosa nigra is common in Black, Hispanic, and some Asian populations, with variations in color and distribution among different racial/ethnic groups.48 For example, in Korean populations, SKs commonly affect males, and in contrast to the dark brown color common in White populations, SKs in Korean patients often appear lighter brown or sometimes pink.49 In contrast to the verrucous and stuck-on appearance often seen in White populations, South Asian populations more often have variants including pedunculated SKs, flat SKs, and stucco keratoses.50 High-resolution dermoscopy improves differentiation from malignant lesions; however, a sudden SK eruption in any population warrants evaluation for underlying malignancy. Cryotherapy, though effective for removal of SKs, can cause pigmentary changes in SOC populations, making laser therapy and electrosurgery preferable for these patients due to the lower risk for pigmentary sequela. If hyperpigmentation occurs, topical treatments such as hydroquinone, tretinoin, or azelaic acid can help. New laser technologies and hydrogen-peroxide–based therapies offer safer and more effective removal options while minimizing pigmentary risks in SOC populations.47,50 While DPNs are common in patients with darker skin tones, there are limited data on optimal treatment frequency, insurance coverage, and efficacy. This literature gap hinders our understanding of treatment accessibility and economic impact on our patients.51

Final Thoughts

Innovations such as standardized scoring systems and customized therapeutic strategies for conditions including acne, pigmentary disorders, and atopic dermatitis have markedly enhanced patient care and outcomes for the most common chief concerns in SOC populations. In addition, population-specific advancements have addressed unique diagnostic and therapeutic developments in Black, Asian/Pacific Islander, and Hispanic groups, from the nuanced presentations of atopic and seborrheic dermatitis in Black patients, to those of psoriasis in Asian/Pacific Islander and Hispanic populations. Finally, updated epidemiologic studies are essential to capture the current and evolving dermatologic concerns pertinent to patients with SOC, ensuring that future clinical and research efforts align with the unique needs of these populations.

