November 25, 2025 • 25 mins
Psoriasis doesn’t look the same on every skin tone. In this episode, we break down how psoriasis appears on darker skin, lighter skin and mixed tones, why inflammation may look purple, brown or gray instead of red, and why these differences can delay diagnosis. We explore the limits of the Fitzpatrick scale, how ancestry shapes skin response, and what patients with melanin-rich skin should know about treatment, light therapy and pigment changes.
With dermatologist Dr. Mona Shariari, we explain how to recognize psoriasis on different skin tones, what symptoms to watch for, and how to advocate for accurate care. If you’ve ever wondered what psoriasis really looks like on brown or Black skin—or why your symptoms don’t match online photos—this episode brings clarity, science and practical guidance.
This episode is sponsored by Eli Lilly. We’re grateful for their support in helping us highlight the importance of accurate, inclusive dermatology education and expand conversations that improve care for every skin tone.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
This podcast is sponsored by Eli Lilly.
Dermatologists like myself, we Ireally care deeply about seeing,
respecting, and treating oldskin tones because when we
disregard it, that's when we ourpatients might end up with not
the best outcome.
I challenge you to put the worstdryasys or AD in Google and see
(00:22):
how far you have to scroll tosee any other shade other than
white bear Caucasian.
SPEAKER_01 (00:28):
I think hopefully we're seeing a movement in the
direction to be more inclusive.
And I think that's definitelyhappening within clinical trials
and dermatology to try to makesure we are looking at how
everyone reacts potentiallydifferently.
SPEAKER_02 (00:40):
And if you're on the patient side of it, you're gonna
think, you know what?
SPEAKER_00 (00:42):
That's probably not what I have because Welcome to
Dermit Trotter, Don't SwearAbout Skin Care, where host Dr.
Shannon C.
Trotter, a board-certifieddermatologist, sits down with
fellow dermatologists andskincare experts to separate
fact from fiction and simplifyskincare.
Let's get started.
SPEAKER_01 (01:02):
Welcome to the Derbitrotter Don't Swear About
Skin Care podcast.
Today we are going to tackle avery unique topic that's been
hot in the dermatologyliterature, but then also for a
lot of you listeners out there,you've been asking me questions
about skin tone and what doesthat mean for certain skin
conditions and how do you carefor your skin?
So we're going to really getinto that topic a bit more so
(01:23):
that we have a greaterunderstanding of what it means.
I have a special guest here withme today, Dr.
Mona Sharriari.
She's a board-certifieddermatologist, an associate
clinical professor ofdermatology at Yale University,
and in practice with CentralConnecticut Dermatology.
And she's an expert in psoriasisand also has a great clinical
interest in darker skin tonesand diversity of skin tones.
(01:44):
So welcome to the podcast.
SPEAKER_02 (01:46):
Well, thank you so much for having me, Shannon.
SPEAKER_01 (01:49):
Well, I know this is something that we've seen, you
know, as dermatologists sort oftaking center stage.
And I think it's been longoverdue.
But also in clinical practice, Ihave patients coming in saying,
what exactly do you mean by toneof my skin?
Or what is this whole skin tonediversity concept that's sort of
starting, especially I think,you know, for dermatologists.
So how do you explain that whensomebody asks that question?
SPEAKER_02 (02:11):
Well, it's interesting because sometimes
when that concept of skin tonecomes out, when I'm doing a skin
check, my goal is to understandwhat is your risk of skin
cancer.
And a lot of times patients aretaken aback.
But when we're talking aboutskin tone, we're really talking
about fairest porcelain to thedeepest ebony and really
everything in between.
And really thinking about thatskin tone diversity is just
(02:33):
acknowledging that thespectrum's not only vast, but
culturally, socially, and inthis case medically significant,
because that's what it comesdown to in our day-to-day
clinical practice.
But it really does help shapeindividuals' identity, certain
beauty standards, the waydiseases show up on the skin,
which is why dermatologists likemyself, we I really care deeply
(02:53):
about seeing, respecting, andtreating all skin tones and
acknowledging it.
Because I think sometimes whenwe disregard it, that's when we
our patients might end up withnot the best outcomes.
SPEAKER_01 (03:04):
Yeah, and I like that too, because you talk about
just you know more than themedical piece.
Because I think, you know, someof the folks listening,
especially dermatologists, mightbe thinking I'm just trying to
figure out how this likeinterplays medically, but it's
much more complex than that, asyou just talked about, and how
people identify and then thosekind of social and cultural
implications, which I think youknow, some of our patients are
aware of, or you know,historically, you know, they've
(03:26):
struggled with you know changesin tone, or maybe they've had a
skin condition that you knowsomebody didn't really recognize
at first because it lookeddifferent just based on their
skin tone.
And I know kind of getting intothe academic nitty-gritty, you
know, can can you talk a littlebit why do we see this
variation?
Because a lot of people arelike, you know, why do we have
this vast variety of skin tonesthat you see just in humans?
(03:47):
You know, what is there a reasonfor this?
And you know, maybe evenevolutionary.
SPEAKER_02 (03:52):
Yeah, so this is one of my favorite biology meets
anthropology stories.
So really at the root are themelanocytes, the cells that are
making that pigment in our skin.
And when they produce a lot ofpigment, we're gonna get darker
skin tones.
And then when we don't have asmuch pigment, we're gonna get
the lighter skin tones.
But really, evolution hasfine-tuned what our melanocytes
(04:12):
do.
Near the equator, where that UVradiation is intense, darker
skin developed as thatprotective armor against those
intense UVA and UVB rays.
Near the poles, the lighterpigment allowed for the
UVB-induced synthesis of vitaminD.
And if you look at in betweenthe poles, you had that gradient
with tanning really protectingindividuals against those spikes
(04:35):
in UVA, UVB.
And the way I like to think ofit is our skin is literally a
living history book of where ourancestors came from.
And it's funny because sometimeswhen I see my patients with
atopic dermatitis who have anancestry that takes them close
to the equator, well, when theysee me up in Connecticut, which
is a much higher latitude, theyend up with dry skin and all
(04:55):
these other sequelae.
And I tell the parents, you knowwhat, your child's skin was
meant to be closer to theequator.
If you take them where theirancestors were, you're probably
not gonna have this atopicdermatitis.
SPEAKER_01 (05:05):
Right.
Well, and and and I love thatyou go into that because I think
people don't understand it trulyas a function of biology and
where we all kind of originatedfrom and sort of how that
changed over time and how ourskin adapted to those changes.
I think that's just fascinating.
You know, if you just look backthe historical biological
context and then over-evolution.
And then you're right, once youput us in a different
(05:27):
environment, you know, I, youknow, have heritage kind of more
northern European.
And I always tease my husband,he is Hispanic and has Italian
ancestry.
And we always talk about how ourskin tolerates different things,
you know.
