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

In the opening clip of the most recent Skin of Color Savvy episode, Shawn Kwatra, MD, and Andrew Alexis, MD, MPH, discuss the unique challenges of diagnosing and managing inflammatory skin disease 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.

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