Tiffany Mayo, MD, FAAD

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

Skin of Color Savvy: Live at RAD 2025 with Tiffany Mayo, MD, and Raj Chovatiya, MD, PhD

In this special on-site episode of Skin of Color Savvy: The Art and Science of Treating Patients of Color, by the 

, dermatologists Raj Chovatiya, MD, PhD, and Tiffany Mayo, MD, engage in a wide-ranging discussion on atopic dermatitis in skin of color, recorded live from the 

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Tennessee. Together, the 2 leading voices in dermatology examine diagnostic challenges, patient communication, and the future of topical therapy—offering both clinical insights and actionable strategies for improving care across diverse skin tones.

The conversation begins with an exploration of diagnostic disparities in atopic dermatitis. Mayo highlights how historical underrepresentation of skin of color in dermatologic imagery, along with erythema being a primary clinical feature, contributes to delayed diagnosis in patients with richly pigmented skin. Chovatiya echoes this, noting the visual bias in dermatology and the importance of rethinking severity grading in atopic dermatitis, which often relies on erythema not easily visible in darker skin. Both clinicians emphasize that postinflammatory pigment alteration—especially hyperpigmentation—is not only common in patients of color but often more distressing to patients than the disease itself.

The episode stresses the importance of eliciting patient priorities during consultation. Mayo urges clinicians to directly ask, “What bothers you most?” as pigment changes may be more concerning to patients than active eczema. She also outlines counseling strategies to clarify that medications aren’t the cause of pigment alteration, but rather the disease itself, helping to maintain treatment trust and adherence.

The discussion transitions into clinical pearls for differentiating atopic dermatitis from its mimickers—particularly in darker skin tones. Mayo shares her use of dermoscopy to enhance diagnostic accuracy in cases where morphology is subtle, while Chovatiya recommends palpation as a basic but powerful tool. Both caution against under-recognizing active disease in richly pigmented skin and recommend incorporating validated patient-reported outcome measures like POEM scores to capture disease burden when visual cues are misleading.

As the discussion turns to treatment, the hosts spotlight the growing role of targeted, nonsteroidal topical therapies. Mayo outlines her real-world use of agents such as tapinarof, roflumilast, and ruxolitinib, citing their long-term safety, tolerability, and usefulness across diverse presentations. She emphasizes that simple regimens, monotherapy when possible, and flexible formulations (such as foams) are key to promoting adherence, especially among patients with textured hair, facial involvement, or sensitive skin.

Chovatiya highlights the inclusivity of recent clinical trials, particularly for tapinarof, noting their deliberate enrollment of racially diverse participants and design parameters that more closely mimic real-world behavior. Data from long-term extension studies show that even with intermittent use, patients can maintain control of their disease—an important message for busy individuals who struggle with daily application. Roflumilast and ruxolitinib offer similarly flexible maintenance strategies, supporting proactive or as-needed regimens that match the heterogeneity of atopic dermatitis in the real world.

The episode closes with a mutual call for “intentionality” in atopic dermatitis care: in diagnosis, treatment selection, trial design, and patient communication. Mayo reminds listeners that patients of color may not exhibit textbook signs, making it essential to gather layered diagnostic data and engage patients around their lived experiences. Chovatiya reinforces that clinicians must recognize the multidimensional nature of atopic dermatitis—its signs, symptoms, comorbidities, and psychosocial burden—and approach every patient with individualized, culturally responsive care.

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Editor’s note: This podcast summary was edited through the use of artificial intelligence tools.

Videos

Leading experts discuss managing atopic dermatitis in skin of color in a live recording from the 2025 Revolutionizing Atopic Dermatitis Conference. 

 in Nashville, Tennessee, Tiffany Mayo, MD, provided a Q&A interview to the 

 editorial team regarding takeaways from her conference talk, ‘Complex Cases: AD & Hair Loss.’

