Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University and associate director of clinical trials at Central Connecticut Dermatology, provides on overview of the treatment landscape in patients with skin of color with plaque psoriasis.
A lot of dermatologists don't feel comfortable diagnosing and treating psoriasis in patients with skin of color, says Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University and associate director of clinical trials at Central Connecticut Dermatology. Shahriari has always had an interest in inflammatory skin disease, particularly in patients with melanin rich skin and how to treat these patients who may be facing burdens in receiving care.
Can you provide an overview of your presentation at the 2023 Fall Clinical Dermatology Conference on the treatment of plaque psoriasis in patients with skin of color? What unique challenges or nuances were addressed?
I have always had a strong interest in inflammatory skin disease, but in particular, in patients with skin of color, just because in my neck of the woods, I was never trying to be a skin of color expert, but people saw my skin color. So they said, she probably knows how to treat our skin. And they would just flock to me. So, little by little, I had to learn more about how to treat different skin conditions in patients with melanin rich skin.
And what I find is, we don't actually get a lot of training in our residences, things are changing. Now, I'd say in the year 2023, we definitely have a lot more resources at our disposal. But when I was undergoing residency, I won't tell you how long ago, it was not something that was readily available as part of our curriculum. It wasn't something that I would see in my everyday clinical practice. And if I was interested, I had to seek it out myself. And I think that really contributes to some of the disparities that we're seeing in the treatment of plaque psoriasis in our patients with skin color. Because for starters, the social determinants of health are going to lead to issues in terms of patients actually getting to a specialist. Maybe they're in a geographic region where they don't have access to a specialist, maybe due to economic reasons they can't take time off of work to go see a specialist during business hours, so they end up getting paired care in an ER or an urgent care setting where a specialist obviously is not available.
But for those patients that overcome those hurdles, and they actually make it to a dermatologists office, a lot of the [dermatologists] don't feel comfortable diagnosing and treating psoriasis and skin color. Now they're either being incorrectly diagnosed or they're being under-treated because disease severity is being assessed incorrectly, or the treatments that are out there. If the provider doesn't know how to properly educate the patient on the treatments, there may be this sense of distrust between the provider and the patient. And then they can never embark on those new emerging therapies that can be really game changing for that particular patient. So this has definitely been an area of immense research and interest. So we're going to really dive deeper into how we can help bridge the gaps and allow for patients to delay patients to receive more inclusive care.