References
  1. Taylor SC. Diagnosing skin diseases in skin of color. Dermatol Clin. 2023;41:xiii-xv. doi:10.1016/j.det.2023.03.001
  2. Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatol. 2006;55:687-690. doi:10.1016/j.jaad.2005.10.068
  3. Alvarado SM, Feng H. Representation of dark skin images of common dermatologic conditions in educational resources: a crosssectional analysis. J Am Acad Dermatol. 2021;84:1427-1431. doi:10.1016 /j.jaad.2020.06.041
  4. An ongoing commitment to equity in medicine. VisualDx. Accessed April 30, 2025. https://www.visualdx.com/about-visualdx/diversity/
  5. Kelly A, Taylor SC, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color. 2nd ed. McGraw-Hill Education; 2016.
  6. Cruz S, Vecerek N, Elbuluk N. Targeting inflammation in acne: current treatments and future prospects. Am J Clin Dermatol. 2023;24:681-694. doi:10.1007/s40257-023-00789-1
  7. Piette WW, Taylor S, Pariser D, et al. Hematologic safety of dapsone gel, 5%, for topical treatment of acne vulgaris. Arch Dermatol. 2008;144:1564-1570. doi:10.1001/archdermatol.2008.518
  8. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(1 suppl):S21-S37. doi:10.1016/j.ijwd.2017.02.006
  9. Jean-Pierre P, Tordjman L, Ghodasara A, et al. Emerging lasers and light-based therapies in the management of acne: a review. Lasers Med Sci. 2024;39:245. doi:10.1007/s10103-024-04196-8
  10. Goldberg D, Kothare A, Doucette M, et al. Selective photothermolysis with a novel 1726 nm laser beam: a safe and effective solution for acne vulgaris. J Cosmet Dermatol. 2023;22:486-496. doi:10.1111/jocd.15602
  11. Alexiades M, Kothare A, Goldberg D, et al. Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types. J Am Acad Dermatol. 2023;89:703-710. doi:10.1016/j.jaad.2023.05.085
  12. Battle EF Jr, Soden CE Jr. The use of lasers in darker skin types. Semin Cutan Med Surg. 2009;28:130-140. doi:10.1016/j.sder.2009.04.003
  13. Teymour S, Kania B, Lal K, et al. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol. 2023;22:1177-1184. doi:10.1111/jocd.15572
  14. Adawi W, Cornman H, Kambala A, et al. Diagnosing atopic dermatitis in skin of color. Dermatol Clin. 2023;41:417-429. doi:10.1016/j.det.2023.02.003
  15. Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol. 2014;31:21-26. doi:10.1111/pde.12237
  16. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340-357. doi:10.1111/exd.13514
  17. Czarnowicki T, He H, Krueger JG, et al. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143:1-11. doi:10.1016/j.jaci.2018.10.032
  18. Nomura T, Wu J, Kabashima K, et al. Endophenotypic variations of atopic dermatitis by age, race, and ethnicity. J Allergy Clin Immunol Pract. 2020;8:1840-1852. doi:10.1016/j.jaip.2020.02.022
  19. Silverberg JI, Horeczko J, Alexis A. Development of an eczema area and severity index atlas for diverse skin types. Dermatitis. 2024;35:173-177. doi:10.1089/derm.2023.0051
  20. Gan C, Mahil S, Pink A, et al. Atopic dermatitis in skin of colour. part 2: considerations in clinical presentation and treatment options. Clin Exp Dermatol. 2023;48:1091-1101. doi:10.1093 /ced/llad162
  21. Chen V, Akhtar S, Zheng C, et al. Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review. JAMA Dermatol. 2022;158:288-292. doi:10.1001/ jamadermatol.2021.5596
  22. Grayson C, Heath CR. Dupilumab improves atopic dermatitis and postinflammatory hyperpigmentation in patient with skin of color. J Drugs Dermatol. 2020;19:776-778. doi:10.36849/JDD.2020.4
  23. Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
  24. Wu T, Frommeyer TC, Rohan CA, et al. Uncommon petaloid form of seborrheic dermatitis seen in Fitzpatrick skin types V-VI. J Clin Investig Dermatol. 2023;11:10.13188/2373-1044.1000086. doi:10.13188/2373 -1044.1000086
  25. Jackson JM, Alexis A, Zirwas M, et al. Unmet needs for patients with seborrheic dermatitis. J Am Acad Dermatol. 2024;90:597-604. doi:10.1016/j.jaad.2022.12.017
  26. Alexis AF, Zirwas M, Bukhalo M, et al. Long-term safety and efficacy of roflumilast foam 0.3% in patients with seborrheic dermatitis in a 24–52-week, open-label phase 2 trial. Headache. 2022;13:3-3.
  27. Syder NC, Quarshie C, Elbuluk N. Disorders of facial hyperpigmentation. Dermatol Clin. 2023;41:393-405. doi:10.1016 /j.det.2023.02.005
  28. Vashi NA, Wirya SA, Inyang M, et al. Facial hyperpigmentation in skin of color: special considerations and treatment. Am J Clin Dermatol. 2017;18:215-230. doi:10.1007/s40257-016-0239-8
  29. Kania B, Lolis M, Goldberg D. Melasma management: a comprehensive review of treatment strategies including BTX-A. J Cosmet Dermatol. 2025;24:E16669. doi:10.1111/jocd.16669
  30. AboAlsoud ES, Eldahshan RM, AbouKhodair MH, et al. Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman’s formula) in treating melasma: a randomized controlled study. J Cosmet Dermatol. 2022;21:2508-2515. doi:10.1111/jocd.14953
  31. Roggenkamp D, Sammain A, Fürstenau M, et al. Thiamidol® in moderate-to-severe melasma: 24-week, randomized, double-blind, vehicle-controlled clinical study with subsequent regression phase. J Dermatol. 2021;48:1871-1876. doi:10.1111/1346-8138.16080
  32. El-Husseiny R, Rakha N, Sallam M. Efficacy and safety of tranexamic acid 5% cream vs hydroquinone 4% cream in treating melasma: a split-face comparative clinical, histopathological, and antera 3D camera study. Dermatol Ther. 2020;33:E14240. doi:10.1111/dth.14240
  33. Coricciati L, Gabellone M, Donne PD, et al. The 675-nm wavelength for treating facial melasma. Skin Res Technol. 2023;29:E13434.
  34. Ertam Sagduyu I, Marakli O, Oraloglu G, et al. Comparison of 1064 nm Q-switched Nd:YAG laser and Jessner peeling in melasma treatment. Dermatol Ther. 2022;35:E15970.
  35. Obeng-Nyarko CN, Puerta Durango KS, Jackson S, et al. Innovations in hyperpigmentation. Dermatol Clin. 2025;43:111-121. doi:10.1016/j.det.2024.08.009
  36. Bae YC, Rettig S, Weiss E, et al. Treatment of post-inflammatory hyperpigmentation in patients with darker skin types using a low energy 1,927 nm non-ablative fractional laser: a retrospective photographic review analysis. Laser Surg Med. 2020;52:7-12.
  37. Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16-24.
  38. Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021;157:940-946. doi:10.1001/jamadermatol.2021.2007
  39. Janssen Scientific Affairs. Tremfya: overview of VISIBLE clinical trial. Updated January 4, 2025. Accessed April 30, 2025. https://www.janssenscience.com/products/tremfya/medical-content/tremfya-overview-of-visible-clinical-trial
  40. Alexis AF, Gooderham M, Kwatra SG, et al. A descriptive, post hoc analysis of efficacy and safety of risankizumab in diverse racial and ethnic patient populations with moderate-to-severe psoriasis. Dermatol Ther (Heidelb). 2024;14:2877-2887. doi:10.1007 /s13555-024-01268-z
  41. El-Kashlan N, Cices A, Kaufman B, et al. Efficacy and safety of secukinumab in the treatment of psoriasis in patients with skin phototypes IV to VI. J Drugs Dermatol. 2024;23:600-606. doi:10.36849JDD.8128
  42. McMichael A, Desai SR, Qureshi A, et al. Efficacy and safety of brodalumab in patients with moderate-to-severe plaque psoriasis and skin of color: results from the pooled AMAGINE-2/-3 randomized trials. Am J Clin Dermatol. 2019;20:267-276. doi:10.1007 /s40257-018-0408-z
  43. Kontzias CL, Curcio A, Gorodokin B, et al. Efficacy, convenience, and safety of calcipotriene-betamethasone dipropionate cream in skin of color patients with plaque psoriasis. J Drugs Dermatol. 2023;22:668-672. doi:10.36849/JDD.7497
  44. Liu J, Cices A, Kaufman B, et al. Efficacy and safety of calcipotriene/betamethasone dipropionate foam in the treatment of psoriasis in skin of color. J Drugs Dermatol. 2023;22:165-173. doi:10.36849/JDD.6910
  45. Alexis AF, Desai SR, Han G, et al. Fixed-combination halobetasol propionate and tazarotene lotion for psoriasis in patients with skin of color. J Drugs Dermatol. 2021;20:744. doi:10.36849/JDD.735
  46. Desai SR, Alexis AF, Jacobson A. Successful management of a black male with psoriasis and dyspigmentation treated with halobetasol propionate 0.01%/tazarotene 0.045% lotion: case report. J Drugs Dermatol. 2020;19:1000-1004. doi:10.36849/JDD.2020.5347
  47. Chatrath S, Bradley L, Kentosh J. Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations. Arch Dermatol Res. 2023;315:1089-1097. doi:10.1007/s00403-022-02493-2
  48. Xiao A, Muse ME, Ettefagh L. Dermatosis papulosa nigra. In: StatPearls. StatPearls Publishing; 2022.
  49. Kwon OS, Hwang EJ, Bae JH, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed. 2003;19:73-80. doi:10.1034/j.1600-0781.2003.00025.x
  50. Rajesh G, Thappa DM, Jaisankar TJ, et al. Spectrum of seborrheic keratoses in South Indians: a clinical and dermoscopic study. Indian J Dermatol Venereol Leprol. 2011;77:483-488. doi:10.4103/0378-6323.82408
  51. Duncan N, Usatine RP, Heath CR. Key features of dermatosis papulosa nigra vs seborrheic keratosis. Cutis. 2025;115:70-71. doi:10.12788/cutis.1170
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Author and Disclosure Information

