Seemal R. Desai, MD

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Skin of Color Savvy: Tackling Colorism in Dermatology, With Seemal Desai, MD, and Pearl Grimes, MD

, Seemal Desai, MD, past president of SOCS, is joined by Pearl Grimes, MD, a globally recognized expert in vitiligo and pigmentary disorders and founder of the Vitiligo and Pigmentation Institute of Southern California. Together, they engage in a nuanced discussion on colorism, its historical roots, and its intersection with the clinical management of pigmentary disorders.

The conversation begins with an exploration of colorism as a global phenomenon, emphasizing its presence across regions including the United States, Africa, Asia, and Europe. Grimes highlights the complex historical and sociocultural factors underlying colorism, including colonialism, class structures, and longstanding societal preferences for lighter skin tones. These influences, the experts note, extend beyond aesthetics, impacting socioeconomic mobility, professional opportunities, and interpersonal relationships.

Desai and Grimes then transition to the clinical implications of colorism, particularly in dermatology practices focused on treating hyperpigmentation. They discuss how patient motivations for seeking treatment may reflect a combination of medical concerns and deeper sociocultural influences. Conditions such as melasma, post-inflammatory hyperpigmentation, and lichen planus pigmentosus are frequently treated in clinical settings, but patient expectations may extend beyond restoring even skin tone to a desire for overall skin lightening. The speakers emphasize the importance of distinguishing between appropriate medical treatment and requests influenced by colorism-driven preferences.

A significant portion of the discussion centers on the ethical and clinical challenges dermatologists face in navigating these blurred boundaries. Both experts underscore the importance of patient-centered communication, advocating for approaches that validate patient concerns while reinforcing the goal of restoring natural skin tone rather than altering inherent pigmentation. They stress the need for dermatologists to address the psychological and emotional dimensions of pigmentary disorders, particularly as they relate to self-perception and societal pressures.

The episode also highlights the widespread use of unregulated skin-lightening products and the associated health risks. Desai and Grimes discuss the global prevalence of over-the-counter products containing harmful agents such as high-potency topical steroids, mercury, and arsenic, often marketed as cosmetic or “brightening” treatments. They further address emerging trends, including intravenous and oral glutathione use for skin lightening, noting documented risks such as severe adverse reactions and potential links to disease exacerbation. These examples underscore the critical need for clinicians to conduct thorough patient histories and proactively inquire about all skincare products and treatments.

Education and advocacy emerge as central themes throughout the latter portion of the discussion. The speakers emphasize the role of dermatologists in educating patients about safe and evidence-based treatments, as well as the broader responsibility to engage in public health messaging. They also highlight the importance of regulatory efforts to limit the availability of harmful products and the need for continued collaboration with organizations such as the Skin of Color Society and other global advocacy groups.

The episode concludes with a call to action for dermatologists to approach pigmentary disorders with both clinical rigor and cultural awareness. By addressing the medical, psychological, and societal dimensions of colorism, clinicians can better support patients while promoting safe practices and advancing equitable dermatologic care.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This summary was edited with the help of AI tools.

Podcasts

In this episode of the Skin of Color Savvy podcast, 2 leaders in dermatology discuss the complexities of colorism and its impact on pigmentary disorders.

Dr Linda Stein Gold, Dr Mona Shahriari and Dr Seemal Desai share advice for improving psoriasis care for patients with skin of color.

Advice for Dermatologists in Treating Psoriasis in Patients With Skin of Color

This is a video synopsis/summary of a panel discussion involving Linda Stein Gold, MD; Mona Shahriari, MD, FAAD; and Seemal Desai, MD.

The discussion focuses on the implications of research findings for patients with skin of color in psoriasis treatment. The speakers emphasize the importance of utilizing data-driven approaches to guide treatment decisions and advocate for increased diversity in clinical trial participation to ensure representative study populations.

They discuss the significance of cultural sensitivity in patient interactions and highlight the need for continued investment in research and development to generate data that can inform clinical practice effectively. The transcript concludes with a call to action for dermatologists to play a critical role in improving outcomes for all patients with psoriasis, underscoring the value of sharing knowledge and fostering collaboration within the medical community.

Overall, the conversation emphasizes the importance of evidence-based approaches, cultural competence, and ongoing research efforts in addressing the needs of diverse patient populations with psoriasis.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Videos

Dr Linda Stein Gold, Dr Mona Shahriari and Dr Seemal Desai share how they utilize biologics data from skin of color cohorts in their practice.

Data with Biologics in Patients With Skin of Color

The conversation revolves around the significance of post-hoc analyses in biologic studies for patients with skin of color, emphasizing their importance in guiding treatment decisions. While these analyses may not replicate the rigor of randomized controlled trials, they provide valuable insights into treatment efficacy and safety for diverse patient populations.

The discussion highlights various studies, including systematic reviews and specific biologic trials, which have examined treatment outcomes in patients with skin of color. It is noted that despite the need for more dedicated studies with larger sample sizes, post-hoc analyses reveal promising results, indicating comparable treatment responses and safety profiles across different ethnicities.

The speakers stress the relevance of this data in clinical practice, particularly in addressing patient concerns and building trust in the healthcare system. By utilizing the findings from these analyses, clinicians can tailor treatment recommendations based on individual patient needs and preferences.

Furthermore, the conversation touches upon the role of conferences and meetings in disseminating research findings, underscoring the importance of raising awareness and promoting inclusivity in clinical trial participation. Despite the challenges posed by limited representation in large clinical trials, the speakers express optimism about the potential of dedicated studies to provide comprehensive insights into treatment outcomes for patients with skin of color.

Data With Biologics in Patients With Skin of Color

share their thoughts on the early use of psoriasis systemic treatments in patients with skin of color.

Early Use of Systemic Treatments in Patients With Skin of Color

The discussion delves into the challenges of initiating systemic therapy for psoriasis patients and how to effectively communicate its necessity. It emphasizes the importance of early intervention to prevent future complications and improve patient outcomes, regardless of ethnicity or skin type.

An expert dermatologist emphasizes the need to view all psoriasis patients equally and highlights the significance of data from studies like VISIBLE in supporting treatment decisions. He stresses the importance of addressing patient concerns such as safety, cost, and distrust in the medical system, while framing the conversation around collaboration between patient and physician.

Furthermore, the discussion touches upon the potential benefits of early treatment in minimizing post-inflammatory hyperpigmentation (PIH) and the ongoing research to elucidate the pathophysiology of PIH across different diseases. While the exact mechanisms are not yet fully understood, ongoing research aims to provide more insights into the nuances of PIH in various dermatological conditions.

Overall, the conversation underscores the importance of proactive treatment approaches and ongoing research efforts to improve outcomes for psoriasis patients, irrespective of their background or skin type.

Drs Stein Gold and Desai share their thoughts on the early use of psoriasis systemic treatments in patients with skin of color.

Seemal R. Desai, MD

Articles