Diagnosing Skin Conditions in Diverse Pediatric Patients

At the 2025 Masters of Pediatric Dermatology Conference in Miami Beach, Florida, Dermatology Times had the opportunity to speak with Nanette Silverberg, MD, chief of pediatric dermatology for Mount Sinai Health Systems and clinical professor of dermatology and pediatrics at the Icahn School of Medicine at Mount Sinai. Silverberg shared insights into the presentation of skin diseases in pediatric patients of color and the importance of refining diagnostic approaches to enhance patient care.

Silverberg's session complemented a talk led by Latanya Benjamin, MD, on the clinical appearance of skin diseases by focusing on color science. "What I look at is more the color science. What is skin of color, but also, what are we looking at when we look at race and color, and in fact, what we're looking at is just chromophores in different amounts and how they come together," Silverberg explained.

One of the key challenges in diagnosing skin conditions in patients of color is the variable presentation of inflammation and pigmentation. Inflammatory conditions such as atopic dermatitis and post-inflammatory hyperpigmentation can manifest differently due to the presence of melanin in the dermis. "We have many things that may mask erythema, and so we talk about how the pigmentation develops over time, why it looks different in different people," said Silverberg. She noted that erythema, which is often associated with redness, may be less visible in darker skin tones, requiring clinicians to shift their diagnostic approach.

The discussion also covered the evolution of traditional dermatologic descriptions, which were historically based on lighter skin tones. Silverberg emphasized the importance of recognizing how pigmentation alters the perception of common dermatologic findings. "A lot of our mindset is skewed towards the initial descriptions, which were in individuals who were white, and we have to really revise our mindset to be inclusive of other skin tones," she stated. For example, café-au-lait spots appear as their namesake in lighter skin tones but can take on darker, richer hues in individuals with deeper pigmentation.

Additionally, the talk addressed conditions such as acral nevi, longitudinal melanonychia, and the spectrum of atopic dermatitis presentations in diverse populations. By deepening the understanding of these variations, clinicians can improve the accuracy of diagnoses and tailor treatments more effectively.

Silverberg concluded with a call to action for greater awareness and inclusivity in dermatologic education and practice. "The population is already very diverse. It's getting—I'm not going to say it's going to get more diverse. It's always been diverse. You just have to recognize it for its diversity and be able to really focus on providing excellence in diagnosis and treatment for individuals with all skin tones."