Skin of Color:Progress Made, Challenges Remain

I am honored to serve as Guest Editor for the Skin of Color Special Topic issue of the Journal of Drugs in Dermatology (JDD), especially since this coincides with the 2nd Annual Skin of Color Seminar Series in New York on May 14th.

I commend the journal for addressing this topic, which has become increasingly important with the growing ratio of patient populations comprised of Fitzpatrick skin types IV-VI in many parts of the U.S. and beyond. It has been a pleasure to invite leading authors to share their expertise and research studies on various topics relevant to skin of color, including keloids, pigmentary disorders, scalp disorders and safety of cosmetic procedures.

The dermatologic community has made great strides over the past decade to increase awareness, research and education pertaining to disorders that disproportionally affect patients with skin of color. Examples of this progress are myriad:

Topics relevant to non-white patient populations are increasingly presented in lectures at national and international dermatology meetings, not to mention educational conferences that are entirely devoted to skin of color.

The number of articles related to skin of color that have been published in the peer reviewed literature has increased considerably as has the number of textbooks covering medical and cosmetic dermatology in darker skin types.

Numerous academic departments of dermatology have developed centers or specialty clinics that focus on the care of patients of color.

There is increased research interest in dermatologic disorders of particular relevance to skin of color, which will, in turn, help to elucidate mechanisms of disease and contribute to advances in treatment.

There has been a trend toward greater inclusion of Fitzpatrick skin types IV-VI or nonwhite racial ethnic groups in clinical trials of new therapies, ensuring that study populations are more representative of the population at large

Advances in our understanding of laser-tissue interactions have led to the development of laser and light based devices that can be used safely on all skin types. This has expanded our treatment options for patients with skin of color and has helped reduce the risk of complications associated with laser/light based therapies in this population.

Clinical research and community experience confirming the safety of soft tissue fillers and neurotoxins in nonwhite racial/ethnic groups has greatly improved our ability to address aesthetic concerns in patients with skin of color.

These advances notwithstanding, considerable progress is yet to be made. Shortcomings in our ability to effectively manage numerous conditions that are more prevalent in populations with skin of color remain. The list of such conditions includes (but by no means is limited to): postinflammatory pigment alteration, melasma, keloids and central centrifugal cicatricial alopecia, all of which are frequently associated with considerable adverse effects on quality of life. Multi-systemic medical conditions with dermatologic manifestations should also be included in this list, as some of these, such as lupus erythematosus and sarcoidosis, are also more prevalent in skin of color (the latter examples being more common in African Americans).

Further research into mechanisms of disease is sorely needed in order to identify new therapeutic targets that will hopefully lead to better treatment outcomes for these challenging disorders that more frequently affect patients with skin of color.