Chesahna Kindred, MD, MBA, FAAD: Expert Insights on Enhancing Dermatological Care for Patients with Skin of Color

AbbVie recently hosed its fourth annual "Science of Skin" event on August 8, spotlighting both personal and professional insights into managing chronic skin conditions. The annual event aims to empower and educate the millions of Americans affected by skin diseases through discussions on patient control, supportive networks, and the unique needs of patients with skin of color.

This year's event, "Science of Skin: Empowering Conversations to Take Control of Chronic Skin Disease," featured 3 expert-led sessions, including a session led by Chesahna Kindred, ​MD, MBA, FAAD, a board-certified dermatologist practicing at Kindred Hair & Skin, and Brenda Kong-Tunac, a psoriasis and psoriatic arthritis patient and advocate.

Dermatology Times recently spoke with Kindred to discuss her involvement in the session, titled, "Amplifying Voices of Skin of Color Patients," and to delve into the important role of dermatologists in supporting patients with skin of color.

Transcript

Chesahna Kindred, MD, MBA, FAAD: Hi, I'm Dr Chesahna Kindred, a board-certified dermatologist with Kindred Hair & Skin Center in Maryland.

Dermatology Times: What are the unique challenges faced by patients with skin of color who have psoriasis and eczema?

Kindred: There are unique challenges for skin of color patients with chronic skin conditions. If we take psoriasis as an example, no matter the disease severity, mild, moderate or severe, patients who are Black, Latino, Asian, compared to White, there's a greater impact on their quality of life. A lot of the data kind of shares that if the psoriasis is mild, it has this level of impact on the patient's lives versus severe. We now know that doesn't quite apply to everyone; that was mostly generated from White patients, which is great. We know the quality of life for them, but regardless of the disease severity, there's a greater impact on the quality of life of non-White patients. That's a great example. Another layer of the impact is just a misdiagnosis, and we know in dermatology that different diseases can look alike: mimickers, and the same disease can look differently. Add the extra layer that if it's a patient with melanin-rich skin, it also can look different, on top of all the differential diagnoses we typically come up with. Those are just a couple of examples where there's a huge impact in the care received, if the patient has skin of color or not.

Dermatology Times: What are some common misconceptions about psoriasis and eczema in skin of color that you encounter in your practice?

Kindred: One common misconception is that there's a cure That might be across the board, but particularly my patients, with my Black and Latino patients, "I want a medication that'll just get rid of it." I'll hear that question more often in that group. Then once they know it's chronic, I commonly get questions such as, it's their diet. What can they eat differently? Do differently to make it go away? I hear that most commonly in my Black patients, about diet being the root of every single skin condition. The other misconception, or, I don't know if it's a "misconception," but the more melanin-rich the skin is, the post-inflammatory hyperpigmentation, or the PIH, that that's a part of the disease as well. We have to educate that that's a secondary condition that we also have to deal with. The insurance will not cover so a little extra burden of disease and extra out of pocket burden that they get. The misconception is that if I get their psoriasis clear or their eczema clear, the misconception is that that means their skin will be back to normal, and it's not. It just means that inflammatory condition be cleared, and then we have to deal with the PIH later.

Dermatology Times: How can dermatologists improve their approach to diagnosing and treating skin of color patients with chronic skin conditions?

Kindred: Since misdiagnosis is so prevalent amongst dermatologists treating patients with skin of color, one helpful tip is, with some humility, recognize that maybe the original diagnosis was incorrect. Don't be so quick to label the patient as being non-compliant or non-adherent. It can be tricky. Let's say you've diagnosed the patient with eczema while they truly have psoriasis, and you would expect this topical corticosteroid to get them clear. Let's say they have partial improvement. It's not necessarily because they're not as adherent to the medication. Maybe this patient does indeed need a biologic for psoriasis, and so that's another tip, is to supplement the education that was received if it was lacking cultural competence. I'm not talking about the warm and fuzzy. We're recognizing behaviors. I'm talking about, at least the basic and recognized conditions like eczema, psoriasis, in patients who are Black or patients who are Latino, Asian, etc, at least supplement step 1, which is diagnosis.

Dermatology Times: What are some recent advancements or research that specifically address the needs of patients with skin of color?

Kindred: There have been advancements in addressing the needs of patients with skin of color that's been really exciting. Some clinical trials that were done all but excluded patients of color, particularly Black patients. I've seen drug manufacturers literally carry out a study specifically in skin of color to try to supplement the data. I've also seen that in feasibility studies, they've asked principal investigators, "How many patients with this particular demographic do you expect to enroll?" For example, if it's hidradenitis, they honestly should ask the private principal investigator, "How many Blacks do you expect to enroll?" Because they carry the burden. I've seen that. That way, the data that comes out to treat Americans include Americans, not just a subset. I've seen increasing efforts to enroll patients from backgrounds that were historically excluded from medicine and science, which is awesome. I've seen efforts where clinical trials go to where their patients are, so instead of just enrolling the site and trying to recruit patients, where are those patients going that typically are, historically have been, excluded, and running the clinical trials at those physician offices. I'm really hopeful for the direction we're going in to making sure that in the US, all Americans are included in clinical trials, and in the conversation, and more.

Dermatology Times: How can dermatology providers collaborate with patients and advocates to improve care?

KindreD: Patient advocates are awesome, because they bridge the gap that's present. As a dermatologist, I know how severe a disease can get, and I want to keep the patient from having severe disease. The patient knows what their normal is, and they want to get back to there. You would think that that's consistent, that is synergistic, but sometimes there's a disconnect, and patient advocates can help the patient to voice what's important to them, what exactly their normal is. A great example would be, if I asked the patient, "When you wake up in the morning, do you have any stiffness in your joints?" because sometimes psoriasis can cause arthritis. If the patient has mild psoriatic arthritis, they might think what they're feeling is normal and coming up, "Everything's fine; everything's okay." That patient advocate can say, "No. Tell them, even if it's a 1 out of 10, let her know that you do have a little bit of stiffness in your right ankle from time to time." These subtle things. Patients are very quick to say they're okay. They're fine. It doesn't hurt, they're sleeping fine, etc, sometimes, because it's their new normal. I don't know what their new normal is compared to their normal normal; there's a disconnect. Patient advocates help patients to find their voice, if they've been silenced from other physicians. Patient advocates also help to educate and dispel some of the myths that are out there, whether [from] social media or the internet. Then patient advocates honestly kind of keep us in check from time to time, because again, we can get a little bit too focused on the most severe part of disease: death, infections, disability, etc, that we might miss, that what was important to the patient was something that, in our minds, wasn't severe.

Dermatology Times: What else would you like to share with dermatology clinicians?

Kindred: What I think we all should do as a collective effort is to indeed help to recruit patients who historically have been excluded from clinical trials. This should be a nationwide, full-force campaign. I think if we do that, we all will win.

[Transcript has been edited for clarity.]