Mayo is known for her work as both a board-certified dermatologist and assistant professor of Dermatology at the University of Alabama at Birmingham. Regarding her presentation on hair loss and 

, Mayo was asked to go over some of the most notable points made during the talk. The following is her Q&A interview:

In light of your talk regarding complex cases in atopic dermatitis and hair loss, would you go over some of the specifics that you shared during the session?

Some of the things that I think are key takeaways [such as the fact] that the severity of alopecia is not necessarily measured by the amount of disease, but it can really be more the impact of the disease on the patient. That should really drive our treatment, because places like the scalp or other small body surface areas can actually give intense pruritus and cause sleep loss. So we really want to make sure that we're adequately managing our patients, even if they seem to have a small amount of [impacted] body surface area.

Also, it's really important to note that there is an association between alopecia areata and atopic dermatitis, so we should be asking our patients about scalp involvement. But even when it's not alopecia areata, there is an association between alopecia and atopic dermatitis that can be very bothersome to our patients. For these patients, we should not miss the opportunity to let them know that we understand that this is impactful for them, and to help them understand how adequately treating their atopic dermatitis may also help deal with alopecia.

Outside of atopic dermatitis, are there any other areas in dermatology that you're looking forward to in the research space?

Absolutely. I love treating atopic dermatitis and love alopecia, particularly scarring alopecia. I would love to see more research done in that area, as well as hidradenitis suppurativa. Thankfully, over the past few years, hidradenitis has seen a lot more research than it ever had, so that's super exciting. But I hope that continues, because still, there are still a lot of unknowns in hidradenitis suppurativa and a ton of unknowns in scarring alopecia. I am really hoping to see more there.

What would you say is the value of a disease-specific meeting such as RAD 2025?

That's an excellent question. I think there are so many new treatments coming out that we're often left with questions: When do I treat certain patients? When do I choose certain medications? But the more we understand about treatment, we start to understand more about the disease and the nuances of the disease. So even though I've been to several meetings over the past month, being at this meeting talking specifically about atopic dermatitis, talking about all the treatments for atopic dermatitis, talking about the different phenotypes patient populations all in one, all really help us start to understand who we should be selecting for certain treatments and things we should be considering for our different patient populations to make sure we're actually managing and counseling them adequately. [Also] just making sure that we're giving better, complete care for our patients, and that we have a more complete understanding of the disease state.

 Is there any other research that you're working on that you would like to highlight?

I'm always working on projects. I think there still needs to be more disease state awareness, particularly in certain patient populations. So I'm always in the community hoping to better educate patients about the signs of different disease states, such as atopic dermatitis, alopecia, and hidradenitis. I think there can't be enough education related to the different disease states in patients of all skin tones, so that there can be full understanding of what the different nuances may look like. I'm working on quality improvement projects, research in that area, always, but always looking at scarring alopecia as well better understanding the impact of disease and whether or not the current treatments for alopecia and atopic dermatitis, will also have a double duty in helping us out with scarring alopecia.

For any additional information on this topic or related data, view our 

The quotes used in this summary were edited for clarity.

In this Q&A interview at RAD 2025, Tiffany Mayo, MD, highlights the biggest takeaways from her talk on complex cases in atopic dermatitis and hair loss.

Complex Cases in Atopic Dermatitis and Hair Loss, with Tiffany Mayo, MD

 in Nashville, TN, Tiffany Mayo, MD, discussed the association between atopic dermatitis and alopecia, emphasizing the need to address hair loss in patients with 

 and address patients' concerns in a more well-rounded manner.

Mayo, known for her work as an assistant professor of dermatology for the University of Alabama at Birmingham, highlighted studies showing a minor association between atopic dermatitis and alopecia. During the presentation, it was noted that scalp assessments are often neglected.

“I really want to talk about the full spectrum of hair loss in our patients with atopic dermatitis,” Mayo expressed. “So we're going to review atopic dermatitis comorbidities, including alopecia areata, as well as other hair loss that may be seen. We want to analyze the effects of atopic dermatitis on hair health completely, investigate the association between alopecia areata and atopic dermatitis, and then discuss how that itch-scratch cycle may affect our patients in some of the presentations that we have with alopecia.”

