Shawn Kwatra, MD

Improving Recognition of Skin Disease in Diverse Skin Types, With Shawn Kwatra, MD, and Andrew Alexis, MD, MPH

, Shawn Kwatra, MD, and Andrew Alexis, MD, MPH, discuss the unique challenges of diagnosing and managing 

 in patients with skin of color, with a particular focus on chronic pruritus and atopic dermatitis. Their conversation underscores how traditional dermatologic education and assessment tools often fail to capture the full spectrum of disease presentation across diverse skin tones.

Kwatra emphasizes that itch is one of the most common yet underappreciated symptoms affecting patients of color, particularly Black patients, who experience higher rates of chronic pruritus and related inflammatory conditions. He notes that despite this increased burden, these patients are frequently underdiagnosed or undertreated due to gaps in clinical recognition and limited representation in research. Alexis builds on this point by highlighting how erythema—an essential marker of inflammation—may not appear as classic redness in richly pigmented skin, instead presenting as violaceous, gray, or brown hues. This difference can lead clinicians to underestimate disease severity if they rely solely on traditional visual cues.

Both speakers stress the importance of adapting diagnostic frameworks to account for these variations. Alexis points out that clinicians must rely on a combination of texture, scale, patient-reported symptoms, and subtle color changes rather than erythema alone when evaluating inflammation in skin of color. Kwatra adds that emerging research is beginning to quantify these disparities, reinforcing the need for more inclusive clinical trials and better educational resources.

The discussion also touches on broader systemic issues, including environmental exposures, socioeconomic factors, and structural inequities that contribute to disease severity and access to care. Together, Kwatra and Alexis advocate for a more comprehensive, equity-driven approach to dermatology—one that recognizes how skin disease manifests differently across populations and prioritizes culturally informed, patient-centered care.

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

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

Videos

This segment of the most recent episode of Skin of Color Savvy highlights a conversation between Shawn Kwatra, MD, and Andrew Alexis, MD, MPH.

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

Skin of Color Savvy: Highlights From the Most-Watched Episodes of 2025

, the podcast revisits highlights from the three most viewed episodes of 2025, bringing together expert insights on inflammatory skin disease, pigmentary disorders, and diversity in dermatologic research. Featuring conversations with 

 leaders, Andrew Alexis, MD, MPH; Shawn Kwatra, MD; Crystal Aguh, MD; John Harris, MD, PhD; Nada Elbuluk, MD; and Michelle Rodrigues, MBBS, the episode underscores the breadth of clinical, scientific, and equity-focused discussions that resonated most with audiences throughout the year.

The episode opens with a return to one of the show’s most impactful early conversations, in which Alexis and Kwatra discuss diseases that disproportionately affect patients with skin of color, particularly chronic pruritus and inflammatory conditions such as atopic dermatitis and prurigo nodularis. Kwatra reflects on the disconnect between textbook imagery and real-world clinical presentations, noting that many diagnostic criteria and educational resources remain centered on lighter skin types.

Together, they explore emerging data demonstrating racial and ethnic differences in itch prevalence and presentation, while highlighting how environmental exposures, socioeconomic factors, and systemic inflammation intersect to influence disease burden. Alexis builds on this discussion by emphasizing the importance of recognizing how erythema and inflammation present differently in richly pigmented skin. Rather than classic redness, inflammation may appear violaceous, gray, or brown, a distinction that is critical to avoiding underdiagnosis and undertreatment.

The second segment revisits a widely viewed episode focused on pigmentary disorders, featuring Elbuluk and Rodrigues. The pair emphasize that “hyperpigmentation” is not a diagnosis, but a broad category encompassing more than 45 distinct conditions. They discuss common causes of hyperpigmentation, hypopigmentation, and depigmentation seen in patients of color, including post-inflammatory hyperpigmentation, acquired dermal macular hyperpigmentation, melasma, vitiligo, and less common congenital or medication-induced disorders. Key diagnostic principles—such as evaluating lesion location, color, morphology, and patient history—are highlighted, along with the value of dermoscopy as a noninvasive bedside tool to guide management and avoid unnecessary biopsies.