And I said, you know, I don'thave many shades of tan.
I basically get red and maybe aslight hint of color, where he
just laughs the whole timebecause he just gets this nice
golden shade and pretty dark.
(05:49):
And since he's actually moved tothe States, big variation, you
know, you can see that.
And I think that connection isreally important for people to
understand where it comes downto biology and how it may impact
skin disease.
Now, we've gotten a littletechnical, I know, on the derm
side, and we even talk about,you know, scales or Fitzpatrick
type.
And I think some of you, I waseven talking to some colleagues,
(06:09):
they're like, I don't even, I'venever even heard of the monk
skin tone.
I know these Fitzpatrick types,and I was gonna have you talk
more about them, you know, fromthe standpoint of, yeah, what
does it mean maybe on thedermatology side?
But for patients, isn't itimportant they kind of know
where they fit within sort ofthese you know parameters that
we've created as dermatologists?
SPEAKER_02 (06:26):
Yeah, exactly.
So we'll go into the Fitzpatrickskin scale in a little bit more
detail, but that that's what alot of us are used to.
And those of us who see a lot ofpatients with skin of color,
we've realized the limitationsof that scale.
And it's funny because severalyears ago, they put
international skin of colorexperts in a room to see if we
come up with a better scale thatwas more all-encompassing.
And guess what?
(06:46):
We couldn't come up withanything better than what we
currently had with FitzpatrickScale.
But the Monk scale is actually areally interesting um scale that
you mentioned.
It's relatively new.
It came out in 2023, and it's amore modern, inclusive way of
categorizing skin tones that wasmade in partnership with Google.
And actually, it wasn't designedto be used in clinical practice,
it was designed with the goal ofimproving machine learning,
(07:09):
artificial intelligence, um,rather than specifically for
skin pigmentationquantification.
And it uses 10 shades to capturethe real world diversity that we
see in skin tones.
And the way I like to thinkabout it is if you're doing a
Google search for a physician inthe year 2025, you want to see
the heterogeneity of the typesof physicians you would see in
clinical practice.
(07:29):
So now Google can actually usethis monk scale behind the
scenes to give you differenttypes of quote-unquote
physicians that you see in thatsearch.
So I think it's reallyinteresting to be able to use it
that way.
And um I think that it's alsoover time gonna help improve the
diversity that we see across alot of public images, searches.
(07:49):
Because what I find challengingwhen I see patients with skin of
color is when they're trying todiagnose their own skin
conditions, they go online andmaybe they research psoriasis,
they research atopic dermatitis.
I challenge you to put the wordpsoriasis or AD in Google and
see how far you have to scrollto see any other shade other
than white fair Caucasian.
(08:11):
And if you're on the patientside of it, you're gonna think,
you know what?
That's probably not what I havebecause my skin and my um
disease is not represented inthese photos.
And then all of this leads todelays in diagnosis,
misdiagnosis, under treatment.
So I do think the Monk Scale,even though not perfect, it does
offer us another way to be ableto better categorize the
diversity of tones that we seeevery day.
SPEAKER_01 (08:33):
It's kind of funny too, because you know, the
collaboration with Google andknowing about that, you know,
we're always teasing about thechallenges with Dr.
Google.
I think this is uh one of thetimes where there could be a
nice benefit of a collaboration.
And you're exactly right.
All patients come in that havedarker skin, they'll say, you
know, I believe you havepsoriasis, you have eczema, and
they'll say, No, I looked it up.
I looked it up.
I I don't look like that.
(08:54):
And it's true in the room, I'llhave an iPad and I will Google
images and try to find an imagethat may match their skin tone.
And it is an extreme challenge.
So the fact that this is aneffort that's being worked on to
be more representative of thedifferent skin tones and how
skin disease can present, Ithink that's fantastic.
And I have to give, you know,kind of credence a little bit to
(09:14):
Google there, right?
But this type of thing coulddefinitely be beneficial for our
patients.
SPEAKER_02 (09:24):
Absolutely.
And I actually think as aspecialty, the AAD is doing a
really nice job of improving theskin of color presence in their
databases.
I'm actually part of thephysician education committee of
the skin of color society, andwe're working with the AAD to
see if we can just increase thediverse presentations of various
common and even uncommon skindiseases within that database.
(09:45):
Because if residents are trainedon the various ways a disease
can present, then when they'rein attending, they can um
actually diagnose thoseconditions correctly, initiate
treatment more effectively.
Because the reality is just likeyou and your husband, your
children are not gonna be thatclassic fits one, um, fits four.
Everyone is now a mix, and Ilike to call it a spectrum of
(10:06):
different skin colors that we'regonna be seeing in clinical
practice.
So we do need to get better atunderstanding what um disease is
gonna look like across thespectrum of skin tones.
SPEAKER_01 (10:14):
Yeah, and the training is very important, as
you mentioned too, becausedepending upon where you train
demographically, what part ofthe country or region where your
clinic might be, who happens towalk through, your training
could be very one-sided.
So that's amazing that AD ishelping to work on that to
expose, you know, futuredermatologists to that so they
can help our patients, becauseyou never know where you might
(10:35):
land for your career.
And so your career where you'repracticing can have a very
different spectrum of skin tonesthan maybe where you even train.
So to help us all be betterprepared for that is pretty
amazing.
Now, I was gonna touch a littlebit upon that Fitzpatrick piece
that you mentioned, because Iknow we still traditionally do
use it, you know, for you know,sometimes people are looking at
for light therapy.
Maybe somebody comes in anddeciding how they're gonna
(10:57):
approach a patient and utilizingit more of a an assessment tool.
You know, I think for patientswho are like, I don't even know
who Fitzpatrick was or what aFitzpatrick type would mean.
Do you mind kind of talkingabout that, maybe the
limitations and maybe also wherethere still might be a use for
it too?
SPEAKER_02 (11:12):
Absolutely.
So um it I remember when I wasresidency, I would have a
patient that I would see comeout of the room and say, this is
a 59-year-old female withFitzpatrick skin type 2.
But when you think about theFitzpatrick skin typing scale
itself, it was a study back inthe 70s and first developed, and
it was to accurately dosephototherapy for patients that
needed UVA or UVB therapy fortheir skin disease.
(11:35):
We just wanted to make sure thatthe dose of phototherapy
wouldn't cause burning or harmto the patient, which was a very
altruistic reason for it to bedeveloped.
And interestingly, it wasactually first developed for
lighter skin tones.
So FITS 1 through 4 was whatthat initial scale included.
And then we later realized weneed to expand it to include
some of our more melanin-richpatients.
That's where FITS five and sixum were added to the mix.
(11:59):
But as somebody who sees a lotof patients with skin of color,
four, five, six is really notenough to categorize the
heterogeneity of patients that Isee in everyday clinical
practice.
