Understanding Systemic Treatment in Patients with Skin of Color 

In this episode of Topical Conversations, Cherie Frey, MD, and Amy McMichael, MD, discuss the use of systemic agents for treating atopic dermatitis and other skin conditions in patients with skin of color. They highlight biologic differences, challenges in disease assessment, and practical strategies for improving outcomes and access to care. 

Biologic Differences and Disease Presentation 

Patients with skin of color may have lower ceramide levels, contributing to conditions like eczema. Dr Frey and Dr McMichael discuss how atopic dermatitis can present differently, with less visible erythema and more lichenification, hypopigmentation, or dyschromia. This variation can complicate severity assessments and insurance approvals. 

Health Literacy and Access to Care 

Both physicians emphasize the importance of educating patients and their families about skin care and the safety of systemic therapies. Dr McMichael points out that socioeconomic factors and low health literacy can limit access to effective treatments. She underscores the need for outreach to primary care providers to ensure timely referrals to dermatologists. 

Tools and Severity Assessment 

Standard scoring tools that rely on visible erythema may underrepresent disease severity in skin of color. Dr McMichael advises focusing on symptoms like itching and lichenification to accurately capture disease burden and support treatment decisions. 

Early Intervention and Improved Outcomes 

Dr Frey advocates for earlier use of systemic treatments to break the itch-scratch cycle and prevent complications like dyschromia and nodular scars. Dr McMichael highlights the role of newer systemic agents targeting cytokine pathways, such as IL-4 and IL-13, which have transformed atopic dermatitis management. 

A Personal Success Story 

Dr Frey shares a memorable patient case: a young girl who felt too embarrassed by her skin to join cheerleading. After starting a systemic medication, she not only joined the team but excelled, demonstrating how timely intervention can restore confidence and quality of life. 

Key Takeaways

• Atopic dermatitis often presents differently in patients with skin of color, requiring tailored assessment beyond visible erythema.
• Health literacy, socioeconomic factors, and provider education are key to improving access to systemic therapies.
• Systemic agents can break the itch-scratch cycle early, reducing complications and improving quality of life.
• Newer biologics targeting IL-4 and IL-13 offer safe and effective options for severe cases.
• Personal stories highlight the transformative impact of early, appropriate therapy.