Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

New research is shedding light on state- and local-level geographic disparities in the availability of gastroenterologist care, highlighting limited access to care in rural areas and areas with low household incomes relative to urban areas.

Study findings point to substantial disparities in the availability of specialist care, particularly in the Midwest and Southwest regions and rural and impoverished areas, all of which had fewer gastroenterologists than patients with inflammatory bowel disease (IBD) needing care.

“To the best of our knowledge, this is the first nationwide study to comprehensively assess the density of GI specialists at a granular, local level across the US,” Jonathon Casey Chapman, MD, a gastroenterologist at Gastroenterology Associates in Baton Rouge, Louisiana, and colleagues wrote.

 “In addition, this study is the first to evaluate the local-level density of patients with IBD, providing novel insights into geographic disparities in both specialist availability and patient distribution.”

The evolving management of IBD continues to bring both opportunities and challenges, particularly as it pertains to patient access, individualized care, and navigating an expanding therapeutic pipeline. Despite advances in treatment options, most recently with the US Food and Drug Administration (FDA) approvals of a single-injection, once-monthly maintenance regimen of Omvoh (mirikizumab-mrkz) for subcutaneous use in adults with moderately to severely active ulcerative colitis (UC) and upadacitinib (Rinvoq) for the treatment of adults with moderately to severely active UC and Crohn's disease after they have received ≥ 1 approved systemic therapy, barriers such as insurance restrictions, cost, and access to specialist care continue to create hurdles for patients.

The descriptive retrospective analysis assessed the availability of GI specialists using multiple data sources to depict GI specialist density at both state and local levels using the first 3 digits of US postal codes (ZIP codes) as geographical markers. For each first 3-digit ZIP code tabulation area (ZCTA) and state in the US, investigators calculated the density of patients with IBD per 100,000 population, gastroenterologists per 100,000 population, and gastroenterologists per 100 patients with IBD. They used 2022 claims data to identify patients with IBD, the 2022 National Provider Identifier registry for provider details, and the 2020 US Census for area-level variables.

Overall, 520,020 patients with IBD were included in the study. At the national level, the density of patients with IBD per 100,000 population was 156.9. At the state level, the density of patients with IBD per 100,000 population varied, with Maine (337.1) and Rhode Island (251.4) having the highest density and New Mexico (58.2) and Hawaii (63.6) having the lowest density. At the local level, 65.7% of the 3-digit ZCTAs had a density of 100 to <250 patients with IBD per 100,000 general population, whereas 24.6% had a density of patients lower than 100.

A total of 21,611 GI specialists were identified from the 2022 NPI registry. At the national level, there were 6.5 GI specialists available per 100,000 population. Kansas (2.0) and Wyoming (3.1) had the lowest GI specialist density per 100,000 population, while New Jersey (11.2) and Rhode Island (10.8) had the highest GI specialist density. Investigators pointed to similarly considerable disparity in the geographic availability of GI specialists at the local level.

The GI specialist density per 100 patients with IBD at the national level for gastroenterologists was 4.2. At the state level, Kansas (1.4) and Maine (1.9) had the lowest density for gastroenterologists per 100 patients with IBD. While Michigan was among the top 10 states with the highest number of patients with IBD (n=23,969), it had a low density of gastroenterologists (per 100 patients with IBD) of 2.2.

Further analysis revealed one-fifth of ZIP codes had a gastroenterologist density (per 100 patients with IBD) of <1, and more than one-third had a density of 1 to <5. Across the US, 130 3-digit ZCTAs had 0 gastroenterologists/100 patients. Investigators noted 62% of these ZIP codes were in rural areas and 25% had household income <150% of the poverty line.

Additionally, they pointed out ZIP codes with ≥5 gastroenterologists/100,000 population tended to have lower poverty rates and were more urban than those with 1 to <5 gastroenterologists/100,000 population.

“This study shows that despite the burden of IBD in the US, the geographic distribution of gastroenterologists varies widely. Rural areas and areas with low household incomes have fewer gastroenterologists than urban areas, indicating disparities in the availability of GI specialists,” investigators concluded.

“The results may help inform healthcare policies that impact resource allocation for underserved patients with IBD throughout the US.”

