Addressing Discoid Lupus in Skin of Color: Clinical and Social Challenges

In this segment of the latest Skin of Color Savvy episode, Abrahem Kazemi, MD, board-certified dermatologist and director of cosmetics and laser dermatology for Pinnacle Dermatology, reflects on a challenging yet ultimately rewarding case that underscores the intersection of dermatology, systemic disease, and social determinants of health. Through the lens of a young, underinsured African American man with early signs of discoid lupus erythematosus (DLE), Kazemi illustrates the complexities of delivering equitable dermatologic care in vulnerable populations.

Kazemi recounts that the patient initially presented with scalp sores, scarring, and hair loss—clinical features suggestive of early DLE, a subtype of chronic cutaneous lupus erythematosus. On closer examination, he identified atrophic, depigmented plaques within the conchal bowls of the ears, further supporting the diagnosis. Recognizing the potential for permanent scarring alopecia and disfiguring dyspigmentation—particularly devastating in skin of color—Kazemi acted swiftly. He performed multiple punch biopsies, ordered comprehensive laboratory testing including autoimmune panels and standard bloodwork, and initiated treatment with intralesional corticosteroids, oral doxycycline, and topical steroids tailored for facial and body involvement.

Despite early diagnostic confirmation of DLE on biopsy, the case quickly became more complicated. Kazemi emphasized DLE may precede or coexist with systemic lupus erythematosus (SLE), which occurs in a minority, but clinically significant, subset of individuals. He stressed the importance of ruling out systemic involvement, particularly given the increased risk of lupus nephritis and severe renal outcomes in African American populations. However, the patient did not initially complete recommended laboratory work and was inconsistent with follow-up visits and medication adherence.

When the patient’s disease worsened, Kazemi confronted what initially appeared to be noncompliance. Upon further discussion, the patient revealed unstable housing and frequent transitions between shelters, limiting his ability to maintain consistent treatment or appointments. Recognizing that the issue was not apathy but structural instability, Kazemi expanded the care team. He personally contacted the patient’s Medicaid provider to identify an in-network rheumatologist, coordinated care despite a six-month specialist wait time, initiated hydroxychloroquine therapy himself, and ultimately convened a multidisciplinary meeting with social work, rheumatology, and primary care.

Over time, with coordinated support and stabilization of the patient’s living conditions, adherence improved. Kazemi reports that the patient’s cutaneous disease is now well controlled and, importantly, that systemic lupus was ruled out.

The segment highlights a central message: dermatology is not “skin deep.” Kazemi’s account reinforces the need for clinicians to address both medical complexity and social barriers to achieve meaningful outcomes, particularly in patients with skin of color facing disproportionate health and socioeconomic challenges.

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

References

1. Kazemi A. Skin of Color Savvy: Serving the Underserved in Dermatology, With Abrahem Kazemi, MD. HCPLive. February 16, 2026. Accessed February 18, 2026. https://www.hcplive.com/view/skin-of-color-savvy-serving-underserved-dermatology-abrahem-kazemi-md.

2. Kazemi A. Daily Challenges as a Dermatologist Helping Underserved Patients. HCPLive. February 17, 2026. Accessed February 18, 2026. https://www.hcplive.com/view/daily-challenges-as-dermatologist-helping-underserved-patients.