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
mortality.
1
Numerous studies predict that by 2060 the White race will be a minority in the United
States. 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, whereas
on 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 to improve pattern recognition, diagnostic accuracy, and patient
outcomes.
4
We review disparities in presentation and subtle differences in the 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.To read this article in full you will need to make a payment
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References
- Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States.JAMA Dermatol. 2018; 154: 1286-1291
- Fitzpatrick’s Dermatology in General Medicine.7th ed. McGraw-Hill, New York2008
- Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders.Am Fam Physician. 2013; 87: 850-856
- Representation of dark skin images of common dermatologic conditions in educational resources: a cross-sectional analysis.J Am Acad Dermatol. 2021; 84: 1427-1431
- A retrospective study of patient-reported data of bullous pemphigoid and mucous membrane pemphigoid from a US-based registry.Front Immunol. 2019; 10: 2219
- The growing incidence of bullous pemphigoid: overview and potential explanations.Front Med. 2018; 5: 220
- Incidence, prevalence and mortality of bullous pemphigoid in England 1998–2017: a population-based cohort study.Br J Dermatol. 2021; 184: 68-77
- Bullous pemphigoid.Indian J Dermatol Venereol Leprol. 2011; 77: 450-455
- Bullous Pemphigoid.StatPearls Publishing, Treasure Island, FL2021
- Bullous pemphigoid: trigger and predisposing factors.Biomolecules. 2020; 10: 1432
- Concomitant bullous pemphigoid and dermatitis herpetiformis.Dermatology. 2013; 226: 217-221
- Guidelines for the management of bullous pemphigoid.Br J Dermatol. 2002; 147: 214-221
- A patient with both bullous pemphigoid and epidermolysis bullosa acquisita: an example of intermolecular epitope spreading.J Am Acad Dermatol. 2004; 51: 118-122
- Clinical features and diagnosis of epidermolysis bullosa acquisita.Expert Rev Clin Immunol. 2017; 13: 157-169
- Differences in the clinical presentation of bullous pemphigoid in patients with skin of colour and patients with white skin.Br J Dermatol. 2021; 185: 430-432
- Autoimmune bullous disease in skin of color: a case series.JAAD Case Reports. 2020; 6: 1173-1178
- Perifollicular pigmentation in bullous pemphigoid: a diagnostic sign.Indian Dermatol Online J. 2011; 2: 36
- Mortality of bullous skin disorders from 1979 through 2002 in the United States.Arch Dermatol. 2009; 145: 1005-1008
- Targeting type 2 inflammation for treatment of bullous pemphigoid.J Dermatol Skin Sci. 2020; 2: 29-33
- Diagnosis and classification of autoimmune blistering diseases.Autoimmun Rev. 2014; 13: 482-489
- Pemphigus vulgaris.An Bras Dermatol. 2019; 94: 264-278
- Bullous diseases of the skin and mucous membranes.Clin Immunol. 2013; : 760-774
- Intraepithelial autoimmune blistering dermatoses: clinical features and diagnosis.J Am Acad Dermatol. 2021; 84: 1507-1519
- Pemphigus: current and future therapeutic strategies.Front Immunol. 2019; 10: 1418
- Clinical presentation and diagnostic delay in pemphigus vulgaris: a prospective study from Turkey.J Oral Pathol Med. 2020; 49: 681-686
- Pemphigus vulgaris in a Black patient: early recognition of disease saves lives.J Dermatol Skin Sci. 2021; 3: 5-8
- Oral pemphigus vulgaris: case report.Ethiop J Health Sci. 2015; 25: 367-372
- Vesicles and bullae. In: Lookingbill and Marks’ Principles of Dermatology.Elsevier, Philadelphia2019: 135-150
- The members of the plakin family of proteins recognized by paraneoplastic pemphigus antibodies include periplakin.J Invest Dermatol. 1998; 111: 308-313
- IgA pemphigus.Clin Dermatol. 2011; 29: 437-442
- Azathioprine therapy and TPMT and NUDT15 genotype.Medical Genetics Summaries. Bethesda, MD: National Center for Biotechnology Information;. 2012;
- Pemphigus group: overview, epidemiology, mortality, and comorbidities.Immunol Res. 2018; 66: 255-270
- Pemphigus group: overview, epidemiology, mortality, and comorbidities.Immunol Res. 2018; 66: 255-270
- Diagnosis and clinical features of pemphigus foliaceus.Dermatol Clin. 2011; 29: 405-412
Vukmer T, Hassani J, Ros A. Pemphigus foliaceus in an otherwise healthy 35-year-old male. Available at: https://cdn.ymaws.com/www.aocd.org/resource/resmgr/jaocd/contents/volume39/39-13.pdf. Accessed Sep 9 2022.