Upadhyay N, Vadhariya A, Gorritz M, et al. Geographic Distribution of Gastroenterologists and Patients With Inflammatory Bowel Disease in the United States. 

Livingston R. FDA Approves Single-Dose Formulation of Mirikizumab-mrkz for Ulcerative Colitis. HCPLive. October 27, 2025. Accessed November 28, 2025. 

https://www.hcplive.com/view/fda-approves-single-dose-formulation-of-mirikizumab-mrkz-for-ulcerative-colitis

Brooks A. FDA Approves Updated Indication for Upadacitinib (Rinvoq) in IBD. HCPLive. October 13, 2025. Accessed November 28, 2025. 

https://www.hcplive.com/view/fda-approves-updated-indication-for-upadacitinib-rinvoq-in-ibd

Articles

New research highlights significant geographic disparities in gastroenterologist availability, particularly in rural and low-income areas compared to urban regions. The study, the first of its kind, assessed the density of GI specialists and patients with inflammatory bowel disease (IBD) across the US. Findings reveal that rural and impoverished areas, especially in the Midwest and Southwest, have fewer specialists relative to patient needs. Despite advancements in IBD treatment, barriers such as insurance, cost, and specialist access persist, underscoring the need for informed healthcare policies to address these disparities.

State- and local-level disparities in the availability of gastroenterologist care disproportionately affect patients with IBD and populations living in rural and high-poverty areas.

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, IBS and IBD, Crohn's disease, and more.

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On the HCPLive inflammatory bowel disease page, resources on the topics of medical news and expert insight into IBD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBD and more.

Geographic Disparities in GI Specialist Availability Suggest Limited Access to Care

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Almost all patients with oral corticosteroid (OCS)-dependent severe, uncontrolled asthma achieved a maintenance OCS dose of 5 mg per day or less and more than half completely discontinued OCS while maintaining asthma control after 52 weeks of open-label 

Tezepelumab was originally approved by the United States (US) Food and Drug Administration (FDA) in 2021 as the first biologic therapy for treating asthma and was later approved for self-administration in 2023.

 These new data are from the multicenter, single-arm, phase 3 WAYFINDER trial (NCT05274815) and were published in 

“Improvements in asthma therapies in recent years, including the advent of personalised, potentially disease-modifying biologic therapies, have resulted in the evolution of treatment goals from short-term control of symptoms and exacerbations to long-term disease remission. Although there is not yet a consensus on how to define asthma remission, the widely agreed components are the absence of systemic corticosteroid use and asthma exacerbations together with very mild or no asthma symptoms,” study investigator David J. Jackson, MBBS, MSc, PhD, Professor, Guy's Severe Asthma Centre, School of Immunology & Microbial Sciences, Guy's Hospital, King's College London, and colleagues wrote.

 “Therefore, tezepelumab shows promise in helping enable patients with severe asthma to achieve clinical remission.”

WAYFINDER was conducted between May 17, 2022, and Sept 9, 2024 and enrolled adults with severe, uncontrolled asthma receiving a maintenance OCS dose of 5–40 mg per day (or equivalent) of prednisone or prednisolone from 68 clinical centers across 11 countries (Argentina, Belgium, Bulgaria, France, Germany, Latvia, Mexico, Poland, Spain, UK, and US). In the trial, 298 participants (69.1% female; n = 206) received tezepelumab 210 mg subcutaneously once every 4 weeks for up to 52 weeks. The co-primary endpoints were the proportion of participants who reduced their prescribed maintenance OCS dose to 5 mg per day (contingent on participants demonstrating preserved adrenal function) or less without loss of asthma control and the proportion of participants who discontinued OCS without loss of asthma control and were assessed at weeks 28 and 52.

Participants in WAYFINDER had a mean baseline maintenance OCS dose of 10.8 mg per day (SD, 6.5). Jackson and colleagues found that the proportion of participants who had a maintenance OCS dose of 5 mg per day or less without loss of asthma control was 88.9% (n = 265; 95% CI, 84.8–92.3) at week 28 and 89.9% (n = 268; 95% CI, 85.9–93.1) at week 52.

