Skin of color dermatology refers to the diagnosis and treatment of skin conditions that disproportionately or uniquely affect individuals with darker skin tones. These individuals are primarily of African, Asian, Hispanic, Middle Eastern, Native American, or Pacific Islander descent. The field of dermatology has historically focused on conditions affecting those with lighter skin, resulting in disparities in the care of people with skin of color.
Background
Melanin is the pigment that gives skin its color. Those with more melanin in their skin are categorized as having skin of color. Melanin provides some protection against ultraviolet radiation from the sun. However, it also leads to biological differences that can affect the presentation, diagnosis, and treatment of skin disorders.
Some key differences include:
- Increased melanin provides more photoprotection but makes it harder to visually detect conditions like vitiligo, erythema, and bruising.
- Darker skin is more prone to post-inflammatory hyperpigmentation and keloid scarring.
- Higher melanin density also impacts drug absorption and treatment response.
These differences mean skin diseases do not always present the same across skin tones. Skin of color dermatology aims to address these disparities and meet the specific dermatologic needs of diverse populations.
Common conditions
Some of the most common dermatologic conditions that affect darker skin differently include:
Acne
Acne in skin of color is often characterized by dark marks and keloids. Treatment focuses on preventing post-inflammatory hyperpigmentation in addition to clearing breakouts.
Eczema
The chronic itchy rash of eczema often lacks well-defined borders on darker skin. It also more frequently occurs in skin creases. Management involves regular moisturization and avoiding triggers like irritants and allergens.
Psoriasis
Psoriasis causes scaly, thickened patches that can be difficult to see on dark skin. The plaques are often mistaken for fungal infections. Phototherapy is an important treatment option.
Vitiligo
This condition causes loss of skin pigment, creating lighter patches. It is especially noticeable on darker skin. Treatments include phototherapy, topical steroids, and skin camouflaging makeup.
Melasma
Dark, irregular facial patches are characteristic of melasma. It is thought to be caused by sun exposure and hormones. Prevention includes regular sunscreen use and avoiding UV radiation.
Barriers to care
People with skin of color face unique barriers when seeking dermatologic care:
- Lack of access to dermatologists trained in treating diverse skin types
- Delays in diagnosis due to conditions being less recognizable on dark skin
- Clinical images and terminology geared towards fair skin
- Scarce representation in clinical trials of treatments
- Affordability issues and medical mistrust
There are also fewer FDA-approved treatments for disorders like vitiligo and melasma that prevail in communities of color.
Improving care
Advancing the field of skin of color dermatology involves:
- Increasing awareness and dedicated training in medical curriculums
- Conducting further research on conditions affecting pigmented skin
- Diversifying clinical trials to include more people of color
- Developing novel therapies to meet unique needs
- Producing educational resources showing dermatologic conditions across skin tones
- Promoting access to dermatologists familiar with treating diverse populations
Role of dermatologists
Dermatologists play a key role in improving outcomes for patients with skin of color. Important practices include:
- Accounting for racial differences in disease presentation and prognosis
- Avoiding a one-size-fits-all approach to treatment
- Closely monitoring for post-inflammatory hyperpigmentation
- Educating patients on photoprotection and regular skin self-exams
- Familiarizing oneself with skin conditions associated with increased risk in pigmented skin
- Making clinical environments more welcoming for communities of color
The future
While advancements have been made in recent years, there is still a need for expanded knowledge regarding dermatologic care for diverse populations. Increasing expertise and research in skin of color dermatology will help provide optimal, evidence-based care for all patients regardless of skin tone.
With growing understanding of the impact of skin biology on disease emergence and treatment response, the management of conditions prevalent in communities of color can be significantly improved. Dermatology practices also need to prioritize diversity, inclusion and cultural competence. Addressing barriers to care and health disparities will lead to better access and outcomes.
Skin of color dermatology has emerged as an essential subspecialty to provide quality, equitable dermatologic care to our increasingly diverse population. Continued progress will benefit both patients and dermatologists alike.
| Condition | Key Differences in Darker Skin |
|---|---|
| Acne | Increased risk of post-inflammatory hyperpigmentation and keloid scarring |
| Eczema | Poorly defined borders, often found in skin creases |
| Psoriasis | Plaques can be mistaken for fungal infections |
| Vitiligo | Loss of pigment is more noticeable on darker skin |
| Melasma | Irregular dark facial patches caused by sun exposure |
Conclusion
Skin of color dermatology focuses on conditions affecting individuals with diverse skin tones. Historical disparities and biological differences based on melanin levels mean skin disorders can manifest differently across races and ethnicities. By improving awareness, research, and clinical expertise, dermatologists can provide optimal treatment to all patient populations regardless of skin color.