Adewole (Ade) Adamson, MD, MPP, is an assistant professor at Dell Medical School.

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

Skin of Color Savvy: UV Safety in Skin of Color, with Rebecca Vasquez, MD and Adewole Adamson, MD, MPP

In this clinical episode of Skin of Color Savvy: The Art and Science of Treating Patients of Color, this week's host Rebecca Vasquez, MD, associate professor of dermatology at UT Southwestern, is joined by long-time colleague Adewole (Ade) Adamson, MD, MPP, assistant professor at Dell Medical School and expert in skin cancer epidemiology, to discuss UV safety and photo protection in patients with skin of color.

The conversation begins by addressing a pervasive myth: that melanin-rich skin is immune to ultraviolet (UV) damage. Adamson clarifies that UV radiation can harm all skin types, though the outcomes and risk levels vary by pigmentation and genetic ancestry. While darker skin types are less susceptible to sunburn and UV-induced skin cancers, they remain at risk for pigmentary disorders, photoaging, and photosensitive conditions—underscoring the need for nuanced, individualized counseling.

Both dermatologists highlight the importance of educating patients about risk factors beyond skin tone, such as family history, immune status, and occupational sun exposure. Vasquez and Adamson emphasize the need to move beyond the oversimplified “sunscreen-first” messaging and instead promote a broader approach that includes shade-seeking, UV-protective clothing, and behavioral modifications. Critically, they caution against fear-based messaging and advocate for compassion and empowerment in photo protection counseling.

Vasquez encourages tinted sunscreens containing iron oxide to address visible light-induced hyperpigmentation, while both physicians acknowledge ongoing challenges in color-matching for melanin-rich skin. They agree that product accessibility, aesthetic acceptability, and cost are key to adherence and recommend patient-driven choices guided by basic SPF and UVA criteria.

The conversation shifts to research gaps. Adamson shares findings from his team’s systematic review of melanoma and UV exposure, revealing no consistent link between UV exposure and melanoma in patients of color. Instead, melanoma tends to appear on non–sun-exposed sites like palms and soles. Similarly, he notes a lack of high-quality data on nonmelanoma skin cancers (e.g., basal cell carcinoma) in patients of color, largely due to poor representation in registries and trials.

The episode closes with practical pearls, including Adamson’s tip to store sunscreen in coolers—protecting its efficacy and enhancing comfort during reapplication. Both guests stress culturally competent counseling and authentic, evidence-based conversations that build trust with patients of color.

To learn more about the Skin of Color Society's (SOCS) mentorship programs and initiatives, visit 

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

This clinical episode of Skin of Color Savvy features a discussion on UV safety and photo protection in patients with skin of color.

Adewole (Ade) Adamson, MD, MPP

In part 2 of this episode of Crisis Point, 4 experts on pain and opioid misuse discuss continuing efforts to turn the tide.

Crisis Point: Turning the Tide in The Opioid Crisis

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

Addressing the Opioid Crisis: Efforts to Turn the Tide

This episode examines the growing and evolving opioid crisis, a public health emergency that has claimed more than half a million lives over the past 2 decades in the United States.

What began as a prescribing-driven epidemic has evolved into a more complex crisis fueled by the proliferation of illicit synthetic opioids, persistent gaps in access to treatment, and social determinants that drive vulnerability to substance use disorder.

In 2023, the overall rate of mortality from drug overdoses slightly fell for the first time since 2018.

 The decrease could be due to a number of factors, including new pharmaceutical options for treating opioid use disorder, a shift away from opioid prescribing regimens, regulatory and advocacy action, and even the COVID-19 pandemic. While the decrease is a positive sign for those working with OUD, overdose deaths related to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine remain at historic highs and the work is only beginning.

Be sure to check out part 1 of this episode, which into the complex challenges surrounding OUD, exploring how the opioid crisis has evolved and grown in recent years and how new pharmaceuticals and prescribing regimens may be helping to turn the tide.

In part 2, the conversation shifts to ongoing advocacy and regulatory action and significant progress in turning the tide in the opioid crisis so far.

Brief descriptions of the speakers featured in this project are provided below:

Angel Goenawan, MD, hospitalist at Bayhealth in Delaware

Bobby Mukkamala, MD president-elect of the American Medical Association (AMA) and chair of the AMA’s Substance Use and Pain Care Task Force

Michele J. Buonora, MD, MS, MSHS, assistant professor of medicine, Albert Einstein College of Medicine, Montefiore Einstein

Shoshana Herzig, MD, assistant professor of medicine, Harvard Medical School and Beth Israel Deaconess Medical Center

For more video content, visit our Crisis Point page to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. Webpage. CDC. May 15, 2024. 