Noelle Desir is from Weill Cornell Medical College, New York, New York. Iain Noel Encarnacion is from Eastern Virginia Medical School, Norfolk. Dr. Taylor is from the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Noelle Desir and Iain Noel Encarnacion have no relevant financial disclosures to report. Dr. Taylor has served as a consultant, advisory board member, investigator, and/or speaker for AbbVie, Allergan Aesthetics, Arcutis, Armis Biopharma, Avita Medical, Beiersdorf, Biorez, Bristol-Myers Squibb, Cara Therapeutics, Catalyst Medical Education, Concert Pharmaceuticals, Croma-Pharma GmbH, Dermsquared, Dior, Eli Lilly and Company, EPI Health, Estée Lauder, Evolus, Galderma, GloGetter, Hugel America, Incyte, Johnson & Johnson Innovate Medicine, LearnSkin, L’Oreal USA, Medscape, MJH LifeSciences, Pfizer, Piction Health, Sanofi, Scientis US, UCB, and Vichy Laboratories. Dr. Taylor also serves on the board of directors for Mercer Strategies; has received stock options for Armis Biopharma, GloGetter, and Piction Health; and has received royalties from McGraw-Hill.

Correspondence: Susan C. Taylor, MD, Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 ([email protected]).

Cutis. 2025 August;116(2):50-52, 68. doi:10.12788/cutis.1245

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Author and Disclosure Information

Noelle Desir is from Weill Cornell Medical College, New York, New York. Iain Noel Encarnacion is from Eastern Virginia Medical School, Norfolk. Dr. Taylor is from the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Noelle Desir and Iain Noel Encarnacion have no relevant financial disclosures to report. Dr. Taylor has served as a consultant, advisory board member, investigator, and/or speaker for AbbVie, Allergan Aesthetics, Arcutis, Armis Biopharma, Avita Medical, Beiersdorf, Biorez, Bristol-Myers Squibb, Cara Therapeutics, Catalyst Medical Education, Concert Pharmaceuticals, Croma-Pharma GmbH, Dermsquared, Dior, Eli Lilly and Company, EPI Health, Estée Lauder, Evolus, Galderma, GloGetter, Hugel America, Incyte, Johnson & Johnson Innovate Medicine, LearnSkin, L’Oreal USA, Medscape, MJH LifeSciences, Pfizer, Piction Health, Sanofi, Scientis US, UCB, and Vichy Laboratories. Dr. Taylor also serves on the board of directors for Mercer Strategies; has received stock options for Armis Biopharma, GloGetter, and Piction Health; and has received royalties from McGraw-Hill.

Correspondence: Susan C. Taylor, MD, Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 ([email protected]).

Cutis. 2025 August;116(2):50-52, 68. doi:10.12788/cutis.1245

Author and Disclosure Information

Noelle Desir is from Weill Cornell Medical College, New York, New York. Iain Noel Encarnacion is from Eastern Virginia Medical School, Norfolk. Dr. Taylor is from the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Noelle Desir and Iain Noel Encarnacion have no relevant financial disclosures to report. Dr. Taylor has served as a consultant, advisory board member, investigator, and/or speaker for AbbVie, Allergan Aesthetics, Arcutis, Armis Biopharma, Avita Medical, Beiersdorf, Biorez, Bristol-Myers Squibb, Cara Therapeutics, Catalyst Medical Education, Concert Pharmaceuticals, Croma-Pharma GmbH, Dermsquared, Dior, Eli Lilly and Company, EPI Health, Estée Lauder, Evolus, Galderma, GloGetter, Hugel America, Incyte, Johnson & Johnson Innovate Medicine, LearnSkin, L’Oreal USA, Medscape, MJH LifeSciences, Pfizer, Piction Health, Sanofi, Scientis US, UCB, and Vichy Laboratories. Dr. Taylor also serves on the board of directors for Mercer Strategies; has received stock options for Armis Biopharma, GloGetter, and Piction Health; and has received royalties from McGraw-Hill.

Correspondence: Susan C. Taylor, MD, Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 ([email protected]).

Cutis. 2025 August;116(2):50-52, 68. doi:10.12788/cutis.1245

Article PDF
CT116002050_0.pdf
Article PDF
CT116002050_0.pdf

The umbrella term skin of color (SOC) includes individuals identifying as Black/African, Hispanic, Asian, Native American, Middle Eastern, and Mediterranean as well as multiracial groups. While the Fitzpatrick skin typing system is not an accurate proxy for describing skin tone, SOC populations typically correspond to Fitzpatrick skin types IV to VI, and clinical researchers often report the Fitzpatrick skin type of their study populations.1

Over the past several decades, the underrepresentation of diverse skin tones in educational resources has limited clinical training.2 For example, only 10.3% of conditions featured in contemporary dermatology textbooks are shown in darker skin tones.3 This educational resource gap has spurred a transformative movement toward inclusivity in dermatologic education, research, and clinical practice. Notable examples include VisualDx4 and Dermatology for Skin of Color.5 In addition, Cutis began publishing the Dx Across the Skin Color Spectrum fact sheet series in 2022 to highlight differences in how cutaneous conditions manifest in various skin tones (https://www.mdedge.com/cutis/dx-across-skin-color-spectrum).

