Letters to the Editor

Skin Disorders in Patients with Skin of Color


Am Fam Physician. 2020 Jul 15;102(2):74.

Original Article: Erythema Multiforme: Recognition and Management

Issue Date: July 15, 2019

See additional reader comments at: https://www.aafp.org/afp/2019/0715/p82.html

To the Editor: The article by Drs. Trayes, Love, and Studdiford was informative and well written. However, it was unclear from the article if erythema multiforme presents differently in patients with skin of color. Are the lesions erythematous, hyper-, or hypopigmented? I needed to search my Atlas of African Dermatology to find that one presentation of erythema multiforme was target lesions composed of different shades of brown.1 This information gap highlights a broader issue in medical education. A 2006 analysis found limited and inconsistent coverage of skin conditions in skin of color in textbooks and at national dermatology meetings.2 This disparity applies to most dermatologic conditions, including skin cancer. A recent article about the disparities in outcomes of patients with melanoma suggested that the “disproportionately high melanoma mortality rates in patients with skin of color may be driven by a lack of representation and data in awareness campaigns, in clinical research, and in the field of dermatology itself.”3 By 2060, more than one-half of the population is projected to belong to a minority group.4 Family physicians must learn how dermatologic conditions present in skin of color to serve our increasingly diverse patient population better and to avoid incorrect or delayed diagnoses. Any article about dermatologic disorders in American Family Physician (AFP) must include how the skin disorder presents in skin of color. If there is no available information about the presentation, then that should be noted.

Author disclosure: No relevant financial affiliations


show all references

1. Leppard B. An Atlas of African Dermatology. Radcliffe Medical Press Ltd.; 2002....

2. Edebe T, Papier A. Disparities in dermatology educational resources. J Am Acad Dermatology. 2006;55(4):687–690.

3. Nelson B. How dermatology is failing melanoma patients with skin of color. Cancer Cytopathol. 2020;128(1):7–8.

4. United States Census Bureau. New census bureau report analyzes U.S. population projections. March 3, 2015. Accessed January 28, 2020. https://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html

In Reply: We thank Drs. Irwin and Crawford-Faucher for pointing out that the lesions of erythema multiforme present differently in skin of color. We agree that, whenever possible, review articles about skin conditions should include examples of the condition in skin of color. Unfortunately, suitable, noncopyrighted photos of sufficient resolution for publication are not always available. For further information, readers may wish to consult AFP's previous two-part article on dermatologic conditions in skin of color.1,2


1. Kundu RV, Patterson S. Dermatologic conditions in skin of color: Part I. Special considerations for common skin disorders. Am Fam Physician. 2013;87(12):850–856. https://www.aafp.org/afp/2013/0615/p850.html

2. Kundu RV, Patterson S. Dermatologic conditions in skin of color: Part II. Disorders occurring predominantly in skin of color. Am Fam Physician. 2013;87(12):859–865. https://www.aafp.org/afp/2013/0615/p859.html

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Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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