Mayo touched on some of the biggest concerns she believes healthcare providers should have over hair loss and its relationship to atopic dermatitis, highlighting the neglect of this subject that can be seen in many clinicians’ offices.

“When we think about the spectrum of comorbidities, often we don't think about alopecia in our patients with atopic dermatitis,” Mayo said. “But our patients are living with alopecia, and it is quite impactful to them…Many studies have shown, looking at atopic dermatitis, that alopecia is a minor association, so it is seen in some publications. But when we look at those bigger studies on atopic dermatitis, scalp assessments are usually not reported on. They're more so looking at the body, looking at flexural sites. So we don't know a lot about the association between the scalp and how that may impact the hair.”

Patients do not always bring up the topic of hair to clinicians. This is the reason, she noted, that it is up to physicians to bring the subject up or risk neglecting the topic.

“We know that barrier dysfunction is really a pivotal issue in patients with atopic dermatitis,” Mayo said. “That also means that barrier dysfunction, including the scalp, may lead to sensitization from products such as shampoos, conditioners, and various styling products. I don't know if you all have opened certain products and then immediately smell this beautiful, fragrant smell. There aren't many products that you can buy over the counter that don't have these smells. We know that there are irritants in these products that may be affecting our patients with atopic dermatitis.”

A case study illustrated how a patient's scalp itch and hair thinning were exacerbated by a new hair dye, leading to a diagnosis of alopecia areata.

“This is one of my patients who comes in with an itchy scalp, a 56-year-old female history of atopic dermatitis, coming in for scalp pruritis and hair thinning,” Mayo explained. “No new medications, no significant past medical history other than the atopic dermatitis that had been pretty well-controlled using topicals…I'm about to nail this early [central centrifugal cicatricial alopecia], right? I give the patient a potent topical steroid, intralesional. I've found that biopsy when I'm concerned about early CCCA, sometimes isn't that revealing, and so I'll often see the patient back in 4 to 6 months when I start them on the regimen.”

In this case study, Mayo highlighted that she saw this same patient back in 4 months, noting significantly more trichorrhexis than before.

“Then I had to kind of sit down and think and ask her more questions,” Mayo said. “She is telling me, ‘This is driving me crazy, all of my eczema is flaring! My scalp is itchy and I can't sleep at night.’ So I did a biopsy, and I did not see the CCCA that I thought I was going to see. I saw a little bit of mild androgenetic alopecia and spongiotic dermatitis. Then, more questions for the patient revealed that the patient had the onset of this intense pruritus after she got her beautiful new hair dye, which I didn't know was new at the time.”

The patient had not been aware of this hair dye’s relevance at the time of the original discussion.

“That gets us to this question, whether this scalp atopic dermatitis…or is this allergic contact dermatitis?” Mayo said. “My issue when I saw this patient is that I fell into the trap of too narrow a differential diagnosis. I think that happens to the best of us, when we see so much alopecia that we don’t want to miss it. I was probably on the other end of the spectrum, but I missed the thing that was right in my face. I do think a lot of times, especially in skin of color patients, we miss the atopic dermatitis because it looks like PIH, so we just have to make sure that we're expanding our differential, truly listening to our patients, and really thinking about what may be going on.”

Mayo stressed the importance of expanding differential diagnoses, using appropriate therapies, and considering systemic treatments for patients with significant scalp disease. She also discussed the overlap of atopic dermatitis with autoimmune diseases and the potential benefits of antihistamines in managing alopecia areata.

For additional information on this topic and related information, check out the 

The quotes contained in this description of Mayo’s session were edited for clarity.

Articles

At the 2025 Revolutionizing Atopic Dermatitis Conference, Dr. Tiffany Mayo emphasized the overlooked association between atopic dermatitis and alopecia, urging clinicians to address hair loss in these patients. She highlighted the neglect of scalp assessments in studies and clinical practice, stressing the importance of considering hair health in atopic dermatitis management. Mayo shared a case study illustrating the impact of hair products on scalp health and the need for broader differential diagnoses. She advocated for systemic treatments and antihistamines for significant scalp disease and discussed the overlap with autoimmune conditions.

