Addressing Disparities in Inflammatory Skin Diseases in Darker Skin Tones

“Many of the disparities that we see with disease identification, epidemiology, quality of life impairment, and even burden, oftentimes have to do with social and structural factors. I tried to address these in the second half of my lecture by focusing in on some interesting things that have been happening in the space for each disease state,” said Raj Chovatiya, MD, PhD, MSCI, in an interview at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.

Chovatiya, clinical associate professor at Rosalind Franklin University Chicago Medical School, founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, and a Dermatology Times Editorial Advisory Board member, recently presented “Inflammatory Disorders Part 2: Atopic Dermatitis, Psoriasis, Hidradenitis Suppurativa” at AAD.

In his session, Chovatiya focused on atopic dermatitis (AD), hidradenitis suppurativa (HS), and psoriasis in patients with skin of color, providing a critical examination of disease disparities and the role of social determinants in clinical outcomes.

Chovatiya highlighted the limitations of using broad terms such as "skin of color," "race," and "ethnicity" when discussing disease variability. He emphasized that while these classifications may provide epidemiologic insight, they often fail to capture true biological differences. Instead, he examined how structural and social determinants impact disease burden, diagnostic challenges, and treatment access. Through a series of clinical examples, he demonstrated how these conditions present across diverse skin tones, emphasizing the need for improved recognition of atypical manifestations in patients with darker skin tones.

For HS, Chovatiya introduced a structured model based on social determinants of health, developed by his team, to better understand disparities in disease severity and access to care. He emphasized that while the pathophysiology of inflammatory skin diseases is largely consistent across populations, systemic inequities contribute significantly to differential outcomes.

In discussing AD and psoriasis, he examined recent clinical trials designed to enhance diversity and inclusion. He highlighted findings from the VISIBLE study evaluating guselkumab in psoriasis and the ADmirable study assessing lebrikizumab for AD. A key focus was on trial design modifications to improve representation, including adjustments in eligibility criteria and assessment methodologies. He advocated for incorporating measures such as hyperpigmentation and hypopigmentation scoring in patients with darker skin tones to capture treatment impact beyond traditional erythema-based scales better.

Chovatiya concluded by emphasizing the need for a change in thinking in dermatologic research and clinical practice. Rather than solely focusing on intrinsic disease differences, dermatologists should consider external factors driving disparities. Optimizing clinical trial inclusivity, refining diagnostic tools, and addressing structural inequities are essential to providing equitable care.

For all news from AAD, click here.