Recognizing Morphologic Differences, Diagnostic Challenges in Asian Patients: Joseph Lam, MD

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In a session titled ‘Unlocking Key Dermatologic Clues in Asian Patients,’ at the American Academy of Dermatology (AAD) 2026 Annual Meeting, Joseph Lam, MD, clinical professor in pediatrics and associate member of the Department of Dermatology and Skin Sciences, BC Children's Hospital at the University of British Columbia, discusses the importance of identifying common pediatric and adult inflammatory and neoplastic skin conditions in Asian patients.

Eczema and other inflammatory dermatoses often follow similar distributions across skin types, but their clinical appearance can differ significantly in patients with darker skin tones, including many Asian patients. For clinicians, recognizing these nuances is critical to avoiding underdiagnosis of disease severity and overestimation of pigmentary change.

In lighter skin, atopic dermatitis is classically characterized by erythematous, scaly plaques. However, in Asian and darker skin types, the morphology may skew papular or bumpy rather than overtly scaly. Erythema itself can be difficult to appreciate. As Lam illustrates, drawing with a red crayon on a dark sheet of paper makes the red far less visible. The result is that a child with severe eczema may appear only mildly inflamed to a clinician not attuned to these differences, potentially delaying treatment escalation.

Conversely, certain findings can be more conspicuous in darker skin. Dryness and xerosis, or conditions such as pityriasis alba, may present with strikingly lighter patches due to post-inflammatory hypopigmentation. These benign changes often cause disproportionate distress to parents, who may fear vitiligo, even when the child is comfortable and asymptomatic. Importantly, these pigmentary changes usually improve with time and control of underlying inflammation.

Other papulosquamous conditions, including pityriasis rosea, may also deviate from textbook descriptions. Instead of a classic scaly herald patch and plaques, Asian and darker-skinned patients may show predominantly papular lesions. When the distribution and clinical course fit, clinicians should recognize that morphology alone—especially in skin of color—should not exclude a working diagnosis.

For managed care clinicians, integrating this knowledge into training materials, care pathways, and patient education can improve diagnostic accuracy, align treatment intensity with true disease burden, and address culturally driven concerns about visible color change. Ultimately, understanding how different skin conditions present in skin of color is essential for equitable, patient-centered dermatologic care.