Photodermatoses in Skin of Color: Clinical Considerations, Presentation, and Management

Conclusions

• Photodermatoses occur across all skin types, but their prevalence and clinical appearance can differ substantially in skin of color.
• Erythema is often harder to recognize in darker skin, so symptom history and careful exam are critical for diagnosis.
• PMLE is common in skin of color and may present with more papular, neck-predominant, or easily misdiagnosed variants.
• Chronic actinic dermatitis in skin of color is often more pigmentary, lichenified, and potentially widespread, making patch and phototesting especially important.
• Actinic prurigo is disproportionately seen in Native American and Native Alaskan populations and can involve mucosal and ocular sites.
• Drug-induced photosensitivity, including diltiazem-related eruptions, should be considered when new photodistributed hyperpigmentation appears in skin of color.
• Photoaggravated disorders such as lupus and lichen planus can look different in skin of color and may present with more pigmentary change than classic erythema.
• Genodermatoses with photosensitivity can occur in non-White populations, and consanguinity may increase risk in some groups.
• Post-inflammatory pigment alteration is a major and often more distressing outcome than the primary rash for many patients with skin of color.
• Treating the underlying inflammation quickly is important because pigmentary sequelae can persist for years.
• Photoprotection is essential but must be individualized to improve adherence and effectiveness in skin of color.
• Tinted, higher-SPF, and visible-light-protective sunscreens are often preferable, especially when hyperpigmentation is a concern.
• Barriers such as cost, cosmetic acceptability, inadequate application, and poor reapplication limit sunscreen use in skin of color populations.
• Secondary photoprotection agents such as polypodium leucotomos may offer additional benefit in selected photodermatoses.
• Overall, management of photodermatoses in skin of color should emphasize accurate recognition, individualized treatment, and tailored photoprotection counseling.