But when we think of thedifferent six categories that we
have, type one is the categorythat always burns and never
tans.
Think of the person who has redhair, pale skin.
Type two is somebody who burnseasily, tans minimally.
(12:21):
Type three is someone who burnsand also sometimes burns, but
tans uniformly.
And then type four rarely burnsand tans easily.
That's where I fall in.
And then type five, they rarelyburn, they're deeply pigmented,
and type six never burns, andthey're they tend to be
profoundly pigmented.
And it's really incorrect of usto walk into a room and just
(12:42):
decide based on the color of theindividual what that Fitzpatrick
type is.
Because the way you shouldreally do it is use a
colorometer, which is just adevice that you put um on the
inner surface of the arm, whichis an area where sun isn't
present, just to get a bettergauge of what that individual's
um skin tone may be.
Now, I mentioned that I'm typefour, and that's how I
(13:03):
categorize myself based on howmy skin reacts to the sun.
But when I use the colorimeter,I actually came back as a type
three.
So it's really interesting forme as a dermatologist.
Now I'm conflicted.
Like, which category do I reallyfall into?
Um, but I think that if Dr.
Fitzpatrick knew how this scalewas being used in day-to-day
clinical practice, he'd rollover in his grave because that
(13:24):
was not the intention reallywhen we first started out.
But I do think it's something.
It gives us an idea of what isthis individual's skin tone?
Do we need to be more concernedabout the behavior when we put
them in front of phototherapy ifwe're doing laser on them?
But as I mentioned, it is farfrom ideal.
And one of the reasons why Idon't love some of our studies,
look, clinical trials that arelooking at skin of color is
(13:47):
because they gradate patientsand put them into these
categories of skin of colorbased on having, say, type four,
five, six skin.
But the reality is you could beskin of color based on your
racial and ethnic identity andmaybe have skin type two.
Now you're going to be excludedfrom a trial, even though your
body and your skin's behaviorwhen it's exposed to laser or
(14:09):
light may be a little bitdifferent than somebody who's a
true type two Caucasian person.
SPEAKER_01 (14:14):
It's very interesting to point that out
because I don't think a lot ofpeople would think of that, you
know, right off the bat, youknow, whether it be the patient
or sometimes even as theclinician, I think a lot of
times that there's a disconnectthere.
So that's a really importantthing that you highlight.
And mentioning the clinicaltrials, you know, when we have
inflammatory disease, inparticular psoriasis, I know,
which is kind of a passion ofyours, atopic dermatitis.
(14:37):
When we're thinking about, youknow, skin tone, Fitzpatrick
types, I mean, we kind of talkmore about how, you know, they
obviously impact, you know, withFitzpatrick, you know, your
risk, you know, of burning orlikelihood of tanning, you know,
looking at the skin tone betterrepresentation.
How does it all kind of get puttogether when you're looking at
just different skin conditionsand how they might actually look
(14:58):
different, or maybe even thepathophysiology have some
differences based on diversityof skin tones?
SPEAKER_02 (15:04):
Yeah, so I think the clinical presentation is
probably one of the main placeswhere having melanin to your
skin is going to differ.
Because when we think ofpsoriasis, for example, to use
your um uh previous example, wethink of erythematous plaques
with silvery scale.
And when you look up erythema,you're thinking red and pink.
Those are the colors that we'reused to.
You Google it, that's what yousee.
(15:25):
But when we're dealing withmelanin-rich skin, even someone
who has type four skin, you uharen't necessarily seeing those
shades of red.
It might be dark brown, it mightbe violet, it might even be
gray.
And that's where it's reallyimportant for us to understand
that the erythema doesn't alwayslook that classic red or pink
that we're used to in atextbook.
And the reason why it'simportant to identify this, one
(15:47):
is you want to identify thedisease correctly, but two,
erythema is also used to assessdisease severity in plaxoriasis.
So if you're not seeing thosehigh levels of erythema, you may
now underassess and thenunder-treat somebody's um
condition.
So it's really important for usto really broaden our color
palette when we're examiningpatients with melanin-rich skin
with the darker skin tones.
(16:07):
Now, the Fitzpatrick skin typecomes into play when I'm doing
phototherapy for my patientswith um darker skin tone,
because some patients may notwant a systemic agent, topicals
may not be sufficient.
And I do indicate theFitzpatrick type, but because
phototherapy really wasn'tstudied in patients with, say,
type five and type six skin,we're at a loss as to what is
that perfect dose, what is theperfect time underneath the
(16:30):
light to get a desired effect.
So it's not a perfect model.
That's all I can say.
SPEAKER_01 (16:36):
No, and that and that's really good because I
think for patients, they mighthave an assumption too, oh, this
has been looked at andthoroughly studied.
And even as the dermatologist, Ithink historically going back,
you look at those demographicsand makeups of our clinical
trials, and there obviously isan imbalance there where we
don't often have, you know,patients with diverse skin tones
included, and you know, tryingto make a that translation into
(16:58):
the real world that, oh, it'sdefinitely going to work the
same, we're gonna have the sameoutcomes really isn't fair.
And it sort of puts it back, Ithink, on the dermatologist like
yourself.
You're trying to figure outbased on your clinical
experience and what you'reestimating without those studies
to back you up on what mightactually be beneficial for the
patient.
So I think hopefully we'reseeing a movement in the
direction to be more inclusive.
(17:19):
And I think that's definitelyhappening within clinical trials
and dermatology to try to makesure we are looking at how
everyone reacts potentiallydifferently based on their skin
tone.
And you know, back in the daytoo, you know, they would talk
about how they studiedcardiovascular disease or heart
attacks in women versus men.
A lot of these studies weredone, you know, just if you look
at gender and Caucasian men, andthey found over time, well,
women present differently nowtoo.
(17:40):
They may not have the classic,you know, radiating pain and on
the left side or elephantpressure on the chest and all
the things that we've learned.
I think we're becoming just moreeducated in how you know people
are very different and how wepresent with certain things.
And it's important to understandthat so we can recognize it,
obviously, and then treat itmore effectively as well, and
making patients aware of thattoo, and making them feel more
(18:01):
included in the process.
SPEAKER_02 (18:03):
Yeah, it's so interesting you mentioned women
and the differences becauseactually it wasn't until the 90s
that women were included inclinical trials.
Before that, the assumption wasthat women are just like men,
but with different sex workers.
And I think it was an aha momentwhen we realized actually, like
you said, there are differentdiseases that present
differently, different therapiesthat can um be a little bit more
(18:25):
challenging in one gender versusanother.
But to your point, I thinkthat's where the skin of color
piece becomes very relevant inour clinical trial design
because our trials are supposedto be a small population that
represent the larger group.
So we can take the results fromthat small group and apply it to
everyday clinical practice.