Furthermore, 32.2% of participants (n = 96; 95% CI, 26.9–37.8) were able to discontinue OCS without loss of asthma control by week 28, increasing to 50.3% (n = 150; 95% CI, 44.5–56.2) by week 52. OCS reduction and discontinuation outcomes were consistent across prespecified subgroups defined by baseline blood eosinophil count, fractional exhaled nitric oxide, and allergy status. Serious adverse events occurred in 9.4% of participants (n = 28), most commonly asthma (13 cases) and pneumonia (3 cases), and 1.3% (n = 4) experienced adverse events that led to tezepelumab discontinuation. Two deaths occurred during the study, though neither was considered related to tezepelumab treatment.

In a related editorial, Paola Rogliani, MD, and Luigino Calzetta, PhD, both from University of Rome “Tor Vergata” in Italy, compared the positive findings of WAYFINDER to the previously negative findings of the similar SOURCE trial of tezepelumab.

The SOURCE and WAYFINDER trials of tezepelumab differed notably in design, patient populations, and outcomes. SOURCE was a rigorous, randomized, double-blind, placebo-controlled study that failed to meet its primary endpoint overall, showing meaningful OCS reduction only in patients with baseline eosinophils ≥150/μL. In contrast, WAYFINDER was a larger, open-label, non-randomized trial that enrolled OCS-dependent patients across a wider eosinophil range with striking reductions in OCS use, though its lack of a control group and higher-risk baseline profile limit direct comparison. Differences in baseline eosinophil counts and starting OCS doses further complicate interpretation, and adjusted analyses suggest that WAYFINDER’s apparent benefits may be partially explained by placebo effects seen in SOURCE.

“In conclusion, although WAYFINDER4 provides suggestive evidence that tezepelumab might reduce OCS dependence in severe asthma, methodological limitations, baseline imbalances, and the influence of the placebo effect indicate that these findings are not definitive; well-designed randomized, placebo-controlled trials or high-quality pooled analyses are needed to confirm the OCS-sparing effect of tezepelumab,” Rogliani and Calzetta wrote.

Jackson DJ, Lugogo NL, Gurnell M, et al. Oral corticosteroid reduction and discontinuation in adults with corticosteroid-dependent, severe, uncontrolled asthma treated with tezepelumab (WAYFINDER): a multicentre, single-arm, phase 3b trial. 

. Published online November 26, 2025. doi: 10.1016/S2213-2600(25)00359-5

Iapoce C. FDA Approves Tezepelumab Self-Administration for Severe Asthma. Article. HCPLive. February 2, 2023. https://www.hcplive.com/view/fda-approves-tezepelumab-self-administration-severe-asthma

Rogliani P, Luigino Calzetta. Efficacy of tezepelumab in reducing oral corticosteroid use in severe asthma. 

. Published online November 1, 2025. doi: 10.1016/s2213-2600(25)00395-9

Wechsler ME, Menzies-Gow A, Brightling CE, et al. Evaluation of the oral corticosteroid-sparing effect of tezepelumab in adults with oral corticosteroid-dependent asthma (SOURCE): a randomised, placebo-controlled, phase 3 study. 

 Published online March 2022. doi: 10.1016/s2213-2600(21)00537-3

Tezepelumab has shown promise in reducing oral corticosteroid (OCS) dependence in patients with severe, uncontrolled asthma. In the WAYFINDER trial, nearly all participants achieved a maintenance OCS dose of 5 mg or less, with over half discontinuing OCS entirely while maintaining asthma control. Despite these positive outcomes, the trial's open-label design and lack of a control group limit the conclusiveness of the findings. Comparisons with the SOURCE trial highlight differences in trial design and patient populations, suggesting the need for further randomized, placebo-controlled studies to confirm tezepelumab's OCS-sparing effects.

However, a related editorial from University of Rome was quick to point out possibly sizable placebo effects in the trial.

Asthma

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Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Tezepelumab Drastically Reduces OCS Use for Asthma in Open-Label Trial

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

Semaglutide, a glucagon-like peptide-1 receptor agonist, is linked with significant cardiorenal improvements and a favorable safety profile in adults with 

, with or without type 2 diabetes mellitus (T2DM).

