Cultural competency
Dermatologists can improve care for people with skin of color through education and inclusivity.
P014 – Skin of Color Primer
3:15-5:15 p.m. | Saturday, July 18
Mercury Ballroom
As growing awareness spotlights persistent gaps in the diagnosis and treatment of patients with skin of color, dermatologists are leading the charge for improved education, representation, and cultural competency within the specialty.
During this afternoon’s session, P014 – Skin of Color Primer, panelists will conduct a comprehensive and high-yield overview of common skin, hair, and nail conditions seen in people with skin of color. Nada Elbuluk, MD, FAAD, director of the session, said many inflammatory, neoplastic, pigmentary, and alopecic skin conditions present differently in darker skin tones, making accurate diagnosis more challenging when physicians rely on traditional materials and research that often lack diversity.
“Dermatologists can improve their diagnosis of dermatologic conditions through seeking education and exposure,” said Dr. Elbuluk, professor of clinical dermatology at the University of Southern California Keck School of Medicine in Los Angeles. “Dermatologists should seek out diverse image databases, training resources, and continuing medical education focused on diverse skin colors to better recognize variations in clinical presentations, diagnostic evaluation, and management.”
Treatment requires tailored approaches
Many patients with skin of color risk being misdiagnosed, diagnosed late, or undertreated for their conditions, Dr. Elbuluk said. Treating these patients also requires careful consideration of pigmentation changes, scarring risk, and inflammation, she said, which can lead to complications such as post-inflammatory dyspigmentation if not properly managed.
“When considering procedural treatments, such as lasers, chemical peels, or energy-based devices, physicians should understand how device settings, wavelengths, and treatment intensity interact with melanin-rich skin,” Dr. Elbuluk said. “Conservative treatment parameters, test spots when appropriate, and familiarity with evidence-based approaches in darker skin types are critical to improving safety.”
Tina Bhutani, MD, FAAD
“It’s important to discuss potential side effects such as dyspigmentation, tailor therapies to the individual patient, and ensure that diverse populations are represented in clinical trials to guide our treatment decisions,” said Dr. Bhutani, an associate clinical professor of dermatology at the University of California San Francisco.
Dermatologists are encouraged to ask open-ended, nonjudgmental questions and engage patients in shared decision-making to build trust and improve adherence to treatment plans.
“Cultural competency begins with humility, curiosity, and a willingness to recognize biases that may impact care,” Dr. Bhutani said. “Dermatologists can improve by creating an inclusive environment, listening to patients’ concerns and practices, and building trust through respectful communication and shared decision-making.”
Amy J. McMichael, MD, FAAD
“It is best to ask the patient what products they are using and then suggest more appropriate products that can be substituted for better outcomes,” said Dr. McMichael, a professor of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina. “In order to maintain safe and effective treatments in patients with skin of color, it is important to minimize any treatment that causes added inflammation, since this can cause post-inflammatory hyperpigmentation.”
Cosmetic goals emphasize natural results
During the session, Cheryl M. Burgess, MD, FAAD, will discuss cosmetic concerns and therapeutic considerations in people with skin of color. According to Dr. Burgess, in cosmetic dermatology, patients with skin of color often prioritize subtle enhancement and preservation of ethnic identity rather than dramatic changes.
Cheryl M. Burgess, MD, FAAD
She said the most successful outcomes occur when dermatologists respect ethnic features, understand melanin biology, minimize inflammation, and prioritize long-term skin health alongside aesthetic enhancement.
Dr. Burgess said energy-based devices and cosmetic procedures can be highly successful in treating patients with skin of color when performed carefully. As such, important principles and considerations include:
- Lower fluence settings
- Conservative treatment parameters
- Test spots when appropriate
- Avoidance of unnecessary thermal injury
“Safer approaches may include superficial chemical peels, nonablative fractional lasers, radiofrequency or micro-focused ultrasound skin lifting/tightening, microneedling, and thulium 1927 nm, 650 nm micro-second, and 755 nm picosecond lasers for pigmentation,” Dr. Burgess said.
A call for improved representation and inclusivity
Nada Elbuluk, MD, FAAD
“Improving cultural competency also requires ongoing self-reflection and education. Physicians should examine implicit biases, diversify the educational content they consume, and advocate for greater inclusivity within training programs, research studies, and leadership spaces in dermatology,” she said.
Finally, Dr. McMichael urges dermatologists to leverage their available resources.
“It is important to take time to learn how to evaluate inflammation in darkly pigmented skin. This can be accomplished by completing an observership, taking the AAD Skin of Color Curriculum learning modules, or studying well-written textbooks on skin of color medical dermatology and cosmetics,” Dr. McMichael said.
The session will also include discussions on skin cancer, scarring alopecias, and pigmentary disorders in patients with skin of color. The full panel includes Seemal R. Desai, MD, FAAD; Achiamah Osei-Tutu, MD, FAAD; and Rebecca Vasquez, MD, FAAD.