These resources play a critical role in advancing dermatologic knowledge, ensuring that dermatologists and other health care professionals are well equipped to diagnose and treat dermatologic conditions in SOC populations with accuracy and cultural humility. These innovations also have enhanced our understanding of how common dermatologic conditions manifest and respond to treatment in SOC populations. Herein, we highlight advances in diagnostic and therapeutic approaches for the most common concerns among SOC populations in the United States, including acne vulgaris, atopic dermatitis (AD), seborrheic dermatitis (SD), melasma, postinflammatory hyperpigmentation, psoriasis, and seborrheic keratosis.

Chief Concerns Common Among SOC Populations in the United States

Acne Vulgaris—In patients with SOC, acne frequently results in pigmentary changes and scarring that can manifest as both hypertrophic and keloidal scars.6 Clinical evidence from randomized controlled studies supports the use of topical dapsone gel as a safe and effective frontline treatment for acne in patients with SOC.7,8 Notably, the US Food and Drug Administration–approved 1726-nm laser with a contact-cooling sapphire window has demonstrated safety and efficacy in the management of acne across Fitzpatrick skin types II to VI.9-11 To manage atrophic acne scars, cutting-edge laser and radiofrequency devices including erbium-doped yttrium aluminum garnet, fractional CO2, and picosecond lasers have been effectively employed in SOC populations. When these energy-based treatments are combined with cooling systems, they substantially reduce the risk for thermal damage in darker skin tones.12,13

Atopic Dermatitis—While epidemiologic data indicate that Black patients experience a higher prevalence (19.3%) of AD than Asian (17.8%), White (16.1%), or Hispanic (7.8%) groups in the United States, this disparity may be influenced by factors such as access to care and environmental stressors, which require further study.14-16 The pathogenesis of AD involves a complex interaction between skin barrier dysfunction, immune dysregulation, and environmental triggers, with patients with SOC exhibiting distinct endotypes.14,17 For example, East Asian individuals have elevated TH17-related cytokines and a blended TH17/TH2 AD-psoriasis endotype,14,18 while Black individuals have greater TH2 skewing and filaggrin variations and higher serum IgE levels.17 Diagnostic advancements, including a modified Eczema Area and Severity Index using grayscale rather than erythema-based assessments for patients with SOC as well as a novel SOC dermatology atlas that includes AD have increased equity in disease evaluation.19,20 Recent clinical trials support the efficacy of topical crisaborole, topical ruxolitinib, and biologics such as dupilumab, tralokinumab, lebrikizumab, and fezakinumab for AD in SOC populations, with dupilumab also improving postinflammatory hyperpigmentation.20-22

Seborrheic Dermatitis—Seborrheic dermatitis is common in patients with SOC, though its manifestations vary by racial/ethnic background.23 In Black patients, petaloid SD is more prevalent and can resemble secondary syphilis, making accurate diagnosis essential to rule out potential mimickers.24 Effective treatments remain limited, as current therapies often fail to address both the underlying yeast-driven inflammation and the resulting pigmentary changes that commonly affect SOC populations.25 Roflumilast foam 0.3%, a phosphodiesterase 4 inhibitor, has emerged as a promising option, offering both anti-inflammatory benefits and improvements in pigmentary alterations—making it particularly valuable for treatment of SD in patients with SOC.26

Melasma—Melasma is more prevalent in women with darker skin types, particularly those of African descent and those from East and Southeast Asia or Latin America.27,28 Standard treatments including hydroquinone, retinoids, azelaic acid, kojic acid, ascorbic acid, arbutin, alpha hydroxy acids, niacinamide, and the Kligman formula (5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone) remain therapeutic foundations in patients with SOC.29 Newer alternatives that are effective in SOC populations include topical metformin 30%30; topical isobutylamido thiazolyl resorcinol or thiamidol31; and tranexamic acid cream 5%, which has comparable efficacy to hydroquinone 4% with fewer adverse effects.32 Laser therapies such as the 675-nm and 1064-nm Q-switched neodymium-doped yttrium aluminum garnet lasers, offer effective pigment reduction and are safe in darker skin tones.33,34

Postinflammatory Hyperpigmentation—Postinflammatory hyperpigmentation, often triggered by acne in SOC populations,23 manifests as brown, tan, or gray discoloration and is managed using similar topical agents as melasma, with the 1927-nm laser providing an additional treatment option for patients with SOC.27,35,36

Psoriasis—In patients with SOC, psoriasis often manifests with thicker plaques, increased scaling, and greater body surface area involvement, leading to considerable quality-of-life implications.37 Although prevalence is highest in White populations (3.6%), Asian (2.5%) and Hispanic/Latino (1.9%) patients experience increased disease severity, potentially explaining why psoriasis is among the top chief complaints for these racial/ ethnic groups in the United States.23,38 Greater diversity in clinical trials has improved our understanding of the efficacy of biologics for psoriasis in SOC populations. The VISIBLE trial—the first SOC-exclusive psoriasis trial—demonstrated a Psoriasis Area and Severity Index 90 response in 57.1% (44/77) of participants receiving guselkumab vs 3.8% (1/26) of participants receiving placebo by week 16 (P<.001).39 Other biologics such as risankizumab, secukinumab, and brodalumab also have shown efficacy in SOC populations.40-42 Additionally, topical therapies such as calcipotriene-betamethasone dipropionate cream/aerosol foam and halobetasol propionatetazarotene lotion have proven effective, with minimal adverse effects and low discontinuation rates in patients with SOC.43-46