Findings from a meta-analysis of 5 randomized controlled trials showed semaglutide significantly reduced the risk of major cardiovascular adverse events (MACE), kidney-related complications, and cardiovascular mortality, additionally pointing to the need to address gaps in the literature and enhance generalizability.

“Our findings advocate for semaglutide's role as a valuable therapeutic option for patients with CKD due to its demonstrated cardiovascular and renal benefits,”

wrote study investigator, Mahir Tesfaye from Addis Ababa University in Ethiopia, and colleagues.

 “The observed reduction in cardiovascular medication usage also means that semaglutide may decrease the need for intensive pharmacological interventions. This might improve patient quality of life, adherence, and healthcare costs.”

Standard treatment strategies for CKD include medication management of associated risk factors, such as hyperglycemia, dyslipidemia, and blood pressure. Recent cardiovascular outcome trials have highlighted renoprotective benefits and glucose-lowering effects in glucagon-like peptide-1 receptor agonists, but have been limited in sample size.

To address this gap in research, investigators conducted a systematic review of MEDLINE, Embase, and Cochrane CENTRAL databases to find studies comparing semaglutide with placebo or standard care in adults 18 ≥ years of age with CKD, regardless of comorbidity of type 2 diabetes mellitus status.

Primary outcomes included major kidney-related adverse events, MACE, cardiovascular mortality, nonfatal myocardial infarction (MI), and nonfatal stroke.

All-cause mortality, serious adverse events, hospitalization due to unstable angina or heart failure, and the use of cardiovascular medications were the secondary outcomes.

Investigators leveraged data from 12,785 participants with comorbid T2DM and CKD from 5 randomized controlled trials. The patient population had a mean age of 64-67 years, was predominantly male, with elevated body weight (~90–109 kg) and body mass index (~32–37 kg/m²), consistent blood pressure (systolic blood pressure ~135–138 mmHg; diastolic blood pressure ~76–78 mmHg) and glycemic control (Hemoglobin A1c ~5.6–8.7%).1

An outlier study, Apperloo, had a younger cohort, with a mean age of 55 years, and was the only trial with a completely non-diabetic CKD population, while the remaining studies enrolled 100% patients with T2DM.

Analysis of the pooled trial data revealed a significantly reduced risk of cardiovascular mortality compared with placebo, with a 26% relative risk reduction (Relative Risk [RR], 0.74; 95% Confidence Interval [CI], 0.62–0.88; I² = 36%).

Investigators observed a 22% reduced incidence of MACE (RR, 0.78; 95% CI, 0.70–0.87; I² = 0%), highlighting consistent cardiovascular benefit. While there was a trend toward reduction in nonfatal myocardial infarction and nonfatal stroke, these outcomes were not statistically significant (MI: RR, 0.86; 95% CI, 0.66–1.12; I² = 24%; stroke: RR, 0.86; 95% CI, 0.53–1.40; I² = 64%).

Kidney outcomes were similarly improved, with a 20% decrease in major kidney adverse events among patients receiving semaglutide (RR, 0.79; 95% CI, 0.71–0.87; I² = 0%).

For secondary outcomes, semaglutide showed a non-significant trend toward reduced all-cause mortality (RR, 0.80; 95% CI, 0.68–0.93; I² = 44%), and was associated with fewer serious adverse events (RR, 0.86; 95% CI, 0.74–0.99; I² = 87%). Sensitivity analysis further strengthened the effect on serious adverse events (RR, 0.92; 95% CI, 0.87–0.98; I² = 14%).

Investigators noted no significant differences in hospitalizations for unstable angina (RR, 1.01; 95% CI, 0.55–1.84; I² = 27%) or heart failure (RR, 1.03; 95% CI, 0.76–1.40; I² = 0%). The need for cardiovascular medications was modestly reduced, corresponding to a 14% relative risk reduction, with low heterogeneity.

“These findings are collectively supportive of its use as a therapeutic strategy for CKD management, with or without diabetes,” investigators concluded.

 “Long-term studies, however, are needed to confirm its role in reducing rates of hospitalization and mortality in broader populations of patients.”

Abdullah A, Sagreeka FNU, Aniket GA, et al. Safety and Efficacy of Semaglutide in Patients With Chronic Kidney Disease, With or Without Type 2 Diabetes: A Systematic Review and Meta‐Analysis. 

