Dermatology Conference Spotlights Skin of Color Diagnostic Challenges

At the 2025 SDPA Annual Summer Dermatology Conference in Washington, D.C., experts explored how dermatological conditions manifest differently in diverse skin tones. The session, led by Dr. Ginette Okoye, emphasized the need for a nuanced approach to diagnosis to avoid misinterpretations.

Unveiling Diagnostic Dilemmas

Dr. Okoye, a dermatology chair at Howard University College of Medicine, presented complex cases to demonstrate diagnostic difficulties. Attendees learned how to identify subtle differences in the appearance of common and uncommon skin conditions in darker skin, which often lead to delayed or missed diagnoses.

One case involved an 11-year-old with a six-month history of facial discoloration, especially on the eyelids, and a rash on the back of the hands, previously diagnosed as eczema. The rash did not improve with topical steroids. The patient also had a history of asthma and muscle weakness.

“So what’s our differential diagnosis for this young man?” Dr. Okoye asked. “I really honed in on dermatomyositis. I just want to talk to you about assessing proximal muscle weakness, because this child did have juvenile dermatomyositis.”

—Dr. Ginette Okoye

Importance of Muscle Weakness

Dermatomyositis often manifests as proximal muscle weakness. In children, Dr. Okoye noted, the risk of cancer is not as significant; nevertheless, screening should be done at diagnosis and yearly for five years. The National Institutes of Health indicates that approximately 2-10 per 1,000,000 adults are diagnosed with dermatomyositis annually (NIH, 2024).

Best Practices for Diagnosis

The session emphasized the importance of pattern recognition, thorough clinical assessment, and strategic use of biopsies and lab tests to arrive at accurate conclusions. Dr. Okoye addressed common diagnostic errors affecting patients with skin of color, providing strategies to avoid these pitfalls.

The conference underscored the necessity of culturally competent communication to foster trust and improve diagnostic accuracy across diverse patient populations. Attendees were encouraged to incorporate visual nuance and a patient-centered approach to refine their clinical judgment.

By adopting a more inclusive lens, dermatology PAs and others in attendance enhanced their understanding of diagnosing complex presentations in skin of color.

Treatment Strategies

At the 2025 SDPA Annual Summer Dermatology Conference, Adam Friedman, MD, discussed effective approaches for chronic hand eczema (CHE). He highlighted that many standard treatments lack specific approval for this condition. Therefore, healthcare providers must closely analyze how patients are using their prescribed medications to make any necessary adjustments. This includes evaluating steroid use, the potential for calcineurin inhibitors, and the use of off-label medications.

“In my own practice over the years, I have found intramuscular analogue to be a nice band-aid on the problem. I find CHE responds very nicely to intramuscular analogue, but of course, that comes with limitations in terms of ongoing use. But what I like about it is that it buys you time.”

—Adam Friedman, Professor, Chair of Dermatology

The prevalence of eczema has risen in recent years. According to the National Eczema Association, more than 31 million Americans have some form of eczema, emphasizing the need for improved and more effective treatment methods (Source 2024).

Long-Term Management

Friedman advises healthcare professionals to consider systemic options early in the treatment plan due to the chronic nature of hand eczema. This strategy helps to control the condition for extended periods. He aims for a six-month symptom-free period before even contemplating a reduction in systemic treatments.

The shift in focus towards a long-term strategy is crucial for managing this chronic condition. It underscores the necessity of an investment by the patient and ongoing care to maintain control of hand eczema. The goal is to prevent recurrence and to provide patients with a higher quality of life.

Sdpa

Discussing Complex Dermatology Cases in Skin of Color