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Autoimmune Bullous Diseases in Skin of Color

      Dermatologic health care disparities disproportionately affect patients with skin of color (SoC), defined as Fitzpatrick skin phototypes IV-VI (light brown, brown and black skin tones), resulting in delayed treatment and increased morbidity and mortality1 Numerous studies predict that by 2060 the Caucasian race will be minority in the United States (US). Despite the rising SoC population, there remains a scarcity of peer-reviewed literature depicting skin conditions in SoC. In 2006, autoimmune bullous diseases (AIBD) were the fourth most common cause of death from skin disease following skin cancers, ulcers, and bacterial infections.2 Many factors contribute to diagnostic delay including differences in pigmentation which can affect the appearance of skin diseases.3 Inflammation with increased blood flow appears red or pink on white skin while in brown or black skin it is more likely to present as brown or violaceous. Pathologic changes manifest differently in various skin tones and access to media depicting skin pathologies helps improve pattern recognition, diagnostic accuracy, and patient outcomes.4 We review disparities in presentation, subtle differences in appearance of bullous diseases in SoC, as well as epidemiology, pathogenesis, clinical features, comorbidities, differential diagnosis and treatment, and its impact on diagnosis in SoC.

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