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm

AMA Substance Use and Pain Care Task Force recommendations. Webpage. AMA. 2025. 

https://www.ama-assn.org/delivering-care/nation-s-overdose-epidemic/ama-substance-use-and-pain-care-task-force

HHS Announces Transformation to Make America Healthy Again. Webpage. HHS. March 27, 2025. 

https://www.hhs.gov/press-room/hhs-restructuring-doge.html

More than a dozen states, DC sue Trump administration over ‘dismantling’ of federal health agencies. Webpage. CNN. May 5, 2025. 

https://www.cnn.com/2025/05/05/health/states-sue-trump-administration-hhs-rfk

Bobby Mukkamala, MD

Importance of Multispecialty Communication in Hypercortisolism Management and Referrals

Video content above is prompted by the following:

What is the role of primary care clinicians in identifying and screening patients for hypercortisolism?

How does hypercortisolism affect mental health? How can primary care clinicians help identify patients with mental health conditions who might be at risk for hypercortisolism?

How does hypercortisolism contribute to osteoporosis and an increased risk of fractures?

Experts discuss the role of primary care clinicians in identifying and screening patients for hypercortisolism, how hypercortisolism affects mental health and how primary care clinicians can identify at-risk patients, and how hypercortisolism contributes to osteoporosis and an increased risk of fractures.

Davida Kruger, MSN, APN-C, BC-ADM 

How Clinicians can Prepare for the Future of Resistant Hypertension Care

Looking to the future, improving approaches to overcome high noncompliance rates with medical therapies remains a critical need. Promising developments include treatments that don't require daily medication ingestion, such as injectable long-acting medications dosed every few weeks or months, and device-based treatment options like renal denervation, which has recently received FDA approval.

Collecting more comprehensive safety data and long-term effectiveness data on these innovative approaches will help improve overall control rates for even the most challenging resistant hypertension cases. These advancements could significantly transform management strategies for difficult-to-treat patients.

Best practices for resistant hypertension management include obtaining accurate blood pressure measurements, focusing on out-of-office readings rather than office measurements, evaluating patients for secondary causes of resistant hypertension (particularly aldosterone dysregulation and primary aldosteronism), and implementing simple treatment protocols. Effective medication regimens typically include long-acting angiotensin receptor blockers, calcium channel blockers, thiazide diuretics, and mineralocorticoid receptor antagonists, which can help most patients reach the target blood pressure of 130/80 mmHg.

A panelist discusses how future improvements in resistant hypertension management will focus on overcoming medication noncompliance through long-acting injectable treatments and device-based options like renal denervation, while emphasizing best practices including accurate out-of-office blood pressure measurements and systematic treatment protocols targeting 130/80 mmHg.

Florian Rader, MD

Joshua Lynch, DO, EMT-P, FAAEM, FACEP, University at Buffalo Jacobs School of Medicine & Biomedical Sciences

Greiwe discussed findings from the phase 3 ADORING 1 and 2 trials in people as young as 2 years of age.

Confirming Tapinarof’s Efficacy and Safety Across Atopic Dermatitis Severities, with Justin Greiwe, MD

Tapinarof was well-tolerated and demonstrated consistent efficacy across body regions in people as young as 2 years old with atopic dermatitis, according to data from the phase 3 ADORING 1 and 2 trials presented by Justin Greiwe, MD, Bernstein Allergy Group, and Clinical Assistant Professor of Medicine, Division of Immunology, Allergy, and Rheumatology, University of Cincinnati, at the 2025 American Academy of Allergy, Asthma, and Immunology (AAAAI)/World Allergy Organization (WAO) Joint Congress, February 28-March 3, in San Diego, California.

Greiwe and colleagues found that in ADORING 1, least squares (LS) mean overall EASI score improvements were –8.4 vs –4.1 (P <.0001) at week 8 and in ADORING 2, LS mean overall EASI score improvements were –10.1 vs –5.2 (P <.0001). By body region, LS mean changes in EASI scores by body region at Week 8 were: head/neck –8.7 vs –4.4 (ADORING 1) and –8.8 vs –4.7 (ADORING 2); trunk –5.9 vs –2.6 (ADORING 1) and –7.2 vs –3.8 (ADORING 2); upper extremities –12.0 vs –5.2 (ADORING 1) and –15.0 vs –6.6 (ADORING 2); and lower extremities –8.6 vs –4.4 (ADORING 1) and –9.9 vs –5.5 (ADORING 2; all P <.0001). Tapinarof was well tolerated across sensitive areas, including the face/neck.

 spoke with Greiwe to learn more about tapinarof, which is a topical aryl hydrocarbon receptor agonist, the efficacy and safety findings from the ADORING 1 and 2 trials, and how it could potentially benefit patients with atopic dermatitis under the age of 2 years.

