New Therapies Shift the Landscape for Skin of Color Dermatology: Andrew Alexis, MD, MPH

As dermatology continues to confront longstanding gaps in diagnosis and treatment across diverse populations, improving care for patients with skin of color has become an urgent priority. At the recent Winter Clinical Dermatology meeting, held in Miami, Florida, from February 27 to March 1, 2026, Andrew F. Alexis, MD, MPH, presented “Skin of Color Therapeutic Pearls,” highlighting key considerations in this space. In this Q&A with The American Journal of Managed Care^® (AJMC^®), Alexis, a professor of clinical dermatology and vice chair for diversity and inclusion at Weill Cornell Medicine, discusses the nuanced clinical challenges dermatologists face, including identifying inflammation in deeply pigmented skin and managing persistent dyspigmentation, and shares emerging evidence on targeted therapies that not only control disease severity but also address pigmentary outcomes.

AJMC: Your presentation highlights several inflammatory and pigmentary disorders in patients with skin of color. From a clinical standpoint, what are the most common diagnostic or treatment challenges dermatologists face when caring for these populations?

Alexis: Some of the most common clinical or therapeutic challenges in the management of dermatologic disorders in patients with skin of color include the accurate assessment of erythema in the context of deeply pigmented skin types, variations in the clinical features of inflammatory disorders, and treatment of associated dyspigmentation.

AJMC: Your study on dupilumab (Dupixent; Sanofi, Regeneron Pharmaceuticals) in patients with skin of color found improvements in both disease severity and post-inflammatory pigmentation—what are the key takeaways for clinicians treating these patients?

Alexis: The DISCOVER study (NCT05590585), an open-label study of dupilumab monotherapy in patients with skin of color and moderate-to-severe atopic dermatitis (AD), not only demonstrated improvements in AD severity, but also improvements in postinflammatory hyperpigmentation were observed over the course of 24 weeks of treatment. In particular, there was a 52.9% decrease in physician-assessed disease severity from baseline to week 24. 

Another study, ADmirable (NCT04250350), evaluated the efficacy and safety of lebrikizumab (Ebglyss; Eli Lilly) in adults and adolescents with skin of color and moderate-to-severe AD. In this open-label study involving patients with Fitzpatrick skin types IV-VI, improvements in AD signs and symptoms, as well as hyperpigmentation, were observed. Specifically, almost 2 out of 3 patients (64.4%) with baseline hyperpigmented areas showed reduced hyperpigmentation at week 24 as measured by a novel pigment alteration scale called PDCA-Derm^™.

AJMC: How do systemic therapies such as guselkumab (Tremfya; Janssen Biotech) affect both psoriasis control and pigmentary changes in patients with skin of color?

Alexis: In a recent study called VISIBLE (NCT05272150) that specifically enrolled patients with skin of color and with moderate-to-severe psoriasis, improvements in psoriasis severity as well as photographic improvements in pigmentation and the quality-of-life impact of pigmentary changes were observed after 48 weeks of treatment with guselkumab.

AJMC: What recent advances in treating melasma, including newer agents like Thiamidol or oral tranexamic acid, are most promising for improving outcomes in patients with skin of color?

Alexis: Recent advances in the treatment of melasma include non-hydroquinone-containing cosmeceutical formulations with novel ingredients such as cysteamine, Thiamidol, and 2-mercaptonicotinoyl glycine that have broadened our treatment options. These agents have demonstrated improvements in melasma comparable with hydroquinone 4%. In clinical practice, these formulations can be used as alternatives or adjuncts to hydroquinone and are particularly useful during breaks in hydroquinone therapy (which are recommended to limit the risk of exogenous ochronosis from excessive or prolonged use of hydroquinone). The off-label use of oral tranexamic acid has also been a valuable addition to melasma treatment, particularly for patients who do not experience an adequate response to topical therapy alone.

AJMC: What role might newer therapies such as topical roflumilast (Zoryve; Acrutis) play in addressing both inflammatory skin disease and dyspigmentation?

Alexis: In the management of seborrheic dermatitis in patients with skin of color, where pigmentary alteration is a frequent concern, topical roflumilast can improve dyspigmentation associated with seborrheic dermatitis. A recently published open-label 52-week trial evaluating the safety and efficacy of roflumilast 0.3% foam in patients with seborrheic dermatitis demonstrated improvements in seborrheic dermatitis signs and symptoms as well as associated dyspigmentation. It was well tolerated in a diverse patient population. This allows clinicians to address both the primary features of the condition (eg, erythema, scaling) and the concomitant pigmentary changes (hyper- and hypopigmentation) with a single treatment.