Seborrheic Keratosis—In SOC, seborrheic keratosis (SK) often appears as a variant known as dermatosis papulosa nigra (DPN), manifesting as small, benign, hyperpigmented papules, particularly on the face and neck.47 Dermatosis papulosa nigra is common in Black, Hispanic, and some Asian populations, with variations in color and distribution among different racial/ethnic groups.48 For example, in Korean populations, SKs commonly affect males, and in contrast to the dark brown color common in White populations, SKs in Korean patients often appear lighter brown or sometimes pink.49 In contrast to the verrucous and stuck-on appearance often seen in White populations, South Asian populations more often have variants including pedunculated SKs, flat SKs, and stucco keratoses.50 High-resolution dermoscopy improves differentiation from malignant lesions; however, a sudden SK eruption in any population warrants evaluation for underlying malignancy. Cryotherapy, though effective for removal of SKs, can cause pigmentary changes in SOC populations, making laser therapy and electrosurgery preferable for these patients due to the lower risk for pigmentary sequela. If hyperpigmentation occurs, topical treatments such as hydroquinone, tretinoin, or azelaic acid can help. New laser technologies and hydrogen-peroxide–based therapies offer safer and more effective removal options while minimizing pigmentary risks in SOC populations.47,50 While DPNs are common in patients with darker skin tones, there are limited data on optimal treatment frequency, insurance coverage, and efficacy. This literature gap hinders our understanding of treatment accessibility and economic impact on our patients.51

Final Thoughts

Innovations such as standardized scoring systems and customized therapeutic strategies for conditions including acne, pigmentary disorders, and atopic dermatitis have markedly enhanced patient care and outcomes for the most common chief concerns in SOC populations. In addition, population-specific advancements have addressed unique diagnostic and therapeutic developments in Black, Asian/Pacific Islander, and Hispanic groups, from the nuanced presentations of atopic and seborrheic dermatitis in Black patients, to those of psoriasis in Asian/Pacific Islander and Hispanic populations. Finally, updated epidemiologic studies are essential to capture the current and evolving dermatologic concerns pertinent to patients with SOC, ensuring that future clinical and research efforts align with the unique needs of these populations.

The umbrella term skin of color (SOC) includes individuals identifying as Black/African, Hispanic, Asian, Native American, Middle Eastern, and Mediterranean as well as multiracial groups. While the Fitzpatrick skin typing system is not an accurate proxy for describing skin tone, SOC populations typically correspond to Fitzpatrick skin types IV to VI, and clinical researchers often report the Fitzpatrick skin type of their study populations.1

Over the past several decades, the underrepresentation of diverse skin tones in educational resources has limited clinical training.2 For example, only 10.3% of conditions featured in contemporary dermatology textbooks are shown in darker skin tones.3 This educational resource gap has spurred a transformative movement toward inclusivity in dermatologic education, research, and clinical practice. Notable examples include VisualDx4 and Dermatology for Skin of Color.5 In addition, Cutis began publishing the Dx Across the Skin Color Spectrum fact sheet series in 2022 to highlight differences in how cutaneous conditions manifest in various skin tones (https://www.mdedge.com/cutis/dx-across-skin-color-spectrum).

These resources play a critical role in advancing dermatologic knowledge, ensuring that dermatologists and other health care professionals are well equipped to diagnose and treat dermatologic conditions in SOC populations with accuracy and cultural humility. These innovations also have enhanced our understanding of how common dermatologic conditions manifest and respond to treatment in SOC populations. Herein, we highlight advances in diagnostic and therapeutic approaches for the most common concerns among SOC populations in the United States, including acne vulgaris, atopic dermatitis (AD), seborrheic dermatitis (SD), melasma, postinflammatory hyperpigmentation, psoriasis, and seborrheic keratosis.

Chief Concerns Common Among SOC Populations in the United States

Acne Vulgaris—In patients with SOC, acne frequently results in pigmentary changes and scarring that can manifest as both hypertrophic and keloidal scars.6 Clinical evidence from randomized controlled studies supports the use of topical dapsone gel as a safe and effective frontline treatment for acne in patients with SOC.7,8 Notably, the US Food and Drug Administration–approved 1726-nm laser with a contact-cooling sapphire window has demonstrated safety and efficacy in the management of acne across Fitzpatrick skin types II to VI.9-11 To manage atrophic acne scars, cutting-edge laser and radiofrequency devices including erbium-doped yttrium aluminum garnet, fractional CO2, and picosecond lasers have been effectively employed in SOC populations. When these energy-based treatments are combined with cooling systems, they substantially reduce the risk for thermal damage in darker skin tones.12,13

Atopic Dermatitis—While epidemiologic data indicate that Black patients experience a higher prevalence (19.3%) of AD than Asian (17.8%), White (16.1%), or Hispanic (7.8%) groups in the United States, this disparity may be influenced by factors such as access to care and environmental stressors, which require further study.14-16 The pathogenesis of AD involves a complex interaction between skin barrier dysfunction, immune dysregulation, and environmental triggers, with patients with SOC exhibiting distinct endotypes.14,17 For example, East Asian individuals have elevated TH17-related cytokines and a blended TH17/TH2 AD-psoriasis endotype,14,18 while Black individuals have greater TH2 skewing and filaggrin variations and higher serum IgE levels.17 Diagnostic advancements, including a modified Eczema Area and Severity Index using grayscale rather than erythema-based assessments for patients with SOC as well as a novel SOC dermatology atlas that includes AD have increased equity in disease evaluation.19,20 Recent clinical trials support the efficacy of topical crisaborole, topical ruxolitinib, and biologics such as dupilumab, tralokinumab, lebrikizumab, and fezakinumab for AD in SOC populations, with dupilumab also improving postinflammatory hyperpigmentation.20-22

Seborrheic Dermatitis—Seborrheic dermatitis is common in patients with SOC, though its manifestations vary by racial/ethnic background.23 In Black patients, petaloid SD is more prevalent and can resemble secondary syphilis, making accurate diagnosis essential to rule out potential mimickers.24 Effective treatments remain limited, as current therapies often fail to address both the underlying yeast-driven inflammation and the resulting pigmentary changes that commonly affect SOC populations.25 Roflumilast foam 0.3%, a phosphodiesterase 4 inhibitor, has emerged as a promising option, offering both anti-inflammatory benefits and improvements in pigmentary alterations—making it particularly valuable for treatment of SD in patients with SOC.26