But if you have one group that'sbeing overrepresented and one
group that's beingunderrepresented, not only are
(18:46):
you not able to get veryaccurate results on the efficacy
and safety of a therapeutic, butalso you don't understand what
are other barriers to a skin ofcolor patient getting the care
they need.
Because many of our patients'mistrust in the healthcare
system is huge.
If I'm giving my Caucasianpatient an injectable as an
option versus my skin of colorpatient an injectable as an
(19:07):
option, it's a very differentconversation because patients
who um who are used to hearingabout being practiced on and
being used as mice, so to speak,in different trials back in the
day.
Like we did not do a good jobwith our skin of color patients,
say 50, 60 years ago.
And that's why a lot of ourrules and regulations for
patient protection were createdfor clinical trials.
(19:28):
But that inherent distrust inthe medical system is there.
Cultural confidence.
Like when you go into a room,somebody from a certain racial
and ethnic background, you haveto deal with that individual's
preferences and theirpreconceived notions a little
bit differently than somebodywho may come from the same
background as you.
And I always say what you thinkyou know about someone and that
individual's background may notapply to the person sitting in
(19:51):
front of you.
So again, I always check mynotions at the door and try to
walk in the room with a cleanslate because those are all the
ways that we can ensure we'redelivering that more inclusive
care to our patients beyond justtherapy selection.
SPEAKER_01 (20:03):
And that's that's great advice because I think
people do we all have our ownassumptions, inherent biases and
experience clinically that canreally influence how we practice
or approach a patient.
And you're right, leaving thatat the door and just trying to
look at the person and theircondition and have them help
educate us and walk through, youknow, what's important to them,
their values, and then trying toget a better understanding that
(20:24):
definitely important to buildthat relationship.
And as you said, I think we'llresult, you know, in better
treatment and trust for thatpatient if we build that rapport
and kind of walk in their shoes,so to say, you know, so to say,
although we can't, you know,really walk in everyone's shoes,
everyone has differentexperiences, but to be more
aware of that and really striveto do better, I think is so
important.
And especially when we'retreating patients, you know, in
skin and the very thing that wedeal with and seeing all these
(20:47):
variations in skin tone as well.
And I know we talked a littlebit about presentation.
I was gonna comment a little bitabout, because I think people
just assume, oh, it might lookdifferent.
In the last few minutes, we havecan you talk a little bit about
what data might be showing orresearch showing that actually
there's some physiologicaldifferences, potentially
psoriasis or atopic dermatitisthat we might see in various
(21:07):
skin tones as well.
SPEAKER_02 (21:09):
Yeah, actually, um there's a lot of data um on the
horizon.
We uh one of the studies thatwas done by uh Johnson and
Johnson, looking specifically atpatients with skin of color who
were being treated for theirplaxoriasis with gazelchumab,
aka trymphya, did find somebiomarker differences in our
patients in terms of how theirbody responded to therapy, some
of the comorbidities that theydealt with.
(21:31):
But we actually have more data,I would say, on the atopic
dermatitis side, because we areseeing differences in terms of
just the genetic makeup.
We always think of phylagrineloss of function mutations being
the common thing in AD, but it'scommon in Caucasians.
When you look actually atAfrican Americans, we see
uncommon phagrine variants thatare gonna be linked to more
(21:52):
persistent symptoms.
Also, transepidermal water lossis more of an issue in our
patients with skin of color thanour Caucasian patients.
This is why picking the rightmoisturizer in somebody with
melanin-rich skin is gonna be avery different conversation than
someone who has Caucasian skin.
And a lot of people, if you'retelling them, you know what,
that moisturizer that's yourmother and your grandmother and
great grandmother youth is notgonna be okay for your skin,
(22:15):
it's a tough belt to swallow.
So again, that culturalcompetence when you're having
those conversations is gonna bevery key.
And there's differentpresentations when it comes to
AD, whether you're looking atthe morphological presentations
with numbular eczema or extensorsurface involvement, scalp
involvement, um, all of thosebeing uh different in
individuals with skin of color.
(22:36):
So there are a lot of uh geneticas well as just clinical
endotypic and phenotypicpresentations that differ in our
patients with skin of colorversus our patients who are from
Caucasian backgrounds.
And being aware of that can helpus better diagnose.
And I tend to biopsy my skin ofcolor patients more because they
don't read the textbook.
And I want to ensure I know whatI'm treating before I start on a
(22:58):
therapeutic journey.
SPEAKER_01 (23:00):
I would totally agree with you.
I feel like I do biopsy morebecause definitely there's
presentations that and theheterogeneity that exists out
there.
And especially I would say,although I know for time today
we won't talk about it for skincancer, which is a whole nother,
you know, topic in our patientswith diverse skin tones as well,
because I do feel like oftenit's missed or underdiagnosed,
or there's also perceptions,both I think on the
(23:21):
dermatologist or clinician sideas well as sometimes even on the
patient side that with darkerskin types, I'm not as
susceptible to have skin canceras well.
And we could talk about kind ofthe differences there.
I know for time we don't haveit, but I think that's really
important that people approach,you know, the individual
patient, look at it, and ifwe're suspicious of something,
that we treat it like anythingelse, you know, regardless of
kind of how the patient comesin.
(23:43):
But keeping in mind with variousskin tones, things can look
quite differently, as youmentioned.
Well, I want to thank you somuch for coming on the podcast
today.
This is a topic that I know alot of our listeners are asking
questions about andunderstanding just, you know, is
there really science behind thisand why do we see this vast
array of skin tones and theimplications it has for
dermatology, diagnosis of skinconditions, treatment
(24:04):
potentially as well.
And your insights are veryhelpful, I think, to kind of
provide a clearer picture on howwe can actually move forward to
include this, you know, as thedermatologist, but also on the
patient to understand how theirskin might behave differently as
well.
SPEAKER_02 (24:19):
Yeah, no, thank you so much for having me.
I just one last thought I wantto leave our audience with is
it's really the skin is the mostvisible organ.
That's why I think there's a lotof psychological impact when
someone has skin disease,because you can see it.
But the benefit is when thingsget better, you can also see it.
And it's really where medicinemeets identity.
So for our patients,understanding diversity means
being seen, both literally andfiguratively.
(24:40):
So as clinicians, it's reallyour job to ensure we are taking
care of the whole patient, notjust having tunnel vision to one
disease process, so it canreally optimize outcomes.
SPEAKER_01 (24:50):
I love that.
That perfectly said, perfectlysaid, and a great way to end our
conversation today.
Well, thanks again for coming onthe podcast.
You know, for our listeners outthere, if they want to find out
more about you, how can theylocate you?
SPEAKER_02 (25:02):
So they can follow me on Instagram, Persian Skin
Doc, and um LinkedIn as well, aswell as um just taking a look at
my profile on my practice page,centralctderm.com.
And thank you so much, Shannon,for having me.
I had a great time.
SPEAKER_01 (25:16):
Well, it was a it was a pleasure, Mona.
