Skin Color Needs to Be Factored in When Discussing Skin Diseases

New programs are being started to educate dermatologists about how skin diseases can react to different types of skin color.

It sounds obvious. When people come in with skin issues, dermatologists need to be aware of the color of that skin.

But all too often, dermatologists aren’t, some experts say.

That can lead to misdiagnoses, ineffective treatments, or even people not coming in to see a doctor in the first place.

And it’s an oversight that often has its roots in medical school, these experts say.

Most skin problems, including the most common ones, such as acne and sunburn, can occur in everyone, no matter their ethnicity or skin color.

But some issues look different in skin of different colors.

The itchy, scaly rashes of psoriasis, for instance, can have different appearances and different colors — purplish rather than reddish — on darker skin.

That can lead to not being recognized by experienced dermatologists, says Dr. Amy McMichael, professor and chair of dermatology at Wake Forest Baptist Medical Center in North Carolina.

That’s largely a matter of education, says Dr. Jenna Lester, a dermatology resident at the University of California at San Francisco (UCSF).

“A lot of dermatology training has to do with pattern recognition,” Lester told Healthline. “Part of that is identifying colors, and certain colors clue us into things that are happening on the cellular level.”

A large part of that training consists of looking at photos. But, Lester says, if those photos don’t adequately represent the range of skin tones a dermatologist may work with in the real world, it’s going to hurt their ability to recognize the different shapes and colors a given issue may take.

Skin cancers, for example, are less common in people of color but are more likely to be pigmented when they do appear, McMichael told Healthline.

And higher melanin levels can make common things such as atopic dermatitis, acne, or insect bites more likely to cause longer-lasting dark spots, or hyperpigmentation.

“Truly any condition that is inflammatory can cause significant hyperpigmentation that lasts much beyond the resolution of the original disease process,” McMichael, the only African-American woman chair of a dermatology department in the United States, said

Lack of diversity

Differences like these can be due to the ethnic background that led to a certain skin color in the first place or simply due to the color of the skin.

Part of the issue might be that dermatology is overwhelmingly dominated by doctors with lighter skin.

A 2016 study found 68 percent of dermatologists in the United States were white, 6 percent were black, 3 percent Latino, and the remainder of Asian descent.

“Historically, there have been only a few dermatologists who have skin of color themselves,” Dr. Bruce Wintroub, chair of dermatology at UCSF, told Healthline.

But, he says, “the field has focused on recruiting individuals with skin of color into it, so there is now an evolution of knowledge in the field.”

Lester says that many dermatologists are aware of the difficulties in diagnosing certain skin diseases in skin of color, and that their comfort level in making those diagnoses has been studied formally.

“I think many doctors are aware, but I think it’s always important to raise awareness,” she said.

That awareness needs to increase not only among doctors but also among patients, so they can advocate for themselves and feel confident that they’re getting the best treatment.

New programs starting

With these goals in mind, Lester is helping establish a skin of color program at UCSF.

Another program, the Skin of Color Society, of which McMichael is past president, works to increase the understanding and awareness of how dermatological conditions affect African-Americans, Latinos, and people of Asian, American Indian, and Pacific Islander descent.

Lester sees programs such as these as serving to educate and throw a spotlight on the issue.

At UCSF, her program would do that for faculty members that come through the department. They might not have spent much time thinking about the need to look for something different in diagnoses for patients with different color skin when they got to UCSF, but it’s something they’ll be aware of for the rest of their career once they see the emphasis it’s given there.

The other advantage, Lester says, is that patients might see the same thing with doctors “focused on treating things that are common in patients of color.”

“It’s important for patients to be able to identify a place where they can go and their needs will be met,” Lester said. “A huge barrier to care is patients thinking their needs aren’t going to be met, so they stay home.”

And programs like hers may also be able to concentrate larger groups of patients of color, which could show the need for and enable further studies to be done on overlooked conditions.

Thus, further increasing knowledge and awareness among dermatologists.