Melasma—Melasma is more prevalent in women with darker skin types, particularly those of African descent and those from East and Southeast Asia or Latin America.27,28 Standard treatments including hydroquinone, retinoids, azelaic acid, kojic acid, ascorbic acid, arbutin, alpha hydroxy acids, niacinamide, and the Kligman formula (5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone) remain therapeutic foundations in patients with SOC.29 Newer alternatives that are effective in SOC populations include topical metformin 30%30; topical isobutylamido thiazolyl resorcinol or thiamidol31; and tranexamic acid cream 5%, which has comparable efficacy to hydroquinone 4% with fewer adverse effects.32 Laser therapies such as the 675-nm and 1064-nm Q-switched neodymium-doped yttrium aluminum garnet lasers, offer effective pigment reduction and are safe in darker skin tones.33,34

Postinflammatory Hyperpigmentation—Postinflammatory hyperpigmentation, often triggered by acne in SOC populations,23 manifests as brown, tan, or gray discoloration and is managed using similar topical agents as melasma, with the 1927-nm laser providing an additional treatment option for patients with SOC.27,35,36

Psoriasis—In patients with SOC, psoriasis often manifests with thicker plaques, increased scaling, and greater body surface area involvement, leading to considerable quality-of-life implications.37 Although prevalence is highest in White populations (3.6%), Asian (2.5%) and Hispanic/Latino (1.9%) patients experience increased disease severity, potentially explaining why psoriasis is among the top chief complaints for these racial/ ethnic groups in the United States.23,38 Greater diversity in clinical trials has improved our understanding of the efficacy of biologics for psoriasis in SOC populations. The VISIBLE trial—the first SOC-exclusive psoriasis trial—demonstrated a Psoriasis Area and Severity Index 90 response in 57.1% (44/77) of participants receiving guselkumab vs 3.8% (1/26) of participants receiving placebo by week 16 (P<.001).39 Other biologics such as risankizumab, secukinumab, and brodalumab also have shown efficacy in SOC populations.40-42 Additionally, topical therapies such as calcipotriene-betamethasone dipropionate cream/aerosol foam and halobetasol propionatetazarotene lotion have proven effective, with minimal adverse effects and low discontinuation rates in patients with SOC.43-46

Seborrheic Keratosis—In SOC, seborrheic keratosis (SK) often appears as a variant known as dermatosis papulosa nigra (DPN), manifesting as small, benign, hyperpigmented papules, particularly on the face and neck.47 Dermatosis papulosa nigra is common in Black, Hispanic, and some Asian populations, with variations in color and distribution among different racial/ethnic groups.48 For example, in Korean populations, SKs commonly affect males, and in contrast to the dark brown color common in White populations, SKs in Korean patients often appear lighter brown or sometimes pink.49 In contrast to the verrucous and stuck-on appearance often seen in White populations, South Asian populations more often have variants including pedunculated SKs, flat SKs, and stucco keratoses.50 High-resolution dermoscopy improves differentiation from malignant lesions; however, a sudden SK eruption in any population warrants evaluation for underlying malignancy. Cryotherapy, though effective for removal of SKs, can cause pigmentary changes in SOC populations, making laser therapy and electrosurgery preferable for these patients due to the lower risk for pigmentary sequela. If hyperpigmentation occurs, topical treatments such as hydroquinone, tretinoin, or azelaic acid can help. New laser technologies and hydrogen-peroxide–based therapies offer safer and more effective removal options while minimizing pigmentary risks in SOC populations.47,50 While DPNs are common in patients with darker skin tones, there are limited data on optimal treatment frequency, insurance coverage, and efficacy. This literature gap hinders our understanding of treatment accessibility and economic impact on our patients.51

Final Thoughts

Innovations such as standardized scoring systems and customized therapeutic strategies for conditions including acne, pigmentary disorders, and atopic dermatitis have markedly enhanced patient care and outcomes for the most common chief concerns in SOC populations. In addition, population-specific advancements have addressed unique diagnostic and therapeutic developments in Black, Asian/Pacific Islander, and Hispanic groups, from the nuanced presentations of atopic and seborrheic dermatitis in Black patients, to those of psoriasis in Asian/Pacific Islander and Hispanic populations. Finally, updated epidemiologic studies are essential to capture the current and evolving dermatologic concerns pertinent to patients with SOC, ensuring that future clinical and research efforts align with the unique needs of these populations.