We'll have to do it againsometime.
And thank you all for listeningand stay tuned for the next
episode of Dermot Trotter.
Don't swear about skincare.
SPEAKER_00 (25:28):
Thanks for listening to Dermot Trotter.
For more about skincare, visitdermittrotter.com.
Don't forget to subscribe, leavea review, and share this podcast
with anyone who needs a littleskincare sanity.
Until next time, stay skinsmart.
This podcast is sponsored by Eli Lilly.
Dermatologists like myself, we Ireally care deeply about seeing,
respecting, and treating oldskin tones because when we
disregard it, that's when we ourpatients might end up with not
the best outcome.
I challenge you to put the worstdryasys or AD in Google and see
(00:22):
how far you have to scroll tosee any other shade other than
white bear Caucasian.
SPEAKER_01 (00:28):
I think hopefully we're seeing a movement in the
direction to be more inclusive.
And I think that's definitelyhappening within clinical trials
and dermatology to try to makesure we are looking at how
everyone reacts potentiallydifferently.
SPEAKER_02 (00:40):
And if you're on the patient side of it, you're gonna
think, you know what?
SPEAKER_00 (00:42):
That's probably not what I have because Welcome to
Dermit Trotter, Don't SwearAbout Skin Care, where host Dr.
Shannon C.
Trotter, a board-certifieddermatologist, sits down with
fellow dermatologists andskincare experts to separate
fact from fiction and simplifyskincare.
Let's get started.
SPEAKER_01 (01:02):
Welcome to the Derbitrotter Don't Swear About
Skin Care podcast.
Today we are going to tackle avery unique topic that's been
hot in the dermatologyliterature, but then also for a
lot of you listeners out there,you've been asking me questions
about skin tone and what doesthat mean for certain skin
conditions and how do you carefor your skin?
So we're going to really getinto that topic a bit more so
(01:23):
that we have a greaterunderstanding of what it means.
I have a special guest here withme today, Dr.
Mona Sharriari.
She's a board-certifieddermatologist, an associate
clinical professor ofdermatology at Yale University,
and in practice with CentralConnecticut Dermatology.
And she's an expert in psoriasisand also has a great clinical
interest in darker skin tonesand diversity of skin tones.
(01:44):
So welcome to the podcast.
SPEAKER_02 (01:46):
Well, thank you so much for having me, Shannon.
SPEAKER_01 (01:49):
Well, I know this is something that we've seen, you
know, as dermatologists sort oftaking center stage.
And I think it's been longoverdue.
But also in clinical practice, Ihave patients coming in saying,
what exactly do you mean by toneof my skin?
Or what is this whole skin tonediversity concept that's sort of
starting, especially I think,you know, for dermatologists.
So how do you explain that whensomebody asks that question?
SPEAKER_02 (02:11):
Well, it's interesting because sometimes
when that concept of skin tonecomes out, when I'm doing a skin
check, my goal is to understandwhat is your risk of skin
cancer.
And a lot of times patients aretaken aback.
But when we're talking aboutskin tone, we're really talking
about fairest porcelain to thedeepest ebony and really
everything in between.
And really thinking about thatskin tone diversity is just
(02:33):
acknowledging that thespectrum's not only vast, but
culturally, socially, and inthis case medically significant,
because that's what it comesdown to in our day-to-day
clinical practice.
But it really does help shapeindividuals' identity, certain
beauty standards, the waydiseases show up on the skin,
which is why dermatologists likemyself, we I really care deeply
(02:53):
about seeing, respecting, andtreating all skin tones and
acknowledging it.
Because I think sometimes whenwe disregard it, that's when we
our patients might end up withnot the best outcomes.
SPEAKER_01 (03:04):
Yeah, and I like that too, because you talk about
just you know more than themedical piece.
Because I think, you know, someof the folks listening,
especially dermatologists, mightbe thinking I'm just trying to
figure out how this likeinterplays medically, but it's
much more complex than that, asyou just talked about, and how
people identify and then thosekind of social and cultural
implications, which I think youknow, some of our patients are
aware of, or you know,historically, you know, they've
(03:26):
struggled with you know changesin tone, or maybe they've had a
skin condition that you knowsomebody didn't really recognize
at first because it lookeddifferent just based on their
skin tone.
And I know kind of getting intothe academic nitty-gritty, you
know, can can you talk a littlebit why do we see this
variation?
Because a lot of people arelike, you know, why do we have
this vast variety of skin tonesthat you see just in humans?
(03:47):
You know, what is there a reasonfor this?
And you know, maybe evenevolutionary.
SPEAKER_02 (03:52):
Yeah, so this is one of my favorite biology meets
anthropology stories.
So really at the root are themelanocytes, the cells that are
making that pigment in our skin.
And when they produce a lot ofpigment, we're gonna get darker
skin tones.
And then when we don't have asmuch pigment, we're gonna get
the lighter skin tones.
But really, evolution hasfine-tuned what our melanocytes
(04:12):
do.
Near the equator, where that UVradiation is intense, darker
skin developed as thatprotective armor against those
intense UVA and UVB rays.
Near the poles, the lighterpigment allowed for the
UVB-induced synthesis of vitaminD.
And if you look at in betweenthe poles, you had that gradient
with tanning really protectingindividuals against those spikes
(04:35):
in UVA, UVB.
And the way I like to think ofit is our skin is literally a
living history book of where ourancestors came from.
And it's funny because sometimeswhen I see my patients with
atopic dermatitis who have anancestry that takes them close
to the equator, well, when theysee me up in Connecticut, which
is a much higher latitude, theyend up with dry skin and all
(04:55):
these other sequelae.
And I tell the parents, you knowwhat, your child's skin was
meant to be closer to theequator.
If you take them where theirancestors were, you're probably
not gonna have this atopicdermatitis.
SPEAKER_01 (05:05):
Right.
Well, and and and I love thatyou go into that because I think
people don't understand it trulyas a function of biology and
where we all kind of originatedfrom and sort of how that
changed over time and how ourskin adapted to those changes.
I think that's just fascinating.
You know, if you just look backthe historical biological
context and then over-evolution.
And then you're right, once youput us in a different
(05:27):
environment, you know, I, youknow, have heritage kind of more
northern European.
And I always tease my husband,he is Hispanic and has Italian
ancestry.
And we always talk about how ourskin tolerates different things,
you know.
And I said, you know, I don'thave many shades of tan.
I basically get red and maybe aslight hint of color, where he
just laughs the whole timebecause he just gets this nice
golden shade and pretty dark.
(05:49):
And since he's actually moved tothe States, big variation, you
know, you can see that.
And I think that connection isreally important for people to
understand where it comes downto biology and how it may impact
skin disease.
Now, we've gotten a littletechnical, I know, on the derm
side, and we even talk about,you know, scales or Fitzpatrick
type.
