Autoimmune bullous diseases in skin of color

Dermatologic health care disparities disproportionately affect patients with skin of color (SoC), defined as Fitzpatrick skin phototypes IV-VI (light brown, brown, and black skin tones), resulting in delayed treatment and increased morbid-ity and mortality.1 Numerous studies predict that by 2060 the White race will be a minority in the United States. Despite the rising SoC population, there remains a scarcity of peer -reviewed literature depicting skin conditions in SoC. In 2006, autoimmune bullous diseases (AIBD) were the fourth most common cause of death from skin disease following skin cancers, ulcers, and bacterial infections.2 Many factors con-tribute to diagnostic delay including differences in pigmen-tation, which can affect the appearance of skin diseases.3 In-flammation with increased blood flow appears red or pink on white skin, whereas on brown or black skin, it is more likely to present as brown or violaceous. Pathologic changes man-ifest differently in various skin tones, and access to media depicting skin pathologies helps to improve pattern recogni-tion, diagnostic accuracy, and patient outcomes.4 We review disparities in presentation and subtle differences in the ap-pearance of bullous diseases in SoC, as well as epidemiology, pathogenesis, clinical features, comorbidities, differential di-agnosis and treatment, and its impact on diagnosis in SoC.