Meeting unmet needs: Seeing patients as individuals

Better understanding and representation of the variety of skin colors and structures are needed in clinical studies and treatments. That was the message of the speakers at Saturday’s “Addressing Unmet Needs in Diverse Populations: Therapeutic, Aesthetic, and Investigational Approaches” (U036).

Hema Sundaram, MA, MD

“Dermatologists can be the primary agents of change” by driving more understanding of these unique patient needs, said Hema Sundaram, MA, MD, a dermatologist in Rockville, Maryland. She said many patients with skin of color are experiencing suboptimal access to high quality medical care, lower rates of treatment, and worse treatment outcomes.

Seemal R. Desai, MD, a dermatologist from Plano, Texas, specifically called out three conditions that lack effective treatment in diverse populations: melasma, vitiligo, and psoriasis. Traditional treatments for melasma include topical retinoids, combination therapy, azelaic acid, hydroquinone, and chemical peels. However, he said tranexamic acid is an interesting option for visibly improving melasma because you can treat for a shorter period of time and not use hydroquinone. He also encouraged further studies on men of color with melasma.

Dr. Desai pointed to the need to stabilize vitiligo, especially in patients from Southeast Asia and India, because they tend to be ostracized as a result of their condition. As a pearl, he suggested oral mini-pulse therapy and prescribing dexamethasone 4 mg daily on two consecutive days per week for eight weeks to get it under control. He said it is safer than prednisone.

“There is very little data on psoriasis for people of color,” he said. “We need more data, so we can offer biologic and topical treatments for these patients.”

Dr. Sundaram said there’s a growing occurrence of skin cancer and cutaneous malignancies in skin of color. This is leading to increased morbidity and mortality in these patients because it’s usually found later. “There are atypical presentations when compared to what we see in Caucasians,” she said.

She encouraged the development of skin cancer prevention and screening programs specifically tailored for the African-American, Latin, and Asian populations.

For dermatology in particular, she said there are ethnic ideals of beauty that need to be respected.

“What constitutes beauty for Asians, Caucasians, and African-Americans is different,” she said. She questioned whether in the pursuit of the ideal ethnic face, patients are actually being ‘caucasianized,’ and in so doing, creating facial disharmony and dissatisfaction in patients.