And I think some of you, I waseven talking to some colleagues,
(06:09):
they're like, I don't even, I'venever even heard of the monk
skin tone.
I know these Fitzpatrick types,and I was gonna have you talk
more about them, you know, fromthe standpoint of, yeah, what
does it mean maybe on thedermatology side?
But for patients, isn't itimportant they kind of know
where they fit within sort ofthese you know parameters that
we've created as dermatologists?
SPEAKER_02 (06:26):
Yeah, exactly.
So we'll go into the Fitzpatrickskin scale in a little bit more
detail, but that that's what alot of us are used to.
And those of us who see a lot ofpatients with skin of color,
we've realized the limitationsof that scale.
And it's funny because severalyears ago, they put
international skin of colorexperts in a room to see if we
come up with a better scale thatwas more all-encompassing.
And guess what?
(06:46):
We couldn't come up withanything better than what we
currently had with FitzpatrickScale.
But the Monk scale is actually areally interesting um scale that
you mentioned.
It's relatively new.
It came out in 2023, and it's amore modern, inclusive way of
categorizing skin tones that wasmade in partnership with Google.
And actually, it wasn't designedto be used in clinical practice,
it was designed with the goal ofimproving machine learning,
(07:09):
artificial intelligence, um,rather than specifically for
skin pigmentationquantification.
And it uses 10 shades to capturethe real world diversity that we
see in skin tones.
And the way I like to thinkabout it is if you're doing a
Google search for a physician inthe year 2025, you want to see
the heterogeneity of the typesof physicians you would see in
clinical practice.
(07:29):
So now Google can actually usethis monk scale behind the
scenes to give you differenttypes of quote-unquote
physicians that you see in thatsearch.
So I think it's reallyinteresting to be able to use it
that way.
And um I think that it's alsoover time gonna help improve the
diversity that we see across alot of public images, searches.
(07:49):
Because what I find challengingwhen I see patients with skin of
color is when they're trying todiagnose their own skin
conditions, they go online andmaybe they research psoriasis,
they research atopic dermatitis.
I challenge you to put the wordpsoriasis or AD in Google and
see how far you have to scrollto see any other shade other
than white fair Caucasian.
(08:11):
And if you're on the patientside of it, you're gonna think,
you know what?
That's probably not what I havebecause my skin and my um
disease is not represented inthese photos.
And then all of this leads todelays in diagnosis,
misdiagnosis, under treatment.
So I do think the Monk Scale,even though not perfect, it does
offer us another way to be ableto better categorize the
diversity of tones that we seeevery day.
SPEAKER_01 (08:33):
It's kind of funny too, because you know, the
collaboration with Google andknowing about that, you know,
we're always teasing about thechallenges with Dr.
Google.
I think this is uh one of thetimes where there could be a
nice benefit of a collaboration.
And you're exactly right.
All patients come in that havedarker skin, they'll say, you
know, I believe you havepsoriasis, you have eczema, and
they'll say, No, I looked it up.
I looked it up.
I I don't look like that.
(08:54):
And it's true in the room, I'llhave an iPad and I will Google
images and try to find an imagethat may match their skin tone.
And it is an extreme challenge.
So the fact that this is aneffort that's being worked on to
be more representative of thedifferent skin tones and how
skin disease can present, Ithink that's fantastic.
And I have to give, you know,kind of credence a little bit to
(09:14):
Google there, right?
But this type of thing coulddefinitely be beneficial for our
patients.
SPEAKER_02 (09:24):
Absolutely.
And I actually think as aspecialty, the AAD is doing a
really nice job of improving theskin of color presence in their
databases.
I'm actually part of thephysician education committee of
the skin of color society, andwe're working with the AAD to
see if we can just increase thediverse presentations of various
common and even uncommon skindiseases within that database.
(09:45):
Because if residents are trainedon the various ways a disease
can present, then when they'rein attending, they can um
actually diagnose thoseconditions correctly, initiate
treatment more effectively.
Because the reality is just likeyou and your husband, your
children are not gonna be thatclassic fits one, um, fits four.
Everyone is now a mix, and Ilike to call it a spectrum of
(10:06):
different skin colors that we'regonna be seeing in clinical
practice.
So we do need to get better atunderstanding what um disease is
gonna look like across thespectrum of skin tones.
SPEAKER_01 (10:14):
Yeah, and the training is very important, as
you mentioned too, becausedepending upon where you train
demographically, what part ofthe country or region where your
clinic might be, who happens towalk through, your training
could be very one-sided.
So that's amazing that AD ishelping to work on that to
expose, you know, futuredermatologists to that so they
can help our patients, becauseyou never know where you might
(10:35):
land for your career.
And so your career where you'repracticing can have a very
different spectrum of skin tonesthan maybe where you even train.
So to help us all be betterprepared for that is pretty
amazing.
Now, I was gonna touch a littlebit upon that Fitzpatrick piece
that you mentioned, because Iknow we still traditionally do
use it, you know, for you know,sometimes people are looking at
for light therapy.
Maybe somebody comes in anddeciding how they're gonna
(10:57):
approach a patient and utilizingit more of a an assessment tool.
You know, I think for patientswho are like, I don't even know
who Fitzpatrick was or what aFitzpatrick type would mean.
Do you mind kind of talkingabout that, maybe the
limitations and maybe also wherethere still might be a use for
it too?
SPEAKER_02 (11:12):
Absolutely.
So um it I remember when I wasresidency, I would have a
patient that I would see comeout of the room and say, this is
a 59-year-old female withFitzpatrick skin type 2.
But when you think about theFitzpatrick skin typing scale
itself, it was a study back inthe 70s and first developed, and
it was to accurately dosephototherapy for patients that
needed UVA or UVB therapy fortheir skin disease.
(11:35):
We just wanted to make sure thatthe dose of phototherapy
wouldn't cause burning or harmto the patient, which was a very
altruistic reason for it to bedeveloped.
And interestingly, it wasactually first developed for
lighter skin tones.
So FITS 1 through 4 was whatthat initial scale included.
And then we later realized weneed to expand it to include
some of our more melanin-richpatients.
That's where FITS five and sixum were added to the mix.
(11:59):
But as somebody who sees a lotof patients with skin of color,
four, five, six is really notenough to categorize the
heterogeneity of patients that Isee in everyday clinical
practice.
But when we think of thedifferent six categories that we
have, type one is the categorythat always burns and never
tans.
Think of the person who has redhair, pale skin.
Type two is somebody who burnseasily, tans minimally.
(12:21):
Type three is someone who burnsand also sometimes burns, but
tans uniformly.
And then type four rarely burnsand tans easily.
That's where I fall in.
And then type five, they rarelyburn, they're deeply pigmented,
and type six never burns, andthey're they tend to be
profoundly pigmented.
