Alia Galadari, MD, discusses subtle erythema, commonly missed diagnoses, and research gaps to help clinicians recalibrate their approach to skin of color.
Recorded on-site at the
Galadari, who also serves as a residency program director, presented as part of the SOCS faculty. She spoke about various ways in which dermatology clinicians of all kinds can sharpen their diagnostic approach for patients with skin of color.
Galadari was asked what recalibrating the clinical lens looks like in practice. Trained in France, where most patients had lighter skin, she said inflammation is often equated with redness, yet erythema can be subtle in darker complexions. She does not advocate overhauling dermatology, but encourages clinicians to change how they look.
Drawing on a roughly 400-year-old Rubens portrait in which the subject tilted his head to reveal different angles, she outlined a sequence: describe morphology, use light to define where a lesion ends, characterize color such as violaceous, gray, or brown, and examine the nails, hair, and mucosa before turning to tools like dermoscopy. She cautioned against relying on textbook images, which capture only part of a broader spectrum of presentations.
Galadari divided the gaps into what clinicians see, measure, and study. Severity scores such as the Eczema Area and Severity Index, SCORing Atopic Dermatitis, and the Psoriasis Area and Severity Index may underestimate disease when erythema is muted, so she suggested giving more weight to features like lichenification and scoring higher when warranted, citing a patient with severe atopic dermatitis whose redness was barely apparent.
On research, she said skin of color accounts for only about 20% of cases represented, with lower figures in cosmetic and surgical work, roughly 2% to 5% depending on region. She urged colleagues to share clinical photographs and called for national and international registries and cross-border collaboration, adding she would welcome sharing experiences with colleagues worldwide.
Psoriasis and atopic dermatitis remain bread-and-butter conditions, but their presentations can differ. Atopic dermatitis may appear more perifollicular, lichenified, and papular, while psoriasis plaques may be thick yet harder to discern, with violaceous or gray hues. Galadari identified acral melanoma, mycosis fungoides presenting as hyperpigmented patches in children, and central centrifugal cicatricial alopecia as diagnoses not to miss, noting delays in acral melanoma carry severe consequences. She advised biopsy when lesions resist treatment, attention to symptoms like itching and burning, and regular use of the dermatoscope.
The most important mindset shift, in her view, is looking at the whole patient. Galadari described visual thinking strategies, an art-observation method recently used in a simulation study in which emergency and internal medicine clinicians offered distinct interpretations of the same image. She encouraged clinicians to ask about patients’ social context, symptoms, and progression, use light liberally, and measure, then return to the lesions to assess texture and the wider context.
Discussing practice in the UAE, Galadari noted Dubai’s population includes more than 207 nationalities, reinforcing the need for individualized care. Awareness, studies, and publications are growing, and she hopes regional research capacity will allow Middle Eastern patients to be represented as part of the mix rather than as an anomaly. She credited SOCS founder Susan Taylor, MD, for a platform where good intentions become standard practice, and voiced hope that representation could one day approach 50%.
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Editor’s note: This summary was edited with the help of AI tools. Galadari highlighted no financial disclosures of note.