‌Alicic RZ, Cox EJ, Neumiller JJ, Tuttle KR. Incretin drugs in diabetic kidney disease: biological mechanisms and clinical evidence. 

https://doi.org/10.1038/s41581-020-00367-2

Caruso I, Giorgino F. SGLT2 inhibitors as cardio-renal protective agents. 

. Published online November 2021:154937. doi:

https://doi.org/10.1016/j.metabol.2021.154937

Semaglutide, a glucagon-like peptide-1 receptor agonist, demonstrates significant cardiorenal benefits and a favorable safety profile in adults with chronic kidney disease (CKD), with or without type 2 diabetes mellitus (T2DM). A meta-analysis of five randomized controlled trials revealed semaglutide's efficacy in reducing major cardiovascular adverse events (MACE), kidney-related complications, and cardiovascular mortality. The analysis also highlighted a reduction in cardiovascular medication usage, potentially improving patient quality of life and healthcare costs. Long-term studies are needed to confirm its broader impact on hospitalization and mortality rates.

Meta-analysis shows semaglutide lowers cardiovascular and kidney risks while supporting safety in adults with chronic kidney disease.


Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

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Semaglutide Provides Cardiorenal Benefits in CKD With or Without Diabetes

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

, already a steadily rising dermatologic condition, will impact even more patients worldwide by 2050, with incidence increasing across age cohorts, sexes, and geographic regions.

These data were authored by investigators such as Linli Liu, MD, from the department of dermatology at Suining Central Hospital in China. Liu and coauthors described psoriasis as a long-standing inflammatory skin condition that continues to contribute substantially to global health challenges. They implemented data drawn from the Global Burden of Disease (GBD) Study 2021 to generate projections of worldwide psoriasis incidence through the year 2050.

Distinctions by age range, sex, and geographic region were particularly emphasized in their analysis, as prior research had not fully assessed these factors.

“Understanding these variations is critical for informing public health strategies, improving health care access, and supporting early diagnosis worldwide,” Liu and colleagues wrote.

The investigative team looked at information on psoriasis from 236 countries collected between 1990 - 2021, taken from the GBD Study 2021, assessing rates of prevalence, disease incidence, and disability-adjusted life-years (DALYs) reported by patients' sex, age, and geographic area. Through the use of an Autoregressive Integrated Moving Average (ARIMA) model, the team forecasted age-standardized incidence rates (ASIR) with 95% prediction intervals.

A sensitivity analysis was used by Liu et al to repeat the modeling after the removal of the 2021 data point and training the model on 1990 - 2020 alone. The investigators extended projections to 2050 and the connection between Sociodemographic Index (SDI) and psoriasis burden was assessed via a Spearman correlation. Additionally, ASIR–SDI links were visualized by Liu and colleagues using a scatterplot displaying 95% uncertainty intervals. All analyses were performed by the investigators in July 2025, with statistical significance being set at a 2-sided 

Globally, Liu and coauthors demonstrated a moderate rise between 1990 - 2021 in disease burden. ASIR rose among male patients from 56.89 to 62.77 cases per 100 000, representing a 10.3% increase. In female patients, the investigative team showed a growth in ASIR from 57.08 to 61.26 cases per 100 000, representing a 7.3% increase.

In their extension of the forecasts based on data through 2021, the team concluded ASIR would likely continue to climb, with roughly 70 per 100 000 in men and 66 per 100 000 in women potentially having the disease by the year 2050. The results of Liu and colleagues' sensitivity analysis excluding 2021 from model training projected ASIR among males flattening and showed much broader prediction intervals, while the trajectory for females remained similar to the investigators' main analysis.

Pronounced geographic disparities were also highlighted by Liu et al. East Asia and sub-Saharan Africa showed substantially lower disease estimates, the findings of which the team suggest likely impacted in part by the limited set of available data and possible under-ascertainment. Western Europe and North America showed the highest crude incidence (CIR) and crude prevalence (CPR) rates.