And it's really incorrect of usto walk into a room and just
(12:42):
decide based on the color of theindividual what that Fitzpatrick
type is.
Because the way you shouldreally do it is use a
colorometer, which is just adevice that you put um on the
inner surface of the arm, whichis an area where sun isn't
present, just to get a bettergauge of what that individual's
um skin tone may be.
Now, I mentioned that I'm typefour, and that's how I
(13:03):
categorize myself based on howmy skin reacts to the sun.
But when I use the colorimeter,I actually came back as a type
three.
So it's really interesting forme as a dermatologist.
Now I'm conflicted.
Like, which category do I reallyfall into?
Um, but I think that if Dr.
Fitzpatrick knew how this scalewas being used in day-to-day
clinical practice, he'd rollover in his grave because that
(13:24):
was not the intention reallywhen we first started out.
But I do think it's something.
It gives us an idea of what isthis individual's skin tone?
Do we need to be more concernedabout the behavior when we put
them in front of phototherapy ifwe're doing laser on them?
But as I mentioned, it is farfrom ideal.
And one of the reasons why Idon't love some of our studies,
look, clinical trials that arelooking at skin of color is
(13:47):
because they gradate patientsand put them into these
categories of skin of colorbased on having, say, type four,
five, six skin.
But the reality is you could beskin of color based on your
racial and ethnic identity andmaybe have skin type two.
Now you're going to be excludedfrom a trial, even though your
body and your skin's behaviorwhen it's exposed to laser or
(14:09):
light may be a little bitdifferent than somebody who's a
true type two Caucasian person.
SPEAKER_01 (14:14):
It's very interesting to point that out
because I don't think a lot ofpeople would think of that, you
know, right off the bat, youknow, whether it be the patient
or sometimes even as theclinician, I think a lot of
times that there's a disconnectthere.
So that's a really importantthing that you highlight.
And mentioning the clinicaltrials, you know, when we have
inflammatory disease, inparticular psoriasis, I know,
which is kind of a passion ofyours, atopic dermatitis.
(14:37):
When we're thinking about, youknow, skin tone, Fitzpatrick
types, I mean, we kind of talkmore about how, you know, they
obviously impact, you know, withFitzpatrick, you know, your
risk, you know, of burning orlikelihood of tanning, you know,
looking at the skin tone betterrepresentation.
How does it all kind of get puttogether when you're looking at
just different skin conditionsand how they might actually look
(14:58):
different, or maybe even thepathophysiology have some
differences based on diversityof skin tones?
SPEAKER_02 (15:04):
Yeah, so I think the clinical presentation is
probably one of the main placeswhere having melanin to your
skin is going to differ.
Because when we think ofpsoriasis, for example, to use
your um uh previous example, wethink of erythematous plaques
with silvery scale.
And when you look up erythema,you're thinking red and pink.
Those are the colors that we'reused to.
You Google it, that's what yousee.
(15:25):
But when we're dealing withmelanin-rich skin, even someone
who has type four skin, you uharen't necessarily seeing those
shades of red.
It might be dark brown, it mightbe violet, it might even be
gray.
And that's where it's reallyimportant for us to understand
that the erythema doesn't alwayslook that classic red or pink
that we're used to in atextbook.
And the reason why it'simportant to identify this, one
(15:47):
is you want to identify thedisease correctly, but two,
erythema is also used to assessdisease severity in plaxoriasis.
So if you're not seeing thosehigh levels of erythema, you may
now underassess and thenunder-treat somebody's um
condition.
So it's really important for usto really broaden our color
palette when we're examiningpatients with melanin-rich skin
with the darker skin tones.
(16:07):
Now, the Fitzpatrick skin typecomes into play when I'm doing
phototherapy for my patientswith um darker skin tone,
because some patients may notwant a systemic agent, topicals
may not be sufficient.
And I do indicate theFitzpatrick type, but because
phototherapy really wasn'tstudied in patients with, say,
type five and type six skin,we're at a loss as to what is
that perfect dose, what is theperfect time underneath the
(16:30):
light to get a desired effect.
So it's not a perfect model.
That's all I can say.
SPEAKER_01 (16:36):
No, and that and that's really good because I
think for patients, they mighthave an assumption too, oh, this
has been looked at andthoroughly studied.
And even as the dermatologist, Ithink historically going back,
you look at those demographicsand makeups of our clinical
trials, and there obviously isan imbalance there where we
don't often have, you know,patients with diverse skin tones
included, and you know, tryingto make a that translation into
(16:58):
the real world that, oh, it'sdefinitely going to work the
same, we're gonna have the sameoutcomes really isn't fair.
And it sort of puts it back, Ithink, on the dermatologist like
yourself.
You're trying to figure outbased on your clinical
experience and what you'reestimating without those studies
to back you up on what mightactually be beneficial for the
patient.
So I think hopefully we'reseeing a movement in the
direction to be more inclusive.
(17:19):
And I think that's definitelyhappening within clinical trials
and dermatology to try to makesure we are looking at how
everyone reacts potentiallydifferently based on their skin
tone.
And you know, back in the daytoo, you know, they would talk
about how they studiedcardiovascular disease or heart
attacks in women versus men.
A lot of these studies weredone, you know, just if you look
at gender and Caucasian men, andthey found over time, well,
women present differently nowtoo.
(17:40):
They may not have the classic,you know, radiating pain and on
the left side or elephantpressure on the chest and all
the things that we've learned.
I think we're becoming just moreeducated in how you know people
are very different and how wepresent with certain things.
And it's important to understandthat so we can recognize it,
obviously, and then treat itmore effectively as well, and
making patients aware of thattoo, and making them feel more
(18:01):
included in the process.
SPEAKER_02 (18:03):
Yeah, it's so interesting you mentioned women
and the differences becauseactually it wasn't until the 90s
that women were included inclinical trials.
Before that, the assumption wasthat women are just like men,
but with different sex workers.
And I think it was an aha momentwhen we realized actually, like
you said, there are differentdiseases that present
differently, different therapiesthat can um be a little bit more
(18:25):
challenging in one gender versusanother.
But to your point, I thinkthat's where the skin of color
piece becomes very relevant inour clinical trial design
because our trials are supposedto be a small population that
represent the larger group.
So we can take the results fromthat small group and apply it to
everyday clinical practice.
But if you have one group that'sbeing overrepresented and one
group that's beingunderrepresented, not only are
(18:46):
you not able to get veryaccurate results on the efficacy
and safety of a therapeutic, butalso you don't understand what
are other barriers to a skin ofcolor patient getting the care
they need.
Because many of our patients'mistrust in the healthcare
system is huge.
If I'm giving my Caucasianpatient an injectable as an
option versus my skin of colorpatient an injectable as an
(19:07):
option, it's a very differentconversation because patients
who um who are used to hearingabout being practiced on and
being used as mice, so to speak,in different trials back in the
day.