“I think with some of these new advancements and new indications, we're slowly moving into the pediatric realm, which, to be honest, is really important, because this is a group that typically suffers a lot and tends to have pretty refractory severe disease,” Greiwe said.

Tapinarof is currently FDA-approved under the name Vtama for the topical treatment of atopic dermatitis in adults and pediatric patients 2 years of age and older.

Greiwe J, Tallman A, Sublett JW, et al. Tapinarof Cream 1% Once Daily: Consistent Efficacy Across All Body Regions, Including Head And Neck, In Adults And Children Down To 2 Years Of Age With Atopic Dermatitis. Presented at: 2025 AAAAI/WAO Joint Congress, February 28-March 3. Abstract 595

FDA Approves VTAMA® (tapinarof) cream, 1% for the Treatment of Atopic Dermatitis in Adults and Children 2 Years of Age and Older. News release. Organon. December 16, 2024. Accessed March 5, 2025. https://www.organon.com/news/fda-approves-vtama-tapinarof-cream-1-for-the-treatment-of-atopic-dermatitis-in-adults-and-children-2-years-of-age-and-older/

Justin Greiwe, MD

Experts continue the discussion on treat-to-target in CD, highlighting monitoring treatment response.

Monitoring Treatment Response in Treat-to-Target in CD

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The experts delve into the reassessment and monitoring strategies for patients undergoing treatment for Crohn's disease. The discussion revolves around determining when and how healthcare providers should assess if the patient is progressing in the right direction and whether the current treatment is effective.

The speakers emphasize the importance of early targets, including clinical response, clinical remission, and biomarker trends. They stress that if patients don't meet these early targets within a reasonable timeframe, there is a need to reassess the monitoring strategy. The concept of treat-to-target is discussed, where clinical response should be assessed within 4 weeks of initiating therapy.

The role of biomarkers, such as fecal calprotectin and c-reactive protein (CRP), is highlighted, with a suggestion to monitor them as early as week 4 and subsequently at 8 weeks, 12 weeks, and every 3 months. The biomarker trends help identify whether the therapy is working or if there's a need for intensification or a change in treatment.

The speakers also touch upon the challenge of convincing patients who feel well to undergo monitoring, emphasizing the importance of using patients as their own control. The goal is to establish a baseline understanding and ensure that even when patients are in endoscopic remission, ongoing monitoring remains crucial.

Overall, the discussion emphasizes the dynamic nature of monitoring strategies, adapting to individual patient responses, and using a combination of clinical, biomarker, and endoscopic assessments to guide treatment decisions effectively.

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

Marla Dubinsky, MD

The last question that we should address is the following: How would you introduce the patient to the fact that they will be or could be taking a biosimilar? What type of discussion would you have with the patient?

 This is a great question, where we’ll have to come up with our ways of explaining a very complicated aspect to our patients in ways that are understandable and reassuring. I’ll be telling most of my patients that this is good news, that these products have been carefully tested and studied at a number of levels and their experience should basically be the same. The benefit of having these biosimilars available is that it should make the therapies more accessible to our patients because they’re so expensive.

It’s going to be challenging, though. With my own practice, we have so many options for psoriasis. I’ll often say, “We have to try biologic A,” and we agree on it. I send them the information on it and then the insurance company says, “No, it’s going to be biologic B.” Even when we agree it’s biologic A, they may be told it’s going to be biologic B and say, “But it isn’t the drug you told me.” It’s now this other thing with a different name they don’t recognize, and we have to go back and have that conversation. That’s likely to be a big source of anxiety for our patients. We know a lot of our patients are reluctant to go on biologics sometimes, so adding these additional complexities and barriers for our patients may cause harm in individuals who tend to be pretty reluctant or anxious about this process from the get-go.

It’s all about patient education, though. When I see a new patient with rheumatoid arthritis—it’s the easiest one—I can persuade 99% of patients to go on methotrexate for the first drug. It isn’t a big problem. Then when 70% of patients respond to methotrexate, and then we have all those other molecules available. I talk about all those molecules. You give the patient informed consent, which has gotten much more complex as time has gone on because there are many more drugs. Then I ask, “Which would you prefer first? Which would you prefer second?” In the end, I say, “Your insurance company is going to make the decision. I want to know what you’d do if the insurance company doesn’t pick your first choice.” They pick one. “What do we do if that one doesn’t work?” That’s how I handle that, and it usually works.