References
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  2. Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatol. 2006;55:687-690. doi:10.1016/j.jaad.2005.10.068
  3. Alvarado SM, Feng H. Representation of dark skin images of common dermatologic conditions in educational resources: a crosssectional analysis. J Am Acad Dermatol. 2021;84:1427-1431. doi:10.1016 /j.jaad.2020.06.041
  4. An ongoing commitment to equity in medicine. VisualDx. Accessed April 30, 2025. https://www.visualdx.com/about-visualdx/diversity/
  5. Kelly A, Taylor SC, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color. 2nd ed. McGraw-Hill Education; 2016.
  6. Cruz S, Vecerek N, Elbuluk N. Targeting inflammation in acne: current treatments and future prospects. Am J Clin Dermatol. 2023;24:681-694. doi:10.1007/s40257-023-00789-1
  7. Piette WW, Taylor S, Pariser D, et al. Hematologic safety of dapsone gel, 5%, for topical treatment of acne vulgaris. Arch Dermatol. 2008;144:1564-1570. doi:10.1001/archdermatol.2008.518
  8. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(1 suppl):S21-S37. doi:10.1016/j.ijwd.2017.02.006
  9. Jean-Pierre P, Tordjman L, Ghodasara A, et al. Emerging lasers and light-based therapies in the management of acne: a review. Lasers Med Sci. 2024;39:245. doi:10.1007/s10103-024-04196-8
  10. Goldberg D, Kothare A, Doucette M, et al. Selective photothermolysis with a novel 1726 nm laser beam: a safe and effective solution for acne vulgaris. J Cosmet Dermatol. 2023;22:486-496. doi:10.1111/jocd.15602
  11. Alexiades M, Kothare A, Goldberg D, et al. Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types. J Am Acad Dermatol. 2023;89:703-710. doi:10.1016/j.jaad.2023.05.085
  12. Battle EF Jr, Soden CE Jr. The use of lasers in darker skin types. Semin Cutan Med Surg. 2009;28:130-140. doi:10.1016/j.sder.2009.04.003
  13. Teymour S, Kania B, Lal K, et al. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol. 2023;22:1177-1184. doi:10.1111/jocd.15572
  14. Adawi W, Cornman H, Kambala A, et al. Diagnosing atopic dermatitis in skin of color. Dermatol Clin. 2023;41:417-429. doi:10.1016/j.det.2023.02.003
  15. Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol. 2014;31:21-26. doi:10.1111/pde.12237
  16. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340-357. doi:10.1111/exd.13514
  17. Czarnowicki T, He H, Krueger JG, et al. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143:1-11. doi:10.1016/j.jaci.2018.10.032
  18. Nomura T, Wu J, Kabashima K, et al. Endophenotypic variations of atopic dermatitis by age, race, and ethnicity. J Allergy Clin Immunol Pract. 2020;8:1840-1852. doi:10.1016/j.jaip.2020.02.022
  19. Silverberg JI, Horeczko J, Alexis A. Development of an eczema area and severity index atlas for diverse skin types. Dermatitis. 2024;35:173-177. doi:10.1089/derm.2023.0051
  20. Gan C, Mahil S, Pink A, et al. Atopic dermatitis in skin of colour. part 2: considerations in clinical presentation and treatment options. Clin Exp Dermatol. 2023;48:1091-1101. doi:10.1093 /ced/llad162
  21. Chen V, Akhtar S, Zheng C, et al. Assessment of changes in diversity in dermatology clinical trials between 2010-2015 and 2015-2020: a systematic review. JAMA Dermatol. 2022;158:288-292. doi:10.1001/ jamadermatol.2021.5596
  22. Grayson C, Heath CR. Dupilumab improves atopic dermatitis and postinflammatory hyperpigmentation in patient with skin of color. J Drugs Dermatol. 2020;19:776-778. doi:10.36849/JDD.2020.4
  23. Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
  24. Wu T, Frommeyer TC, Rohan CA, et al. Uncommon petaloid form of seborrheic dermatitis seen in Fitzpatrick skin types V-VI. J Clin Investig Dermatol. 2023;11:10.13188/2373-1044.1000086. doi:10.13188/2373 -1044.1000086
  25. Jackson JM, Alexis A, Zirwas M, et al. Unmet needs for patients with seborrheic dermatitis. J Am Acad Dermatol. 2024;90:597-604. doi:10.1016/j.jaad.2022.12.017
  26. Alexis AF, Zirwas M, Bukhalo M, et al. Long-term safety and efficacy of roflumilast foam 0.3% in patients with seborrheic dermatitis in a 24–52-week, open-label phase 2 trial. Headache. 2022;13:3-3.
  27. Syder NC, Quarshie C, Elbuluk N. Disorders of facial hyperpigmentation. Dermatol Clin. 2023;41:393-405. doi:10.1016 /j.det.2023.02.005
  28. Vashi NA, Wirya SA, Inyang M, et al. Facial hyperpigmentation in skin of color: special considerations and treatment. Am J Clin Dermatol. 2017;18:215-230. doi:10.1007/s40257-016-0239-8
  29. Kania B, Lolis M, Goldberg D. Melasma management: a comprehensive review of treatment strategies including BTX-A. J Cosmet Dermatol. 2025;24:E16669. doi:10.1111/jocd.16669
  30. AboAlsoud ES, Eldahshan RM, AbouKhodair MH, et al. Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman’s formula) in treating melasma: a randomized controlled study. J Cosmet Dermatol. 2022;21:2508-2515. doi:10.1111/jocd.14953
  31. Roggenkamp D, Sammain A, Fürstenau M, et al. Thiamidol® in moderate-to-severe melasma: 24-week, randomized, double-blind, vehicle-controlled clinical study with subsequent regression phase. J Dermatol. 2021;48:1871-1876. doi:10.1111/1346-8138.16080
  32. El-Husseiny R, Rakha N, Sallam M. Efficacy and safety of tranexamic acid 5% cream vs hydroquinone 4% cream in treating melasma: a split-face comparative clinical, histopathological, and antera 3D camera study. Dermatol Ther. 2020;33:E14240. doi:10.1111/dth.14240
  33. Coricciati L, Gabellone M, Donne PD, et al. The 675-nm wavelength for treating facial melasma. Skin Res Technol. 2023;29:E13434.
  34. Ertam Sagduyu I, Marakli O, Oraloglu G, et al. Comparison of 1064 nm Q-switched Nd:YAG laser and Jessner peeling in melasma treatment. Dermatol Ther. 2022;35:E15970.
  35. Obeng-Nyarko CN, Puerta Durango KS, Jackson S, et al. Innovations in hyperpigmentation. Dermatol Clin. 2025;43:111-121. doi:10.1016/j.det.2024.08.009
