How to Recognize and Treat Atopic Dermatitis in Patients with Skin of Color

Atopic dermatitis (AD) can present uniquely in patients with skin of color, making timely recognition and effective management more challenging for clinicians. Classic signs such as erythema or inflammation may appear muted, harder to detect, or altogether different on darker skin tones, contributing to under-diagnosis, delayed treatment, and increased risk of pigmentary changes or scarring.

In this Q&A, Vinay Mehta, MD, a board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California, discusses practical steps clinicians can take to better identify and manage AD in patients with skin of color. He highlights why traditional training materials often fall short, why dyspigmentation can be a critical clinical clue, and how simple adjustments, such as using alternative lighting or referencing more inclusive photo atlases, can sharpen diagnostic confidence.

HCPLive: How can clinicians more accurately recognize atopic dermatitis in patients with skin of color, given that erythema and inflammation may appear differently?

Mehta: One of the things I think would be helpful is to have atlas pictures. When in medical school and in residency and fellowship, we're used to seeing pictures, and I know there have been some initiatives to include more photos of patients of skin of color.

Erythema can be difficult to appreciate in patients who have darker skin, so what I typically do is I'll turn off the light. I'll use a flashlight so there's a better contrast, so I can better appreciate the erythema [and] dyspigmentation [hyperpigmentation and hypopigmentation]. These are often hallmarks of atopic dermatitis in patients of darker skin tone, which we sometimes don't recognize. [Another key distinction is] more extensor surfaces involvement.

We definitely need more training. We definitely need more examples, photos. I think that's helpful. Perhaps using social media. It's helpful to have real patients [with] skin [of] color, who have atopic dermatitis to just share their story. That will be very helpful in increasing awareness.

HCPLive: What practical steps can dermatologists take to improve diagnostic confidence and avoid underdiagnosis of atopic dermatitis in darker skin tones?

Mehta: I would like to see more studies. The more studies we have, the more information we have, the more we'll be able to appreciate some of the nuances and also see if certain molecules target better [in] this population compared to our typical white population.

HCPLive: What are the most effective strategies for building trust and improving adherence among patients of color with chronic skin conditions like atopic dermatitis?

Mehta: Listening through [stories] is very important to develop trust. Shared decision-making is also important. You really have to listen to their concerns… [to] understand their perspective, understand what is important to them.

HCPLive: Can you discuss additional barriers to treating atopic dermatitis in patients with skin of color?

Mehta: There's health disparities in terms of access, especially in the minority population, in terms of what health insurance they have, in terms of access to care, and access to specialists.

Sometimes there may also be language barriers, particularly in the immigrant population. There may be cultural barriers as well, and so I think it's important to really spend time [with the patient].

Getting that trust [is important]. Once they trust you as a health care provider, it really improves adherence, and that goes a long way. These are chronic diseases, and there's no quick fix. Some of these therapies…have to be continued long term, and so that really requires good communication and a good relationship between the patient and the provider.

HCPLive: How can clinicians address pigmentation changes, scarring, and other post-inflammatory effects that are particularly concerning for patients with skin of color?

Mehta: Unfortunately, with atopic dermatitis, we do see that. We do see the pigmentation changes, hyperpigmentation or hypopigmentation. Perhaps in this case…start patients on systemic therapy, not wait until they have the scarring. In other words, move them from topicals to a systemic therapy, whether it's the biologic or an [oral JAK inhibitor] or something else. Move them quickly to prevent some of those side effects, those pigmentary changes.

This transcript has been edited for clarity.