In speaking to a patient, you have to simplify, just as you did, that the biosimilars have shown that they’re very similar to the reference product and that almost all patients who will respond to a reference product will respond to a biosimilar. It’s that switch patient, the ones who do well, where I think there’s a little more angst. Even there, I’d say, “The literature shows that 95% of patients do well,” but I like to have the availability to switch back to the bio-original if I can.

 The critical thing for clinicians to know is the importance of instilling confidence, because the data give us the confidence that’s well earned. In my practice, when I choose mechanism of action A and then the insurance company says, “No, you have to use B,” as long as I think B is a very good option, I’ll go back to the patient and say, “The company wants you to use this biologic. It’s an outstanding option for you. It’s very likely to clear your skin, and I recommend it.” Almost all my patients in those settings are OK with that situation and are willing to make that switch. It should be an even easier thing to instill confidence when we’re staying within the same mechanism of action and a similar biologic. They should expect the same experience, whether we call it adalimumab or whatever the biosimilar name is going to be.

Thank you. To summarize, the prescribing physician has to have confidence in the biosimilar, and then the physician, the nurse practitioner, and all the ancillary personnel have to have that same degree of confidence. I can imagine a physician telling the patient, “There’s almost no difference between these drugs,” and then the infusion nurse or some laboratory person says, “I wouldn’t take a biosimilar.” Who’s the patient going to listen to? A well-educated physician or the laboratory tech? It’s going to be the lab tech.

 Or it might be social media. It might be what someone googles online or reads in a chatroom, where someone says, “I was doing OK on this, and I went on that, and now I’m having a problem.” As clinicians, we have to expect that there will be some uncertainty, and we’ll have to be there for our patients, empathize with them, and help them make the best decisions possible and move forward in a way that’s of best interest to their health.

presentation. We hope you found this presentation to be rich and informative.

Drs Roy M. Fleischmann and Joel M. Gelfand discuss addressing patient concerns to biosimilars and provide take-home messages to clinicians utilizing biosimilars.

Addressing Patients' Concerns With Biosimilars

Roy M. Fleischmann, MD

Globally, an estimated 850 million and 64 million people live with some form of kidney disease and heart failure (HF), respectively. Patients with chronic conditions of HF, chronic kidney disease (CKD), and diabetes, as well as those taking certain medications like RAAS inhibitors, are at an increased risk of developing hyperkalemia (HK) - a higher-than-normal potassium level in the blood.

HK can be a chronic condition and has been associated with increased hospitalizations and death. In a US-based retrospective study from integrated health delivery networks, HK was found to be an independent risk factor for all-cause mortality in almost 1 million patients including those with CKD, HF, and/or diabetes.

 In a second US-based retrospective analysis of a medical claims database of 39,626 matched pairs of patients with or without HK, 40% of patients with HK experienced 2 or more hyperkalemic events during the 1-year post index period.

“It is important to take hyperkalemia seriously, as it is a potentially fatal condition,” says Pamela Kushner, MD, FAAFP, a primary care physician (PCP) and clinical professor at the University of California Irvine Medical Center. “People with CKD, and/or HF, or other cardio-renal comorbidities, if they are diagnosed with chronic hyperkalemia, they may need long-term management due to the underlying condition. As a PCP, I often support my patients with a diagnosis of hyperkalemia, and I make regular potassium monitoring a part of their long-term care plans as soon as possible.”

RAASi therapy are a group of medicines recommended by the 2021 European Society of Cardiology (ESC) and the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) for the treatment of patients with HF. The 2022 and 2021 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines recommend the use of ACEi or ARB for the treatment of patients with CKD and hypertension with/or without diabetes.

Javed Butler, MD, MPH, MBA, a cardiologist at Baylor Scott and White Health in Dallas, Texas, and a professor of medicine at the University of Mississippi Medical Center in Jackson, Mississippi, explains, “RAASi therapy is one of the most important management approaches for HF patients. These lifesaving treatments reduce the number of HF-related hospitalizations and reduce mortality risk.”

Unfortunately, RAASi therapy has been associated with HK, which is often treated with a reduction or discontinuation of RAASi therapy. In a US-based medical records analysis of patients prescribed a RAASi, including ACE inhibitors, ARBs, direct renin inhibitors and select MRAs, mortality was at least 2x higher for patients with CKD whose RAASi had been reduced (20.3%) or discontinued (22.4%) compared to patients on maximum RAASi doses (9.8%).