Incidence rates, both age- and sex-specific, were shown by the investigators to be similar among boys and girls in their childhood and adolescent years (ages 5 - 19 years), though disease incidence rose sharply with age among male subjects of the study. Liu and colleagues found this particularly to be the case in older age cohorts. A strong positive link between ASIR and SDI was noted as well (

Overall, the modeling study demonstrated a rise in the global burden of psoriasis between 1990 - 2021, aligning with previously-available data. These forecasts would indicate a continual rise in psoriasis incidence among both sexes through 2050, though Liu and coauthors found when they excluded 2021 from model fitting the projected increase for males to have diminished. This led to greater uncertainty, and the team noted the drivers of such sex-specific differences warrant further study.

The finding that psoriasis burden was greatest in high-income regions of the world such as North America and Western Europe was notable as well. The positive correlation between ASIR and SDI mirrors earlier reports, though country-level GBD data was noted by Liu et al as not fully accounting for various ecological confounders, including data availability and demographic composition.

Liu L, Wang R, Yu C, et al. Global Psoriasis Burden and Forecasts to 2050. JAMA Dermatol. Published online November 26, 2025. doi:10.1001/jamadermatol.2025.4572.

GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2133-2161. doi: 10.1016/S0140-6736(24)00757-8. Epub 2024 Apr 17. PMID: 38642570; PMCID: PMC11122111.

Psoriasis is projected to affect more individuals globally by 2050, with increasing incidence across various demographics and regions. Researchers, including Linli Liu, utilized data from the Global Burden of Disease Study 2021 to forecast these trends. The study highlighted significant geographic disparities, with lower estimates in East Asia and sub-Saharan Africa, and higher rates in Western Europe and North America. The analysis revealed a strong correlation between psoriasis incidence and the Sociodemographic Index. The study underscores the need for targeted public health strategies and further investigation into sex-specific differences.

This global analysis highlights the incidence of psoriasis around the world by 2025, noting various distinctions in region, age groups, and sex.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

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The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Psoriasis Incidence Projected to Increase by 2025 Across Various Groups

Vinay Mehta, MD: Board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Credit: Allergy & Asthma Associates of Southern California

 can present uniquely in patients with skin of color, making timely recognition and effective management more challenging for clinicians. Classic signs such as erythema or inflammation may appear muted, harder to detect, or altogether different on darker skin tones, contributing to under-diagnosis, delayed treatment, and increased risk of pigmentary changes or scarring.

In this Q&A, Vinay Mehta, MD, a board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California, discusses practical steps clinicians can take to better identify and manage AD in patients with skin of color. He highlights why traditional training materials often fall short, why dyspigmentation can be a critical clinical clue, and how simple adjustments, such as using alternative lighting or referencing more inclusive photo atlases, can sharpen diagnostic confidence.

How can clinicians more accurately recognize atopic dermatitis in patients with skin of color, given that erythema and inflammation may appear differently?

 One of the things I think would be helpful is to have atlas pictures. When in medical school and in residency and fellowship, we're used to seeing pictures, and I know there have been some initiatives to include more photos of patients of skin of color.

Erythema can be difficult to appreciate in patients who have darker skin, so what I typically do is I'll turn off the light. I'll use a flashlight so there's a better contrast, so I can better appreciate the erythema [and] dyspigmentation [hyperpigmentation and hypopigmentation]. These are often hallmarks of atopic dermatitis in patients of darker skin tone, which we sometimes don't recognize. [Another key distinction is] more extensor surfaces involvement.

We definitely need more training. We definitely need more examples, photos. I think that's helpful. Perhaps using social media. It's helpful to have real patients [with] skin [of] color, who have atopic dermatitis to just share their story. That will be very helpful in increasing awareness.

What practical steps can dermatologists take to improve diagnostic confidence and avoid underdiagnosis of atopic dermatitis in darker skin tones?

 I would like to see more studies. The more studies we have, the more information we have, the more we'll be able to appreciate some of the nuances and also see if certain molecules target better [in] this population compared to our typical white population.

What are the most effective strategies for building trust and improving adherence among patients of color with chronic skin conditions like atopic dermatitis?

 Listening through [stories] is very important to develop trust. Shared decision-making is also important. You really have to listen to their concerns… [to] understand their perspective, understand what is important to them.

: Can you discuss additional barriers to treating atopic dermatitis in patients with skin of color?