The episode concludes with highlights from a conversation featuring Aguh and Harris, which centers on the importance of diversity in dermatology research and clinical trials. Using examples from alopecia and autoimmune disease research, the discussion expands the definition of diversity beyond race and ethnicity to include diversity of thought, training background, and scientific perspective. Both speakers emphasize that collaborative, multidisciplinary research leads to stronger study design, fewer blind spots, and more clinically meaningful outcomes for patients.

Together, this Savvy Stories episode captures why these three conversations stood out among viewers in 2025. By blending clinical insight, scientific rigor, and a commitment to equity, the episode reflects Skin of Color Savvy’s mission to elevate dermatologic care through education, representation, and inclusive dialogue.

This new episode from January 2026 features a compilation of 3 clips from the most viewed episodes of 2025.

2025 Fall Clinical Dermatology Conference

 in Las Vegas, Shawn Kwatra, MD, professor and chairman of dermatology at the University of Maryland School of Medicine, presented 2 sessions regarding inflammatory skin disease management.

Kwatra spoke in an interview about these 2 presentations, the first of which being titled ‘What’s Itching You Today? Contact Derm? Atopic Derm? What Else?’ Kwatra highlighted some key takeaways in his interview.

The OX40 Ligand Signaling Pathway and Atopic Dermatitis, With Shawn Kwatra, MD

“We talked today about many different case presentations of chronic itch, and we had a few key takeaways and pearls,” Kwatra explained. “One of them was that prurigo nodularis has a very unique morphology. You can have various presentations. You can have nodules, papules, excoriations, or plaques. I presented a few cases of patients who had been mislabeled as having neurotic excoriations, and actually they responded very well to biologic therapy. So [it’s important] to ask about that itch when you have the excavated phenotype.”

Kwatra highlighted other key points in the talk, including a discussion of itch and malignancy. He also discussed chronic pruritus of unknown origin.

“There's an immune subset,” Kwatra said. “They don't have to have these blood biomarkers. And many have high IgE, high blood eosinophils, and we know that there's immune-stimulated pruritus, which is a term our group described where folks, even after Covid vaccine or a PDE1-inhibitor for cancer therapy, develop generalized pruritus that responds to therapies, intramuscular triamcinolone and off-label biologics such as dupilumab.”

Later, Kwatra was asked about his session presentation, titled ‘Exploring the OX40 Ligand Signaling Pathway in Atopic Dermatitis.’

“The way to think about this is that OX40 ligand is the prequel to inflammation,” Kwatra explained. “So we talked about how we see classical cytokines like IL-4, IL-13, IL-31. The question is, how do those cytokines even get there? What is this inflammatory prequel?...There's an epidermal barrier dysfunction in atopic dermatitis, and that allows for antigens to enter the skin, and they actually go to the antigen presenting scale cell, which expresses OX40 ligand interaction with activated T cells.”

Kwatra added that this causes these cytokines to go up and causes T regulatory cells to be suppressed, which he notes are endogenously anti-inflammatory. It also leads to the formation of memory T cells.

“So the thought is that by blocking this ‘inflammatory prequel’ OX40 ligand pathway, you're going to be able to have longer periods of remission to that reduction in memory T cells, and that's what we're seeing,” Kwatra said. “In the STEAM-AD, phase 2b trial, we saw that many of these patients off treatment after 24 weeks maintained response, even after serum levels of the drug had completely diminished and gone away, compared to patients remaining on the drug.”

To find out more about Kwatra’s talk at the Fall Clinical Conference, view the video interview posted above.

Kwatra's disclosures included the following: AbbVie, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte, Johnson & Johnson, Novartis, Pfizer, Regeneron Pharmaceuticals Inc., Sanofi – advisory board member/consultant; Galderma, Incyte, Pfizer, Sanofi – investigator.

Kwatra S. What’s Itching You Today? Contact Derm? Atopic Derm? What Else? Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Kwatra S. Exploring the OX40 Ligand Signaling Pathway in Atopic Dermatitis. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Kwatra spoke at Fall Clinical about several key highlights from his sessions discussing atopic dermatitis, prurigo nodularis, and the OX40 ligand (OX40L).