Given the impact that HK can have on patients, a long-term and continued approach to treating HK is needed.

 diet is a non-therapeutic approach to managing HK, however, there is a lack of high-quality evidence demonstrating its effectiveness as a HK management strategy. A major contributor to HK in patients with advanced CKD is inadequate excretion of K

 through the kidneys, so reduction in dietary K

 alone may not be sufficient. In addition, a low K

 diet may deprive patients of important nutrients or could conflict with some aspects of a heart-healthy diet. Dietary modifications can be challenging to achieve and adhere to in patients with CKD as well.

There are several guideline recommended options for managing HK which include both therapeutic and non-therapeutic approaches.

According to one practice point from the 2021 KDIGO clinical practice guidelines for the management of blood pressure in CKD, HK associated with RASi use can often be managed by measures to reduce the serum K

 levels rather than decreasing dose or stopping RASi. Strategies to control chronic HK include dietary potassium restriction; discontinuation of potassium supplements, certain salt substitutes, and hyperkalemic drugs; adding potassium-wasting diuretics; and oral potassium binders. In CKD patients receiving RASi who develop HK, the latter can be controlled with newer oral K

 binders in many patients, with the effect that RASi can be continued at the recommended dose.

The 2022 KDIGO Clinical Practice Guideline for Diabetes Management in CKD recommends that treatment with an ACEi or ARB be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated. Hyperkalemia associated with the use of an ACEi or ARB can often be managed by measures to reduce serum potassium levels rather than decreasing the dose or stopping the ACEi or ARB immediately. Measures to manage HK include: review concurrent drugs including over the counter and herbal drugs as well as supplements to avoid/discontinue drugs that impair K

 excretion, moderate potassium intake, and consider diuretics, sodium bicarbonate, and potassium binders. Potassium binders should be considered to decrease serum K

 levels after other measures have failed, rather than decreasing or discontinuing ACEi or ARB treatment.

Among patients with HF, the ESC 2021 guideline refers to the use of potassium binders for the treatment of acute and chronic HK in patients with HF which may allow initiation or uptitration of RAASi in patients with renal dysfunction or HK.

Rethinking Episodic Hyperkalemia Management in Support of Current Guideline Recommendations

HK can present as a single episode, but the reality for many patients with CKD is that their HK will, or already has, become a chronic condition. HK remains an ongoing threat in patients with comorbidities such as HF, CKD, and/or diabetes, as many within this patient population have recurrent HK episodes.

“Viewing hyperkalemia as a chronic or recurrent condition is an important step for patients and their care teams to ensure an optimal approach to ongoing management,” says Professor Kam Kalantar-Zadeh, MD, MPH, PhD. “There are guideline recommended ways for nephrologists and other clinicians to manage their patients’ hyperkalemia episodes over the long-term, which include options in addition to potassium restrictive diets, which may deprive patients of healthy fruits and vegetables, especially those with CKD.”

Physicians should take a guideline-informed approach when managing HK, including RAASi-associated HK, especially in patients with HF, CKD and/or diabetes.

*Retrospective study of 911,698 patients from multiple integrated health delivery networks (Humedica). Control group included 338,297 individuals without known HF, CKD, diabetes, cardiovascular disease, or hypertension. Patient data came from private insurers, Medicare and Medicaid users, and uninsured individuals.1

†Based on a retrospective analysis of a medical claims database with 39,626 matched pairs of patients with or without hyperkalemia. Patients with hyperkalemia were defined as having 2 laboratory tests with a serum potassium level >5.0 mEq/L, at least 1 diagnosis code corresponding to hyperkalemia (ICD-9-CM code: 276.7), or at least 1 prescription fill of SPS.3

‖Based on data from an analysis of medical records of patients 5 years and older with at least 2 serum K+ measurements from the Humedica database. Patients with ESRD at the index date were excluded from outcomes analyses. Patients were included if they had at least 1 outpatient prescription for a RAAS inhibitor, including ACE inhibitors, ARBs, direct renin inhibitors, and select MRAs. Patients were categorized by their last RAAS inhibitor dose level for the analysis of mortality, where maximum was defined as the labeled dose and submaximum was defined as any dose lower than the labeled dose. Mortality rates for the overall population (N=201,655) during the 12-month period were 4.1% for patients on maximum RAAS inhibitor dose, 8.2% for patients on submaximum dose, and 11.0% for patients who discontinued RAAS inhibitor therapy. Causality between RAAS inhibitor dose and adverse outcomes was not evaluated.4

Collins AJ, Pitt B, Reaven N, et al. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3):213-221

Betts KA, Woolley JM, Mu F, Xiang C, Tang W, Wu EQ. The cost of hyperkalemia in the United States. Kidney Int Rep. 2018;3(2):385-393

Epstein, Murray et al. “Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors.” The American journal of managed care vol. 21,11 Suppl (2015): S212-20.

Authors