Medical professionals should aim to eliminate biases in their clinical practice—notably, assumptions or expectations regarding treatment for people of color. Unfortunately, there is still a white-leaning bias across many aspects of the field of dermatology, and dermatologic education (for laypeople and health care professionals) is often geared toward white people and the way skin conditions manifest on white skin. According to Healthline, the higher melanin content in black skin affects the way certain conditions, like psoriasis on black skin, present themselves. This is detrimental for people of color because without proper representation of all types of skin, it's difficult to recognize certain skin issues, which can lead to a delayed diagnosis—or worse, a missed diagnosis.
Psoriasis on Black Skin
Psoriasis is a chronic skin condition where the affected skin is covered by thick plaques with silvery scales. On white skin, psoriasis often has pink or red patches with silvery scales, but the clinical appearance may vary across skin types. Psoriasis on black skin often has a more purple or dark hue with gray scales and can be mistaken for fungal infections or eczema. People living with psoriasis are at risk for other chronic conditions, like psoriatic arthritis, high blood pressure, heart disease, and diabetes, so it's imperative that doctors are well-equipped to evaluate and treat skin of all colors.
Cellulitis on Black Skin
Cellulitis is a common bacterial skin infection where the affected skin becomes swollen, red, warm to the touch, and painful. Patients with advanced cases of cellulitis may require inpatient hospitalization and treatment with intravenous antibiotics. The clinical hallmark of cellulitis is its bright red color, but it is not as prominent on darker skin tones, so it is often overlooked by patients and doctors.
Rosacea on Black Skin
Rosacea is a skin condition that commonly affects facial skin and causes redness in the nose, cheeks, chin, or forehead. When not treated, red solid bumps and pus-filled pimples can develop. Because of the pigmentation of dark skin, it can be difficult to spot this redness, which can, again, lead to a delay in diagnosis. If you're having trouble determining for yourself, a board-certified Dermatologist should know how to spot the signs of rosacea in black skin: face flushness or feeling warm, unidentified discoloration of the face, dry patches of skin that appear swollen, and many more.
How to Advocate for Yourself in the Doctor's Office
Even though physicians strive to be unbiased in the workplace, it is difficult to eliminate all biases. Providers should learn a certain cultural competence and be proficient in recognizing the spectrum of skin diseases across different patient populations, but it is also important that you advocate for yourself in the doctor's office. Some ways you can do this include the following:
- Do your own research: Come to the office well-equipped with information so you can clearly and confidently explain your symptoms, and be prepared to ask questions.
- Find the right Dermatologist: It may take some time to find the right doctor, but a Dermatologist who is trained in treating patients of color or is a person of color themselves will be more familiar with your skin and any possible issues.
- Trust your doctor: Once you find a Dermatologist who listens to you and is well-versed in skin issues for people of color, trust them. They have your best interests in mind and are an ally to you in your healthy skin journey.
The dermatology world still has some room to improve, but many Dermatologists are making strides in an effort to center people of color in medical conversations. Educating yourself on how skin conditions present on black skin will help in the shift toward a more-inclusive medical world.
Author
