AbbVie recently hosted its fourth annual Science of Skin event on August 8, highlighting both personal and professional insights on managing chronic skin conditions. The goal of the annual event is to empower and educate the millions of Americans affected by skin conditions through discussions on patient control, support networks and the unique needs of patients of color.
This year’s event, “Science of Skin: Empowering Conversations to Control Chronic Skin Disease,” featured three expert-led sessions, including a session led by Chesahna Kindred, MD, MBA, FAAD, a board-certified dermatologist in practice at Kindred Hair & Skin, and Brenda Kong-Tunac, a psoriasis and psoriatic arthritis patient and advocate.
Dermatology Times recently spoke with Kindred to discuss her participation in the session titled “Amplifying Voices of Skin of Color Patients” and the important role dermatologists play in supporting patients of color.
Transcript
Chesahna Kindred, MD, MBA, FAAD: Hi, I’m Dr. Chesahna Kindred, a board-certified dermatologist at Kindred Hair & Skin Center in Maryland.
Dermatology Times: What are the unique challenges faced by patients with dark skin who suffer from psoriasis and eczema?
Relationship: Patients with dark skin and chronic skin conditions face unique challenges. Take psoriasis, for example: regardless of the severity of the disease (mild, moderate, or severe), black, Latino, or Asian patients have a greater impact on their quality of life compared to white patients. A lot of data shows that mild psoriasis impacts patients’ lives to that extent as opposed to severe psoriasis. We now know that this is not true for everyone; the data is mostly from white patients, which is great. We know their quality of life, but regardless of the severity of the disease, it has a greater impact on the quality of life of non-white patients. That’s a great example. Another level of impact is simply misdiagnosis, and we know in dermatology that different diseases can look similar: mimics, and the same disease can look different. Then there’s the added layer that it can look different in patients with melanin-rich skin as well, in addition to all the differential diagnoses that we normally do. These are just a few examples of how whether the patient has dark skin or not has a huge impact on the treatment.
Dermatology Times: What common misconceptions about psoriasis and eczema in dark skin do you encounter in your practice?
Relationship: A common misconception is that there is a cure. That may be generally true, but especially my patients, my black and Latino patients, they say, “I want a drug that will just get rid of it.” I hear that question more often in that group. Then when they know that it’s chronic, I often get questions like, “It’s their diet. What can they eat differently? Do differently to make it go away?” That’s what I hear most often from my black patients, which is that diet is the cause of every single skin condition. The other misconception, or, I don’t know if it’s a “misconception,” but the more melanin-rich the skin, the more post-inflammatory hyperpigmentation or PIH is also part of the disease. We need to educate that this is a secondary condition that we have to deal with as well. Insurance doesn’t cover that, so there’s a little bit of additional disease burden and an additional out-of-pocket burden. The misconception is that if I get rid of their psoriasis or their eczema, the skin will go back to normal. But that’s not the case. It just means that the inflammation goes away and we have to deal with the PIH later.
Dermatology Times: How can dermatologists improve their approach to diagnosing and treating patients with dark skin and chronic skin conditions?
Relationship: Because misdiagnosis is so common among dermatologists treating patients with dark skin, a helpful tip is to acknowledge with some humility that the original diagnosis may have been wrong. Don’t be so quick to label the patient as uncooperative or noncompliant. This can be tricky. Let’s say you diagnosed the patient with eczema when he actually has psoriasis, and you would expect this topical corticosteroid to help him. Let’s say he has partial improvement. It’s not necessarily because he’s not taking the medications as consistently. Maybe this patient actually needs a biologic for psoriasis, and that’s another tip: Supplement the education received if he lacks cultural competency. I’m not talking about a warm and fuzzy feeling. We recognize behaviors. I am talking about at least the basic and recognized conditions such as eczema and psoriasis in patients of black, Latino, Asian, etc. origin, at least as a complement to step 1, which is diagnosis.
Dermatology Times: What recent advances or research findings specifically address the needs of patients with dark skin?
Relationship: There have been really exciting advances in addressing the needs of patients of color. Some clinical trials almost completely excluded patients of color, particularly black patients. I’ve seen drug companies literally do a study specifically on black skin to supplement the data. I’ve also seen in feasibility studies, they ask the principal investigators, “How many patients of this particular demographic do you expect to enroll?” If it’s hidradenitis, for example, they should honestly ask the private principal investigator, “How many black people do you expect to enroll?” Because they’re carrying the burden. That’s what I’ve seen. That way, the data that comes out on treating Americans includes Americans and not just a subset. I’ve seen increasing efforts to enroll patients from backgrounds that have historically been excluded from medicine and science, which is great. I’ve seen efforts where clinical trials go where the patients are. So instead of just registering the site and trying to recruit patients, it’s bringing patients where they’re normally excluded and doing the clinical trials in doctors’ offices. I’m very hopeful that we can move in that direction and make sure that in the United States, all Americans are included in clinical trials and conversations and more.
Dermatology Times: How can dermatology providers collaborate with patients and stakeholders to improve care?
Relationship: Patient advocates are great because they bridge the gap that exists. As a dermatologist, I know how severe a disease can get, and I want to prevent the patient from becoming severely ill. The patient knows what is normal for them, and they want to get back to that. You might think that that’s consistent, that’s synergistic, but sometimes there’s a discrepancy, and patient advocates can help the patient express what’s important to them, what exactly their normal is. A good example would be if I ask the patient, “Do you have stiffness in your joints when you wake up in the morning?” because sometimes psoriasis can cause arthritis. If the patient has mild psoriatic arthritis, they might think what they’re feeling is normal and say, “Everything’s fine, everything’s OK.” The patient advocate can say, “No. Tell them, even if it’s 1 in 10, let them know that you have a little stiffness in your right ankle from time to time.” Those subtle things. Patients are very quick to say they’re OK. They’re fine. It doesn’t hurt, they’re sleeping well, etc., sometimes because that’s their new normal. I don’t know what their new normal is versus their normal normal; there’s a disconnect there. Patient advocates help patients find their voice when they’ve been silenced by other doctors. Patient advocates also help educate and dispel some of the myths that are floating around on social media or the internet. Then patient advocates honestly keep us in check from time to time because again, we can get a little too focused on the most serious part of the disease: death, infections, disability, etc., that we might miss that what was important to the patient was something that wasn’t serious in our eyes.
Dermatology Times: What else would you like to tell dermatologists?
Relationship: I think we should all work together to recruit patients who have been excluded from clinical trials. This should be a national, all-out campaign. I think if we can do that, we will all win.
(The transcript has been edited for clarity.)