 There's health disparities in terms of access, especially in the minority population, in terms of what health insurance they have, in terms of access to care, and access to specialists.

Sometimes there may also be language barriers, particularly in the immigrant population. There may be cultural barriers as well, and so I think it's important to really spend time [with the patient].

Getting that trust [is important]. Once they trust you as a health care provider, it really improves adherence, and that goes a long way. These are chronic diseases, and there's no quick fix. Some of these therapies…have to be continued long term, and so that really requires good communication and a good relationship between the patient and the provider.

How can clinicians address pigmentation changes, scarring, and other post-inflammatory effects that are particularly concerning for patients with skin of color?

 Unfortunately, with atopic dermatitis, we do see that. We do see the pigmentation changes, hyperpigmentation or hypopigmentation. Perhaps in this case…start patients on systemic therapy, not wait until they have the scarring. In other words, move them from topicals to a systemic therapy, whether it's the biologic or an [oral JAK inhibitor] or something else. Move them quickly to prevent some of those side effects, those pigmentary changes.

This transcript has been edited for clarity.

Atopic dermatitis (AD) presents unique challenges in patients with skin of color due to differences in the appearance of erythema and inflammation, often leading to under-diagnosis and delayed treatment. Clinicians can improve diagnostic accuracy by using alternative lighting and inclusive photo atlases. Building trust through shared decision-making and addressing health disparities are crucial for effective management. Early intervention with systemic therapies can help prevent pigmentary changes and scarring. Enhanced training and research are needed to better understand and manage AD in diverse populations.

Board-certified allergist shares how clinicians can better recognize and prevent atopic dermatitis in patients with skin of color, addressing pigmentation.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

How to Recognize and Treat Atopic Dermatitis in Patients with Skin of Color

Brandon Yan, MD, is a resident physician at the University of California.

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Yan discusses the reversion of 50-year trends in mortality and the steps needed to reduce these rates back to pre-pandemic levels.

Cardiology

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Cardiomyopathy

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Addressing Post-Pandemic Cardiovascular Mortality Rate Increases, With Brandon Yan, MD

This research, presented at the SDPA Fall Conference, highlights a consensus report proposing the first formal set of dermoscopy proficiency expectations for PAs.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Expert Consensus Provides Recommendations on Dermoscopy Standards for PAs 

Marcus Shaker, MD, a professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine

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A quick guide for clinicians on epinephrine dosing, optimal observation periods, and the role of tryptase and other labs in anaphylaxis care.


Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Anaphylaxis Treatment FAQ: When to Give Epinephrine, Order Tests, Call 911

Michelle O'Donoghue, MD, is the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women's Hospital and associate professor at Harvard Medical School

O’Donoghue discusses the results of the recent OCEAN(a)-DOSE trial and addresses the implications for Lp(a)-lowering therapies moving forward.

Atherosclerotic Cardiovascular Disease

Dyslipidemia

Olpasiran Lowers Lp(a) Irrespective of Apo(a) Isoform Size, With Michelle O’Donoghue, MD

Yasmine Kirkorian, MD, is a dermatologist and chief of Dermatology at Children's National Hospital.

Kirkorian speaks in this interview about her sessions at SDPA Fall on genetic disorders in pediatric dermatology patients.

Guidelines on Genetic Disorders of the Skin and Pediatric Patients, With Yasmine Kirkorian, MD

Halpin reviews the state of triple therapy inhaler prescribing strategies in the era of new biologic options.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

COPD Inhaler Use in the Biologic Era, with David Halpin, MBBS, DPhil

Associate Professor, University of Alabama and Chief Medical Officer for AllerVie Clinical Research

Soong discussed the role of allergist's in atopic dermatitis care at a recent HCPLive clinical forum.

Shared Decisions, Better Outcomes in Atopic Dermatitis, With Weily Soong, MD

Explore the long-term safety and efficacy of JAK inhibitors in atopic dermatitis, enhancing patient care and clinician confidence.

Special Report: Safety, Future Directions, & the Art of Therapy Selection in Atopic Dermatitis

Healthcare providers discuss the importance of effective communication when switching patients from biologics to JAK inhibitors.

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