New phase 3 data, pooled from the LIBERTY-PN PRIME and PRIME2 trials, suggest dupilumab is efficacious among patients both above and below the age of 65 years who live with prurigo nodularis.

These data were highlighted in a recent interview with Shawn Kwatra, MD, during the 

2025 European Academy of Dermatology and Venereology (EADV) Congress

. Kwatra is a renowned leader in the dermatology space, currently serving as a professor and chairman of dermatology at the University of Maryland School of Medicine.

Discussing New Phase 3 Results on Dupilumab for Prurigo Nodularis, With Shawn Kwatra, MD

“Prurigo nodularis is one of those diseases that robs people of their dignity. The Itching is relentless,” Kwatra explained. “The scratching is constant, and for many patients, especially our older patients with other medical conditions, it becomes a daily battle. So the question has always been, can we deliver a therapy that is both safe and powerfully effective across patient groups? In particular age groups, it is very important for us to know, since many of our prurigo nodularis patients actually start in middle age. But many are older adults.”

Adult patients with moderate to severe prurigo nodularis had been assessed in the LIBERTY-PN PRIME/PRIME2 studies (NCT04183335/NCT04202679).

 These subjects specifically had disease that was inadequately controlled via topical drugs or for whom those medications were shown to be inadvisable.

Kwatra and colleagues randomized these individuals to 300-mg dupilumab on an every-2-week basis (n = 153) or into the matched placebo cohort (n = 158) for a total of 24 weeks. At Week 24, the investigatorsa evaluated the proportion of individuals younger or older than 65 years who attained a ≥4-point Worst Itch Numerical Rating Scale (WI-NRS) score reduction or Investigator’s Global Assessment for PN-Stage (IGA PN-S) score 0/1.

“In the pooled analysis…dupilumab showed robust efficacy in prurigo nodularis,” Kwatra said. “This was a game changer. I've been studying prurigo nodularis for my career, and we didn't know if we'd ever have an FDA-approved therapy for prurigo nodularis. But the biology happened fast. The trials happened quickly, and we got that approval. Dupilumab led the way here with that first FDA-approved therapy for prurigo nodularis. At 24 weeks, what we found here is that both in PRIME and PRIME2, over 60% of patients, both over and under age 65, had at least a four-point reduction in their itch. That's significant.”

Kwatra highlighted the data in this analysis, noting that those given the treatment compared to those on placebo saw significantly greater proportion of patients aged <65 years (63.5% versus 23.1%; 

 < .0001) and ≥65 years (63.2% versus 25.0%; 

 = .0142) attaining a reduction of WI-NRS scores by ≥4 points from baseline.

The investigators also found that a significantly greater proportion of dupilumab-treated individuals aged <65 years (44.4% versus 19.4%; 

 = .0023) and ≥65 years (52.6% versus 4.2%; 

 < .0001) were successful in attaining an IGA PN-S score 0/1 at the 24-week mark.

 Safety was also shown by Kwatra and coauthors to be similar between these age cohorts. It was also noted to have been generally consistent with the established safety profile of dupilumab.

Kwatra S, Ständer S, Wiggins S, et al. Dupilumab Is Efficacious in Patients Above and Below 65 Years Old With Prurigo Nodularis: Pooled Results From Two Phase 3 Trials (LIBERTY-PN PRIME and PRIME2). Presented at the 2025 European Academy of Dermatology and Venereology (EADV) Congress, Sept 17-20, 2025.

Yosipovitch G, Kim BS, Kwatra SG, et al. Dupilumab improves pruritus and skin lesions in patients with prurigo nodularis: Pooled results from 2 phase 3 trials (LIBERTY-PN PRIME and PRIME2). JAAD Int. 2024 Apr 10;16:163-174. doi: 10.1016/j.jdin.2024.03.025. PMID: 39006917; PMCID: PMC11246003.

Shawn Kwatra, MD, highlights his team’s findings presented at EADV on the efficacy of dupilumab in treating prurigo nodularis.

Shawn Kwatra, MD

Articles