Like we did not do a good jobwith our skin of color patients,
say 50, 60 years ago.
And that's why a lot of ourrules and regulations for
patient protection were createdfor clinical trials.
(19:28):
But that inherent distrust inthe medical system is there.
Cultural confidence.
Like when you go into a room,somebody from a certain racial
and ethnic background, you haveto deal with that individual's
preferences and theirpreconceived notions a little
bit differently than somebodywho may come from the same
background as you.
And I always say what you thinkyou know about someone and that
individual's background may notapply to the person sitting in
(19:51):
front of you.
So again, I always check mynotions at the door and try to
walk in the room with a cleanslate because those are all the
ways that we can ensure we'redelivering that more inclusive
care to our patients beyond justtherapy selection.
SPEAKER_01 (20:03):
And that's that's great advice because I think
people do we all have our ownassumptions, inherent biases and
experience clinically that canreally influence how we practice
or approach a patient.
And you're right, leaving thatat the door and just trying to
look at the person and theircondition and have them help
educate us and walk through, youknow, what's important to them,
their values, and then trying toget a better understanding that
(20:24):
definitely important to buildthat relationship.
And as you said, I think we'llresult, you know, in better
treatment and trust for thatpatient if we build that rapport
and kind of walk in their shoes,so to say, you know, so to say,
although we can't, you know,really walk in everyone's shoes,
everyone has differentexperiences, but to be more
aware of that and really striveto do better, I think is so
important.
And especially when we'retreating patients, you know, in
skin and the very thing that wedeal with and seeing all these
(20:47):
variations in skin tone as well.
And I know we talked a littlebit about presentation.
I was gonna comment a little bitabout, because I think people
just assume, oh, it might lookdifferent.
In the last few minutes, we havecan you talk a little bit about
what data might be showing orresearch showing that actually
there's some physiologicaldifferences, potentially
psoriasis or atopic dermatitisthat we might see in various
(21:07):
skin tones as well.
SPEAKER_02 (21:09):
Yeah, actually, um there's a lot of data um on the
horizon.
We uh one of the studies thatwas done by uh Johnson and
Johnson, looking specifically atpatients with skin of color who
were being treated for theirplaxoriasis with gazelchumab,
aka trymphya, did find somebiomarker differences in our
patients in terms of how theirbody responded to therapy, some
of the comorbidities that theydealt with.
(21:31):
But we actually have more data,I would say, on the atopic
dermatitis side, because we areseeing differences in terms of
just the genetic makeup.
We always think of phylagrineloss of function mutations being
the common thing in AD, but it'scommon in Caucasians.
When you look actually atAfrican Americans, we see
uncommon phagrine variants thatare gonna be linked to more
(21:52):
persistent symptoms.
Also, transepidermal water lossis more of an issue in our
patients with skin of color thanour Caucasian patients.
This is why picking the rightmoisturizer in somebody with
melanin-rich skin is gonna be avery different conversation than
someone who has Caucasian skin.
And a lot of people, if you'retelling them, you know what,
that moisturizer that's yourmother and your grandmother and
great grandmother youth is notgonna be okay for your skin,
(22:15):
it's a tough belt to swallow.
So again, that culturalcompetence when you're having
those conversations is gonna bevery key.
And there's differentpresentations when it comes to
AD, whether you're looking atthe morphological presentations
with numbular eczema or extensorsurface involvement, scalp
involvement, um, all of thosebeing uh different in
individuals with skin of color.
(22:36):
So there are a lot of uh geneticas well as just clinical
endotypic and phenotypicpresentations that differ in our
patients with skin of colorversus our patients who are from
Caucasian backgrounds.
And being aware of that can helpus better diagnose.
And I tend to biopsy my skin ofcolor patients more because they
don't read the textbook.
And I want to ensure I know whatI'm treating before I start on a
(22:58):
therapeutic journey.
SPEAKER_01 (23:00):
I would totally agree with you.
I feel like I do biopsy morebecause definitely there's
presentations that and theheterogeneity that exists out
there.
And especially I would say,although I know for time today
we won't talk about it for skincancer, which is a whole nother,
you know, topic in our patientswith diverse skin tones as well,
because I do feel like oftenit's missed or underdiagnosed,
or there's also perceptions,both I think on the
(23:21):
dermatologist or clinician sideas well as sometimes even on the
patient side that with darkerskin types, I'm not as
susceptible to have skin canceras well.
And we could talk about kind ofthe differences there.
I know for time we don't haveit, but I think that's really
important that people approach,you know, the individual
patient, look at it, and ifwe're suspicious of something,
that we treat it like anythingelse, you know, regardless of
kind of how the patient comesin.
(23:43):
But keeping in mind with variousskin tones, things can look
quite differently, as youmentioned.
Well, I want to thank you somuch for coming on the podcast
today.
This is a topic that I know alot of our listeners are asking
questions about andunderstanding just, you know, is
there really science behind thisand why do we see this vast
array of skin tones and theimplications it has for
dermatology, diagnosis of skinconditions, treatment
(24:04):
potentially as well.
And your insights are veryhelpful, I think, to kind of
provide a clearer picture on howwe can actually move forward to
include this, you know, as thedermatologist, but also on the
patient to understand how theirskin might behave differently as
well.
SPEAKER_02 (24:19):
Yeah, no, thank you so much for having me.
I just one last thought I wantto leave our audience with is
it's really the skin is the mostvisible organ.
That's why I think there's a lotof psychological impact when
someone has skin disease,because you can see it.
But the benefit is when thingsget better, you can also see it.
And it's really where medicinemeets identity.
So for our patients,understanding diversity means
being seen, both literally andfiguratively.
(24:40):
So as clinicians, it's reallyour job to ensure we are taking
care of the whole patient, notjust having tunnel vision to one
disease process, so it canreally optimize outcomes.
SPEAKER_01 (24:50):
I love that.
That perfectly said, perfectlysaid, and a great way to end our
conversation today.
Well, thanks again for coming onthe podcast.
You know, for our listeners outthere, if they want to find out
more about you, how can theylocate you?
SPEAKER_02 (25:02):
So they can follow me on Instagram, Persian Skin
Doc, and um LinkedIn as well, aswell as um just taking a look at
my profile on my practice page,centralctderm.com.
And thank you so much, Shannon,for having me.
I had a great time.
SPEAKER_01 (25:16):
Well, it was a it was a pleasure, Mona.
We'll have to do it againsometime.
And thank you all for listeningand stay tuned for the next
episode of Dermot Trotter.
Don't swear about skincare.
SPEAKER_00 (25:28):
Thanks for listening to Dermot Trotter.
For more about skincare, visitdermittrotter.com.
Don't forget to subscribe, leavea review, and share this podcast
with anyone who needs a littleskincare sanity.
Until next time, stay skinsmart.
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