When it comes to skin disorders, the color of your skin really matters. It can affect how your body reacts to the condition and what treatment is most effective.
Take eczema, for example. This rash typically appears red and scaly on lighter skin but may look either darker or lighter than the normal skin color on darker skin. Topical steroids like creams and ointments are often used to treat eczema on lighter skin. On darker skin, however, these medications can cause lightening that stands out dramatically if the dosage is too high or if they are used for too long.
The field of dermatology has become more aware of nuances like these in recent years. Brigham and Women’s Hospital has long recognized these variations and the need for a specialized approach.
Brigham Skin of Color Dermatology Program
The Brigham’s Skin of Color Dermatology Program, formerly known as the Multicultural Dermatology Program, was founded in 2011. It was the first program of its kind in New England. Our team of four dermatologists provides specialized care for skin and hair conditions more commonly found in people with olive, tan, light brown or dark brown skin.
“There has traditionally been a tendency to dismiss skin and hair issues in patients with darker skin,” said Deborah A. Scott, MD, program co-director. “But it’s not just cosmetic. These disorders have such a huge impact on people, and we all need to be more sensitive to that fact.”
Experts in safe, effective skin and hair disorder treatments
The Brigham’s Skin of Color Dermatology Program regularly sees patients with conditions such as eczema, hyperpigmentation (darker spots), keloids and other forms of scarring, psoriasis and hair loss/breakage. Its doctors have expertise in safe and effective treatments for skin of color, including laser treatments, chemical peels, fillers and Botox injections.
According to program co-director Jennifer Y. Lin, MD, multiple studies have shown that patients with skin and hair disorders feel more comfortable seeing a doctor who looks like them and/or has extra training in their particular skin type. Collectively, she and her colleagues check both those boxes.
“We have each treated many different skin types for many years,” she said. “And we really think about the individual patient and how to take a personalized approach to their care. With the diversity of our patient population, it’s important for us to hone in on each patient’s skin type as well as personal needs and exposures.”
Though all of the program’s dermatologists diagnose and treat a variety of conditions, each also has a particular niche. Dr. Scott’s is alopecia, while Dr. Lin’s is cosmetics and melanoma. Kristina J. Liu, MD, MHS, and Sotonye E. Imadojemu, MD, MBE, have clinics in vitiligo and sarcoidosis, respectively.
Dr. Liu noted that vitiligo — which causes whitish patches to develop on the skin — is much more noticeable with darker skin. She said that people of color tend to feel self-conscious about their appearance and the perceived stigma that comes with the disease. Since she treats so many patients of color with vitiligo, she is sensitive to the full spectrum of issues they may face.
“As with other conditions, we take a holistic approach to vitiligo,” Dr. Liu said. “Patients want to feel like someone can help them on this journey, which is emotionally distressing and debilitating for them. While we treat them with medication, we can also talk about resources for psychosocial support, options for cosmetic coverup and even surgical treatments.
“Vitiligo is an unpredictable condition, but many treatment strategies are proven to work. Don’t just resign yourself to living with it — it’s worth coming into the clinic to see what’s possible.”
A less invasive way to diagnosis sarcoidosis
Sarcoidosis, an area of focus for Dr. Imadojemu, is marked by inflammation and/or fibrosis of affected organs. Fibrosis is scarring of connective tissue. The disease is more likely to involve the skin in people of African descent and can cause skin problems like rashes and discoloration.
Dr. Imadojemu encourages all patients, regardless of skin color, to see a dermatologist if there is reason to suspect they may have sarcoidosis. As she explained, a dermatologist can evaluate the patient and, if necessary, order a skin biopsy (removal of tissue) to confirm the diagnosis. This is a much less invasive option than, for instance, taking a biopsy of the lung or a lymph node in the chest.
Like Dr. Scott, Dr. Imadojemu is dual-certified in internal medicine and dermatology. She said this rare blend of specialized expertise allows the Skin of Color program to collaborate with a patient’s other doctors and deliver more comprehensive care during a clinic visit. Equally important, the existence of the program lets patients know they are not alone.
“Many patients have told me they felt their previous dermatologist didn’t understand their skin and their skin issues,” Dr. Imadojemu said. “Our program’s dermatologists want to ensure patients of color are well taken care of. We’re here and we care about your skin disease, just like we care about any other patient’s skin disease.”
Increasing awareness in the dermatology community
The mission of the Skin of Color Dermatology Program goes beyond clinical care. Dr. Scott and her colleagues began training first-year dermatology residents in the clinic this year and plan to expand educational efforts in the future. They are also working to increase awareness in the dermatology community about the manifestations of skin and hair disorders in people of color. Among their current projects is compiling an atlas of photos from the clinic to document how various skin diseases look on certain skin types.
“All of us look forward to the day when we don’t need to have a clinic like this,” Dr. Scott concluded. “No matter what your color, it’s all skin. It’s all hair. What we do here shouldn’t be separate; it should be integrated into dermatologic practice. The learning curve will be quite steep, but we’ll get there one day.”
The Skin of Color Dermatology Program has locations at the Brigham’s Boston campus and at the Brigham and Women’s Health Care Center in Chestnut Hill. To make an appointment, call 617-525-9496 or email firstname.lastname@example.org.