In this session at RAD 2025, Tiffany Mayo, MD, spoke to attendees about several examples of complex cases in atopic dermatitis and touched on hair loss concerns.

Spotlighting Complex Cases of Atopic Dermatitis and Hair Loss, with Tiffany Mayo, MD

Skin of Color Savvy: HS Management in Skin of Color, with Tiffany Mayo, MD, Steven Daveluy, MD, Jasmine Ivanna Espy

02:15 Diagnostic challenges with HS in skin of color

07:01 Hesitancy in using laser hair removal

11:13 Physician blindspots with HS management

12:33 Patient experiences and stigmatization

, host Tiffany Mayo, MD, leads a dynamic conversation on hidradenitis suppurativa (HS) in patients with diverse skin types, joined by dermatologist Steven Daveluy, MD, and patient advocate Jasmine Ivanna Espy.

Together, they offer a unique triangulation of perspectives—clinician, researcher, and lived experience—that frames HS not only as a medical challenge but also a public health, quality-of-life, and equity issue.

The conversation begins with Daveluy highlighting key diagnostic challenges of HS in patients with skin of color. Notably, studies show a prolonged diagnostic delay—seven to ten years on average—that is even longer in patients with skin of color. Contributing factors include clinical misrecognition due to erythema presenting differently in richly pigmented skin, leading to underdiagnosis or misdiagnosis. Daveluy also discusses disparities in disease severity and access to dermatologic care, underscoring that while HS itself is not more severe in patients of color biologically, delayed diagnosis and limited access to early interventions result in more advanced disease at presentation.

The discussion transitions to treatment considerations, particularly the use of laser hair removal in HS management. Daveluy explains that laser treatments are safe and effective for patients with darker skin types when used appropriately. He emphasizes that clinicians should not be deterred from using lasers for HS in skin of color, as patients often prioritize relief from pain and inflammation over potential dyspigmentation. Mayo reinforces this by noting that many providers already have the necessary tools—they simply need confidence and patient-centered guidance on how to apply them effectively.

Turning to the patient journey, Jasmine Ivanna Espy shares her powerful personal experience with HS, which began at age 13 but had not been accurately diagnosed until high school. She describes years of being misdiagnosed, experiencing physical pain and emotional isolation, and having to navigate a system that failed to validate her symptoms. Espy details the intense psychosocial toll of the disease, from clothing restrictions and social stigma to clinical depression and suicidal ideation.

Despite this, her story is one of transformation: through surgery, lifestyle changes, and community support, she ultimately achieved remission and founded a nonprofit—the Association of Hidradenitis Suppurativa and Inflammatory Diseases (AHSID)—to support others with similar experiences.

As the episode progresses, Daveluy and Espy discuss recent advances in treatment, including the growing arsenal of FDA-approved biologics and evolving surgical strategies like wide excision. Daveluy notes a shift in dermatologists’ willingness to treat HS now that more tools exist, while Espy underscores how having treatment options has empowered patients to make informed decisions rather than act out of desperation. Both stress the importance of combination therapy and in-office procedures like deroofing to manage chronic tunnels and flare-ups.

The episode closes with a call to action on building trust and centering the patient voice. Espy urges clinicians to approach patients with humility, curiosity, and respect—asking what matters most to them, acknowledging cultural and emotional factors, and fostering shared decision-making. Daveluy echoes this, encouraging dermatologists to either become that steadfast provider who does not give up on patients or develop trusted referral pathways to those who can.

Ultimately, the conversation affirms that HS care is about more than controlling lesions—it is about restoring dignity, reducing disparities, and empowering patients with both clinical and emotional support.

Editor’s note: This episode summary was edited through the use of artificial intelligence tools.

This episode of the SOCS podcast features an in-depth discussion between Tiffany Mayo, MD, Steven Daveluy, MD, and patient advocate Jasmine Ivanna Espy.
