Buchi Neita, PA-C, briefly reviews her lecture, Dermatologic Conditions in Skin of Color, at the 2nd Annual Elevate-Derm Alliance Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah.

In this video

In conversation with Shannon Marianti, Buchi Neita explains why every clinician — even those with 20-plus years of practice — needs to sharpen their skills with skin of color patients: by 2044, roughly half the US will belong to a minority group, and patients of color are more often misdiagnosed and undertreated, leading to higher morbidity and mortality. She points to melanoma, where Black males are more likely to die despite not being the population that develops it most.

Neita walks through normal variants that shouldn't cause alarm — longitudinal melanonychia, volar (palmar/plantar) pigmentation, and pigmented demarcation lines — while cautioning clinicians to still move with care so a true melanoma isn't missed. She then covers common conditions and treatment pearls, and stresses precise diagnosis: no patient should leave with a diagnosis of just "alopecia," and clinicians shouldn't "hang your hat" on a presumed diagnosis when frontal fibrosing or androgenetic alopecia can mimic traction alopecia.

  • Learn the normal variants — longitudinal melanonychia, volar pigmentation, pigmented demarcation lines — and offer to examine palms and soles even when patients aren't there for that reason; it improves the interaction and sharpens your clinical skills.
  • With keloids, "go hard or go home" on intralesional triamcinolone — small dilutions of 5 or 10 won't get you far; go up to 40 depending on the body site. For AKN, over-the-counter 1% diclofenac gel twice daily for three months can give excellent results (a pearl from Dr. Zirwas).
  • Catch scarring alopecias like CCCA early — central tenderness, hair breakage, inflammation, redness, and hair thinning starting in the center are red flags — because permanent hair loss can't be reversed; biopsy when unsure.
  • Skin cancers present differently: squamous cell carcinoma (the most common in skin of color) often appears on the lower extremities, groin, and genital area or in chronic scars and burns; basal cell carcinomas are almost always pigmented; and acral lentiginous melanoma shows up on the palms and soles.
  • For inflammatory dermatoses, look for a violaceous or brown hue, white scarring, and pigmentary change rather than obvious erythema — and warn acne patients ahead of time about post-inflammatory hyperpigmentation so they don't blame the treatment.