Understanding Systemic Treatment in Patients with Skin of Color
In this episode of Topical Conversations, Cheri 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 biological 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
In this 45-minute symposium, expert faculty cover the latest updates for JAK inhibitors, including head-to-head efficacy and safety data for JAK inhibitors and biologics, and share clinical pearls for using JAK inhibitors in dermatology practice for atopic dermatitis."I can say that in my clinic, I am reaching for those high bars. You have toput yourself in the position of the patient or imagine that patient is your family member. Would you want mediocre treatment for them or average treatment or moderate treatment? You’d want them to get the best possible treatment. In my practice I’m now counseling patients 'yes we want clear skin. Yes, we want minimal itch. Yes we want your skin pain gone and for you to sleep better.'”- David Cotter, MD, PhDFC25: Charting the Course to Higher Targets With JAK Inhibition in Atopic Dermatitis: An Online ActivityThis activity is supported by an educational grant from AbbVie.
Don’t miss this Satellite Symposium from the 2025 Fall Clinical Dermatology Conference®, as Dr. Alexandra Golant, Dr. Mona Shahriari, and Dr. G. Michael Lewitt discuss IL-13 targeting biologics in the treatment of atopic dermatitis as well as strategies for optimizing their use.“To me, coming into an exam room in 2025, when we have so many different treatment options for these patients, it's a unique opportunity to use what we know about the data of these therapeutics and walk patients though their options and how to understand their disease state, and how to best choose the therapy that feels right for them.” – Alexandra Golant, MD FC25: Illuminate the Role of IL-13 Inhibitors for the Management of Atopic DermatitisThis activity is supported by an educational grant from Lilly.
“Of course we’re always starting with our basics: we’re using our gentle cleansers, our moisturization, our avoidance of known allergens or triggers, and then we're doing our topicals. But it can be very difficult if you have heavy stuff on your face or you’re required to put it on over and over. It can be really tough. So this paves the way really nicely to say it is time to move up, it is time to think about the next level, and typically the next step up is going to be a biologic agent.” - Peter Lio, MDA ‘HowTo’ activity delivers a short burst of engaging and compact content for learners to study at their own convenience. This microlearning activity is intended to provide practical insights from two experts on ‘HowTo’ improve care in head and neck atopic dermatitis in 10 minutes.This activity is supported by an educational grant from LEO Pharma.
This 30-minute symposium from the 2025 Pediatrics360 Virtual Conference takes a closer look at biologic therapies that can address the immune pathophysiology, associated comorbidities, and progression of moderate-to-severe atopic dermatitis in pediatric patients.“A lot of them (children with atopic dermatitis) do have tactile sensitivities and don’t like the way any creams, ointments, anything, feel on their skin. Thinking about a shot, even though it hurts, doing a shot once or twice a month can actually often be so much easier than having the parents have to argue with the kid two to three times a day to get the topicals on. So, I actually think of injections very quickly for patients with tactile sensitivities.” – Dr. Elizabeth SwansonPEDS25: Controlling the Wolf in Sheep’s Clothing: Managing Pediatric Atopic Dermatitis with Biologic Therapies: An Online ActivityThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals, Inc.