  36. Bae YC, Rettig S, Weiss E, et al. Treatment of post-inflammatory hyperpigmentation in patients with darker skin types using a low energy 1,927 nm non-ablative fractional laser: a retrospective photographic review analysis. Laser Surg Med. 2020;52:7-12.
  37. Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16-24.
  38. Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021;157:940-946. doi:10.1001/jamadermatol.2021.2007
  39. Janssen Scientific Affairs. Tremfya: overview of VISIBLE clinical trial. Updated January 4, 2025. Accessed April 30, 2025. https://www.janssenscience.com/products/tremfya/medical-content/tremfya-overview-of-visible-clinical-trial
  40. Alexis AF, Gooderham M, Kwatra SG, et al. A descriptive, post hoc analysis of efficacy and safety of risankizumab in diverse racial and ethnic patient populations with moderate-to-severe psoriasis. Dermatol Ther (Heidelb). 2024;14:2877-2887. doi:10.1007 /s13555-024-01268-z
  41. El-Kashlan N, Cices A, Kaufman B, et al. Efficacy and safety of secukinumab in the treatment of psoriasis in patients with skin phototypes IV to VI. J Drugs Dermatol. 2024;23:600-606. doi:10.36849JDD.8128
  42. McMichael A, Desai SR, Qureshi A, et al. Efficacy and safety of brodalumab in patients with moderate-to-severe plaque psoriasis and skin of color: results from the pooled AMAGINE-2/-3 randomized trials. Am J Clin Dermatol. 2019;20:267-276. doi:10.1007 /s40257-018-0408-z
  43. Kontzias CL, Curcio A, Gorodokin B, et al. Efficacy, convenience, and safety of calcipotriene-betamethasone dipropionate cream in skin of color patients with plaque psoriasis. J Drugs Dermatol. 2023;22:668-672. doi:10.36849/JDD.7497
  44. Liu J, Cices A, Kaufman B, et al. Efficacy and safety of calcipotriene/betamethasone dipropionate foam in the treatment of psoriasis in skin of color. J Drugs Dermatol. 2023;22:165-173. doi:10.36849/JDD.6910
  45. Alexis AF, Desai SR, Han G, et al. Fixed-combination halobetasol propionate and tazarotene lotion for psoriasis in patients with skin of color. J Drugs Dermatol. 2021;20:744. doi:10.36849/JDD.735
  46. Desai SR, Alexis AF, Jacobson A. Successful management of a black male with psoriasis and dyspigmentation treated with halobetasol propionate 0.01%/tazarotene 0.045% lotion: case report. J Drugs Dermatol. 2020;19:1000-1004. doi:10.36849/JDD.2020.5347
  47. Chatrath S, Bradley L, Kentosh J. Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations. Arch Dermatol Res. 2023;315:1089-1097. doi:10.1007/s00403-022-02493-2
  48. Xiao A, Muse ME, Ettefagh L. Dermatosis papulosa nigra. In: StatPearls. StatPearls Publishing; 2022.
  49. Kwon OS, Hwang EJ, Bae JH, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed. 2003;19:73-80. doi:10.1034/j.1600-0781.2003.00025.x
  50. Rajesh G, Thappa DM, Jaisankar TJ, et al. Spectrum of seborrheic keratoses in South Indians: a clinical and dermoscopic study. Indian J Dermatol Venereol Leprol. 2011;77:483-488. doi:10.4103/0378-6323.82408
  51. Duncan N, Usatine RP, Heath CR. Key features of dermatosis papulosa nigra vs seborrheic keratosis. Cutis. 2025;115:70-71. doi:10.12788/cutis.1170
References
  1. Taylor SC. Diagnosing skin diseases in skin of color. Dermatol Clin. 2023;41:xiii-xv. doi:10.1016/j.det.2023.03.001
  2. Ebede T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatol. 2006;55:687-690. doi:10.1016/j.jaad.2005.10.068
  3. Alvarado SM, Feng H. Representation of dark skin images of common dermatologic conditions in educational resources: a crosssectional analysis. J Am Acad Dermatol. 2021;84:1427-1431. doi:10.1016 /j.jaad.2020.06.041
  4. An ongoing commitment to equity in medicine. VisualDx. Accessed April 30, 2025. https://www.visualdx.com/about-visualdx/diversity/
  5. Kelly A, Taylor SC, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color. 2nd ed. McGraw-Hill Education; 2016.
  6. Cruz S, Vecerek N, Elbuluk N. Targeting inflammation in acne: current treatments and future prospects. Am J Clin Dermatol. 2023;24:681-694. doi:10.1007/s40257-023-00789-1
  7. Piette WW, Taylor S, Pariser D, et al. Hematologic safety of dapsone gel, 5%, for topical treatment of acne vulgaris. Arch Dermatol. 2008;144:1564-1570. doi:10.1001/archdermatol.2008.518
  8. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(1 suppl):S21-S37. doi:10.1016/j.ijwd.2017.02.006
  9. Jean-Pierre P, Tordjman L, Ghodasara A, et al. Emerging lasers and light-based therapies in the management of acne: a review. Lasers Med Sci. 2024;39:245. doi:10.1007/s10103-024-04196-8
  10. Goldberg D, Kothare A, Doucette M, et al. Selective photothermolysis with a novel 1726 nm laser beam: a safe and effective solution for acne vulgaris. J Cosmet Dermatol. 2023;22:486-496. doi:10.1111/jocd.15602
  11. Alexiades M, Kothare A, Goldberg D, et al. Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types. J Am Acad Dermatol. 2023;89:703-710. doi:10.1016/j.jaad.2023.05.085
  12. Battle EF Jr, Soden CE Jr. The use of lasers in darker skin types. Semin Cutan Med Surg. 2009;28:130-140. doi:10.1016/j.sder.2009.04.003
  13. Teymour S, Kania B, Lal K, et al. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol. 2023;22:1177-1184. doi:10.1111/jocd.15572
  14. Adawi W, Cornman H, Kambala A, et al. Diagnosing atopic dermatitis in skin of color. Dermatol Clin. 2023;41:417-429. doi:10.1016/j.det.2023.02.003
  15. Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol. 2014;31:21-26. doi:10.1111/pde.12237
  16. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340-357. doi:10.1111/exd.13514
  17. Czarnowicki T, He H, Krueger JG, et al. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143:1-11. doi:10.1016/j.jaci.2018.10.032
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Common Chief Concerns in Skin of Color Populations and Advancements in Diagnostics and Therapeutics

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Common Chief Concerns in Skin of Color Populations and Advancements in Diagnostics and Therapeutics

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