- Pemphigus foliaceus: a case report and short review.Cutis. 2006; 78: 105-110
- Beyond the HLA polymorphism: a complex pattern of genetic susceptibility to pemphigus.Genet Mol Biol. 2020; 43e20190369
- Diagnosing pemphigus foliaceus: a rare blistering disease masquerading as a common dermatologic disorder.Mil Med. 2019; 184: e455-e457
- Pemphigus Foliaceus.StatPearls Publishing, Treasure Island, FL2021
- Bullous impetigo masquerading as pemphigus foliaceus in an adult patient.JAAD Case Reports. 2020; 6: 428-430
- The value of trichoscopy in the differential diagnosis of scalp lesions in pemphigus vulgaris and pemphigus foliaceus.An Bras Dermatol. 2014; 89: 1007-1012
- Psoriasiform pemphigus foliaceus in an African American female: an important clinical manifestation.J Drugs Dermatol. 2018; 17: 471-473
- Pemphigus in the Arab world.J Dermatol. 2015; 42: 27-30
- J Am Acad Dermatol. 2011; 64: 1017-1024
Merck Manual. Dermatitis herpetiformis. Available at: https://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/epidermolysis-bullosa. Accessed Sep 9, 2022.
- Dermatitis herpetiformis: novel perspectives.Front Immunol. 2019; 10: 1290
- Dermatitis herpetiformis: potential for confusion with linear IgA bullous dermatosis on direct immunofluorescence.Dermatol Online J. 2008; 14: 21
- Dermatitis herpetiformis in an African woman.Pan African Med J. 2018; 30: 119
- The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol. 2015; 8: 257-265
- Glucose-6-phosphate dehydrogenase deficiency: disadvantages and possible benefits.Cardiovasc Hematol Disord Drug Targets. 2013; 13: 73-82
- Prevalence and age distribution of pemphigus and pemphigoid diseases in Germany.J Invest Dermatol. 2016; 136: 2495-2498
- Spectrum of subepidermal immunobullous disorders seen at the National Skin Centre, Singapore: a 2-year review.Br J Dermatol. 2002; 147: 476-480
Ngan V. Epidermolysis bullosa acquisita. Available at: https://dermnetnz.org/topics/epidermolysis-bullosa-acquisita. Accessed Sep 9, 2022.
- Black patients of African descent and HLA-DRB1*15:03 frequency overrepresented in epidermolysis bullosa acquisita.J Invest Dermatol. 2011; 131: 2386-2393
- Clinical features and diagnosis of epidermolysis bullosa acquisita.Expert Rev Clin Immunol. 2017; 13: 157-169
- Epidermolysis Bullosa Acquisita.StatPearls Publishing, Treasure Island, FL2021
- Linear immunoglobulin A bullous dermatosis.Clin Dermatol. 2012; 30: 38-50
- Linear IGA bullous dermatosis in Tunisian children: 31 cases.Indian J Dermatol. 2011; 56: 145
- Chronic bullous dermatosis of childhood–clinical and immunological features seen in African patients.Clin Experimental Dermatol. 1991; 16: 160-164
- Chronic bullous dermatosis of childhood in north India.Pediatr Dermatol. 2004; 21: 610-612
- Autoimmune subepidermal blistering diseases in Uganda: correlation of autoantibody class with age of patients.Int J Dermatol. 2006; 45: 1047-1052
- Linear IgA bullous dermatosis.Eplasty. 2013; 13: ic49
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Publication history
Published online: August 16, 2022
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