Skin color is underrepresented in medical courses and textbooks, which can lead to missed diagnoses and disparities in care. These dermatologists take matters into their own hands.
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Dermatologist Dr. Jenna Lester remembers being a medical student and rarely seeing black and brown skin tones in textbooks. Teachers will talk about how a medical condition can look different on dark skin.
"But they didn't have a picture," he said.
He said it was unacceptable that he and his colleagues were not properly trained to identify the condition in skin tones like his. Therefore, in 2018, he started the Color Skin Program at the University of California, San Francisco. He wanted to provide targeted care to people of color and train dermatologists to treat skin of color.
Dark skin is underrepresented in medical courses and textbooks, and research into treatments for skin of color often lags behind, leading to misdiagnosis and incorrect treatment, experts say. More and more dermatologists are taking matters into their own hands to raise awareness of the deficiency and start their own training programs.
Dermatologist Dr. "What is happening now is that medical schools and training programs in general are rethinking their curriculum, the resources they use and the way they teach their students because there are gaps," said Nada Elbulu. He teaches at the USC-funded Skin of Color Center and Clinic for Pigmentary Disorders.
Doctors in training rely on imaging to diagnose skin conditions. Eczema, psoriasis, inflammation, acne and other skin conditions show up in different skin tones.
For example, in black and Hispanic patients, psoriasis patches may be dark brown or purplish-gray, and the scales that cover them may also be gray or silver. With whites, they have a pink or red tone.
But studies have shown that medical textbooks lack diversity in skin color, showing mostly fair-skinned examples. The description of skin color in dermatology textbooks ranges from 4% to 19%. A study published earlier this year found that 11% of images in Dermatology Reviews were of black skin and only two were of very dark skin.
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Meanwhile, little progress has been made. Between 2006 and 2020, only 1 in 6 dermatology textbooks saw an increase in descriptions of dark brown or black skin, and half of the textbooks did not include dark-skinned patients with common conditions such as acne and psoriasis. Lester says black skin is getting more attention in the treatment of sexually transmitted infections, perpetuating harmful stereotypes.
To educate clinicians, Elbulu created Project IMPACT, a clinical image database that helps clinicians make diagnoses in VisualDx, where he serves as director of clinical impact.
In partnership with the New England Journal of Medicine and the Skin of Color Society, Project Impact created the Skin of Color webinar series on skin and hair disorders, structural racism, and bias in medicine for people with skin and hair disorders.
"We work to improve health equity through medical education and expand medical education through medical technology," said Elbulu, an assistant professor at the USC Keck School of Medicine.
A more comprehensive overlay tool for color images like VisualDX can help fill those gaps, Elbuluk said. Dermatologists are increasingly turning to other sources as well, such as the Color Skin Society; Tools like DFTB Skin Deep, a database of descriptions of various skin diseases; and the latest in full-spectrum dermatology. diverse and comprehensive atlas".
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At the same time, professors and students can help textbook publishers make changes quickly, said Northwestern University medical student Trisha Kundiniya and dermatologist Dr. Write in Rupal Kundu magazine. Medical schools have been asked to begin establishing student-led curriculum review panels.
"Publishers and text editors have steadily begun to overcome these differences, but fundamental changes in training are needed to comprehensively address this," they said.
One such medical student, Malone Mukwende of St George's University Medical School in London, collaborated with two professors to develop the Mind the Gap guide to clinical photography of black and brown skin. She launched Hutano, a social platform that connects patients of color with information, skin condition research, and other patients.
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This inadequacy led to the lack of medical research, Dr. Neelam Vashi, founder of Boston University's Ethnic Skin Center and author of the textbook Dermatoanthropology of Ethnic Skin and Hair.
"When we look at all the research studies, they're mostly done on white skin," he says, adding that studies often leave out darker skin tones. We don't know how they will respond if we don't include that large part of the population."
When black patients are diagnosed with certain conditions, the diseases are more advanced. For example, onychomycosis affects black patients more often and is diagnosed later.
Similarly, although skin cancer is less common in dark-skinned patients, when diagnosed, it is often at a more lethal stage. One study found that while nearly 90 percent of white patients survived five years after a melanoma diagnosis, only 66 percent of black patients did. Squamous cell carcinoma is 10 times more common in black patients than in white patients.
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A number of socioeconomic factors that disproportionately affect people of color, such as lower insurance rates or pollution, may exacerbate skin health disparities, experts say.
Lester cites pollution, heat and allergens as triggers for eczema flare-ups. Because of climate change and historical redlining, they disproportionately harm communities of color. He said that doctors should think about the whole life of their patients.
Temple University Lewis Katz School of Medicine scientist Dr. Kendricks Heath says insurance coverage for conditions common to people of color can be considered a cosmetic issue, even if it affects their quality of life.
For example, laser treatment for Vitiligo, which reduces skin pigmentation, may not be covered. But the same phototherapy used to treat psoriasis, which usually occurs on pale skin, can hide it, Heath explains.
"Over and over again in dermatology, we see conditions that are specific or unique to people of color," Heath said, adding that research and funding lag. Her older sister had a large birthmark on her face Laser treatment for the skin condition was initially only tested on white patients, he said.
"Patients of color ... are dermatologically marginalized," Lester said. "Fortunately we have a curriculum that changes, but you never know what you don't know."
Contact Nada Hassanein at nhassanein@usatoday.com or @nhassanein_ on Twitter.