Content area
Full text
By the year 2043, racial and ethnic groups, such as people of African, Hispanic, Latino/a/e, Asian, Native American, and Pacific Islander ancestry, in the United States are projected to comprise more than 50% of the population, with more than 20% of the population younger than age 18 years. It is imperative that both primary care providers (PCPs) and dermatologists recognize common dermatoses in patients with darker skin complexions and be aware of dermatologic conditions that may have a predilection for people of color. Additionally, there are unique cultural and societal considerations that should be factored into treatment decisions.
Diagnostic Challenges
Underrepresentation of People of Color in Dermatology Training
The pool of practicing dermatologists does not reflect the racial and ethnic makeup of the general population of the US. For example, Black people make up 13.4% and Hispanic people comprise 18.5% of the general population, compared to 3% and 4.2% of dermatologists, respectively.2 Dermatology textbooks are known for the lack of representation of people with darker skin phototypes. Among four dermatological textbooks, the skin types represented were far more skewed in the direction of lighter skin tones—failing to represent a diverse distribution of skin phototypes.3 Without the proper representation for people of color in teaching materials, trainees are less likely to be able to eventually diagnose and treat these patients, potentially leading to worse outcomes.
Recognizing Inflammation
A particularly challenging part of the diagnostic process when it comes to darker skin phototypes is the recognition of inflammation, which is integral when evaluating the etiology or extent of certain conditions. In White patients, inflammation is often marked by “erythema” or redness. However, in people of color, inflammation can present as violaceous, ashen gray, or as a darker brown/black color, which may be missed by untrained providers4 (Figure 1). This can lead to the underestimation of disease severity and thus may lead to a less aggressive treatment regimen, which is to the detriment of the patient. Inflammation on darker skin phototypes may also be masked by hyperpigmentary conditions such as postinflammatory hyperpigmentation, making it even more challenging to recognize and treat.
Therefore, clinicians should familiarize themselves with the presentation of inflammation in various skin types, as well as other examination findings that can...