Derm Topics

Challenging Clinicopathologic Scenarios: Traps to Avoid

Histopathology can be rendered useless without good clinical information, according to Dr. Olayemi Sokumbi, a dermatologist and dermatopathologist with Mayo Clinic. Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic & Surgical Conference, interviewed Dr. Sokumbi about traps to avoid in challenging clinicopathologic scenarios. Learn how not to miss a diagnosis of dermatomyositis in your patients with skin of color. Find out why it’s important to stay up to date on new drugs and their side effects. Plus hear why getting the right sample can help you get the right diagnosis.

Further Reading

If you want to read more about challenging clinicopathologic scenarios, check out the following articles published in the Journal of Drugs in Dermatology:

Urticaria Pigmentosa Without Pruritus


Mastocytosis is a group of disorders characterized by the pathologic accumulation of mast cells in various tissues. One example of mastocytosis is urticaria pigmentosa, which presents with mastocytomas that can cause hives and, when irritated, pruritus. To our knowledge, we are describing the first case of urticaria pigmentosa without pruritus. The patient had a positive Darier’s sign, stated that they never felt itchy, and denied ever using a topical steroid or antihistamine. Although our patient declined additional testing, patients like this may benefit from a detailed evaluation of their sensory system through both quantitative sensory testing and genetic analysis.

Atypical Dyschromia in Skin of Color


Dyschromia is a concern for many patients, especially persons of color. Postinflammatory hypopigmentation and depigmentation can affect all skin types; however, it is more apparent in those with darker skin. Some members of the dermatology community may not comprehensively understand the mechanisms of these reactions and the extent of the psychosocial effect they have on persons of color. Skin of color patients experiencing a decrease or loss of pigmentation are left with few treatment options, with no available evidence-based treatment established from a sufficient sample size. Several diseases may present with hypopigmentation and/or depigmentation despite this not being a major criterion for these conditions, including atopic dermatitis, lichen planus, discoid lupus erythematosus, polymorphous light eruption, and scleroderma. Here, we present three cases of atypical dyschromia in skin of color to highlight the underlying hypo- and depigmentation that may present with active disease and persist despite appropriate treatment. 

Practice Points:

    1. These cases foreground the potential for a range of dermatologic conditions to result in atypical pigment changes in persons of color.
    2. Postinflammatory hypopigmentation or depigmentation may persist in skin of color despite the regression of active disease.

Did you enjoy this video interview? Find more here.