Skin Color in Clinicopathological Correlation
Dermatologists should understand how skin of color clinical deficiencies and biases impact dermatopathology. DM disproportionately affects Black and Hispanic people and is underdiagnosed in people with skin of color.
Dr. Olayemi Sokumbi, Associate Professor of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic Alix School of Medicine, Director Clinical Practice, Department of Dermatology, Medical Director, Department of Business Development, Mayo Clinic Florida
October 2024
Dr. Sokumbi presented information about the role of skin color in clinicopathological correlation (CPC) and dermatopathology. She argued that dermatologists should understand how skin of color clinical deficiencies, and biases impact dermatopathology and shared three patient cases of inflammatory dermatoses that demonstrate pitfalls to consider in skin of color.
Case #1: Overcoming bias
A 64-year-old female of African origin with hypertension, hyperlipidemia, and osteoarthritis presented with a chronic itchy eruption for two years. Extensive workup identified high eosinophilia, elevated tryptase, and elevated B12 without a specific cause. Dr. Sokumbi diagnosed the patient with myeloproliferative hypereosinophilic syndrome (mHES). Symptoms improved following treatment with imatinib, a tyrosine kinase inhibitor.
HES is characterized by at least six months’ peripheral blood hypereosinophilia with eosinophil-mediated organ damage or dysfunction, after excluding other potential causes for damage. HES can affect multiple organs and should be evaluated by a multidisciplinary team. Clinically relevant subtypes include mHES and lymphoproliferative HES (lHES).
Dr. Sokumbi highlighted this case because dermatologists might see this patient and assume the diagnosis is parasites or skin picking. Clinicians must prevent cognitive bias from affecting the consideration of other diagnoses such as HES.
Case #2: Hypopigmentation trap
A 47-year-old female presented with hypopigmented macules and patches for three years. Dr. Sokumbi diagnosed the patient with hypopigmented mycosis fungoides (HMF) without systemic disease. The patient was treated successfully with phototherapy.
Mycosis fungoides (MF) is more severe with earlier onset in patients with skin of color. Black race has been identified as a predictor of poor overall survival in patients with MF, after controlling for disease characteristics, socioeconomic factors, and types of treatment. Early recognition in patients with skin of color may help mitigate disparities in outcomes.
HMF is a rare variant of MF more common in Blacks and Hispanics with a more favorable prognosis compared to classic MF. Dr. Sokumbi noted that HMF can be challenging to differentiate from other hypopigmented patches in patients with skin of color.
Case #3: Hyperpigmentation trap
A 44-year-old female presented with persistent hyperpigmentation on the face, trunk, and extremities. Dr. Sokumbi diagnosed the patient with amyopathic dermatomyositis (DM) based on clinical and histopathological findings.
Dr. Sokumbi described the clinical and histopathological features and clinicopathological correlation of DM. Although more commonly diagnosed in white patients, DM disproportionately affects Black and Hispanic people and is underdiagnosed in people with skin of color. Dr. Sokumbi acknowledged that diagnosing DM in those with skin of color can be challenging. Dyschromia is the most prominent cutaneous feature of DM in patients with skin of color.
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