PracticalDermatology

As the dermatology community has continued to expand its focus on the diagnosis and management of skin disease in patients with skin of color generally, particular attention has been paid to the unmet needs of pediatric patients with skin of color. The Society for Pediatric Dermatology (pedsderm.net), as the leading organization for pediatric dermatologists, has been at the forefront of assessing key issues related to patient care, including ongoing pediatric dermatology workforce shortages. According to SPD member Brandi Kenner-Bell, MD, “There are not enough pediatric dermatologists to meet the needs of all the pediatric patients—with or without skin of color—out there who need specialized care.”

SPD is working to advance dermatology care for skin of color patients. Dermatology as a specialty, “Continues to struggle with adequate representation of skin of color in reference and teaching materials. Physicians need appropriate training in recognizing how skin diseases present differently in skin of color,” Dr. Kenner-Bell says. “We need more accessible and searchable (online) resources with examples of diseases in different skin tones.”

Dr. Kenner-Bell has identified a few resources worth considering. These include Pediatric Skin of Color (Ed: Silverberg, Duran-McKinster, and Tay) and Pediatric Dermatology in Skin of Color (Shah and Sheth) and Visual Dx (online).

Focused Treatments

Beyond diagnosis, there are challenges in terms of efficient treatment for pediatric skin disease in patients with skin of color. “There are still many treatments that are not able to be used in some skin of color due to potential side effects (hyper- and hypopigmentation) on skin of color. These changes in skin color are very distressing to patients with skin of color, and we often struggle with trying to adequately treat skin conditions while minimizing secondary effects on the skin,” Dr. Kenner-Bell says. “We need more research in skin of color, more inclusion of patients with skin of color in trials, and innovative technologies designed specifically for their safety and efficacy in skin of color.”

SPD publishes Pediatric Dermatology, an academic journal that shares research on various aspects of pediatric care, including emerging and optimized treatment approaches.

Cultural Sensitivity

Related to the management of patients with skin of color is the need for cultural sensitivity to patients and families of various backgrounds. “Cultural sensitivity is always a challenge when the workforce does not reflect the patient population it serves,” Dr. Kenner-Bell notes. “Understanding cultural differences in skin and hair care practices is essential to being able to adequately and effectively treat patients with skin of color with the cooperation and confidence of the patient. This is central to an effective doctor-patient relationship. If patients don’t trust that you understand how their skin and hair are ‘different,’ they will not trust your assessment, advice, or treatment plan.”

UV Safety

Dermatologists know the importance of educating on UV safety and sunscreen use, and evidence shows that the earlier patients adopt healthy habits, the more likely they are to limit cumulative damage and maintain healthy skin strategies. “We know that it is the UV damage acquired in our early years that leads to skin cancers in our later years,” Dr. Kenner-Bell reminds.

“We also know that the incidence of skin cancer in skin of color is increasing and that diagnosis is often delayed in patients with skin of color—that they present with more advanced disease and have worse outcomes than their white counterparts. It is therefore just as important that we educate our pediatric patients with skin of color about the risks of skin cancer and recommend/encourage sun protection in our pediatric patients with skin of color.”