Primary Care Dermatology in People of Color
Matt Perez MD Family Medicine Neighborcare Health at Meridian Clinical Assistant Professor, UW Dept Family Medicine This is a sensitive, complex topic Goals
• Increase awareness of skin conditions in people of color • Practice describing skin conditions
• (treatment beyond scope of talk) Language of Dermatology morphology Small (<1cm) Big (>1cm) Flat Macule Patch Raised Papule Plaque Papule
Macule
• Bolognia Dermatology Small Big
Macule <1cm Patch >1cm
• Bolognia Dermatology Raised and Small /Big
Papule Plaque <1cm >1cm
• Bolognia Dermatology Fitzpatrick Skin Types 1-6
https://dermnetnz.org/topics/skin-phototype/ Eczema
Dark Skin Light Skin
Psoriasis
Perez 2021 Erythema in dark skin Psoriasis varies even within skin of color • Age, sex, history: 25 y/o healthy man • Acute or Chronic?: Chronic • Symptoms?: burning, weeping • Morphology and location: Follicular papules neck/beardline
• What’s morphology? • Pseudofolliculitis barbae Web pictures
Keloids
Treatment options: • Nothing • Topical steroids • Injections • Surgery + injections • Cryotherapy Refer
Treat
Lido w/ Epi, 4 weeks Post-op Shave biopsy to remove keloid, Re-inject Triamcinolone inject 10-20mg/ml Triamcinolone into base wound Adjective + Noun + Location
Acne Keloidalis Nunchae What Plaque = are Raised >0.5cm lesion types?
Patch = Smooth Flat
>0.5cm Raised Describe Surface features.
Scaly What is different? Scaly vs Smooth Surface
CARP! Pityriasis Alba Hypopigmented Patch
Adjective + Noun?
His skin is always dry. White spots worsened over summer Chronic white rash, progressive Suspected Vitiligo: Use Woods Lamp
• Distinguish hypopigmented vs DEpigmented Treatment is slow Involve the team Vitiligo Treatment
• Global vitiligo foundation • https://globalvitiligofoundation.org/ What are Diagnoses?
Tinea Versicolor
Psoriasis • 4 week follow up Psoriasis
Scalp Psoriasis
Perez 2020 Scalp Psoriasis
Clobetasol Scalp Solution
Perez 2020 Inverse Psoriasis
• Chronic • Bilateral • Itchy • +Groin rash Lichen Planus
SUPER itchy! Wrists & ankles Maybe NSAID or ACEi Lichen Planus – 6 Ps
Lower back/trunk Volar Wrist Ankle Shins Neck genitals Lichen Planus – 6 Ps
• Purple • Polygonal • Planar • Pruritic • Papules • Plaques • Lichen Planus • ACE inhibitor • (other meds) • Post-viral infxn Chronic Papule on scalp of 70 year-old Ethiopian man Enlarging papule in uninsured immigrant
Referred to derm without biopsy by PCP, waited 6 months
Perez 2013 Tinea Capitis Tinea Capitis Notice difference with force flash Id Reaction
Papular eruption days after starting antifungal treatment for tinea capitis Eczema in 11 month old Chronic itchy rash What’s your diagnosis? How would you manage?
• Moisturizers!! • Skin care education • Hydrocortisone 1 or 2.5% Crm/ointment BID for 2 weeks 30g
Who has active eczema (both have itching)? Post-inflammatory Hyperpigmentation doesn’t itch Lichen Simplex Chronicus
?
Present >1 year, really itching, constantly scratching or rubbing it. Began after wearing friends’ necklace Hidradenitis Suppurtiva
• North American Hidradenitis Guidelines 2019
What Stage?
Hurley II 1 or more Widely separated abscess w/ tract & scar What Stage?
Hurley III Multiple interconnecting abscesses Fig 1
Journal of the American Academy of Dermatology 2019 81, 91-101DOI: (10.1016/j.jaad.2019.02.068) Copyright © 2019 American Academy of Dermatology, Inc. Terms and Conditions Abscess Fluctuant Tender Nodule Question to Ponder
• If you accept insurance • but don’t accept Medicaid…. • And BIPOC & Minorities disproportionally have Medicaid insurance…
Is this Structural Racism in Medicine?
Thank you!
• Matt Perez, MD • [email protected] • Site Medical Director, Neighborcare Health at Meridian • AKN • Acanthosis Nigricans • Keloids • SCC scalp • Pseudofolliculitis barbae • Tinea versicolor • Tinea capitits • Vitiligo • Hidradenitis • Psoriasis • Traction alopecia • Lichen planus • Frontal fibrosing alopecia • Melasma • Dermatoosis pap nigra • Ashy dermatosis