Recognizing the Impact of Diseases in Skin of Color

As a highly sensory specialty, dermatology is continually looking at ways to improve how it cares for its patients. Following the anti-racism movements of summer 2020, the field took an inward look at its treatment of and training in skin of color. Jasmine Onyeka Obioha, MD, a dermatologist with Cedars-Sinai Medical Group in the greater Los Angeles, CA, area, said recognizing the shortcomings in education and practice can make a difference in the lives of patients.

“We are very much different from specialties such as cardiology, because most of manifestations of disease are on the skin. If we as the dermatologist or the patient can see the disease, then others can also see them,” said Dr Obioha. Because of this, she explained, patients with skin of color can feel increased shame due to the visible nature of their pigmentary disorders.

“In general, dermatology impacts quality of life more than other conditions primarily treated by other specialties, and there are specific conditions that might have a higher impact in skin of color. There is a culture emphasis on skin color—whether that is shade or uniformity—and pigmentary disorders, specifically, can have an immense effect on our patients of color,” Dr Obioha said.

Vitiligo is a prime example. Grimes¹ described how some societies place a preference on certain skin tones (ie, shadism), and adding pigmentary defects can complicate achieving “standards” of beauty even more difficult. Further, studies have foundthat darker skin types appeared to have an adverse impact on quality of life in patients with vitiligo.^2,3 The increased contrast of pigmented vs depigmented skin can be overwhelming for patients with skin of  color.

“Recognizing this impact is hard to learn in a textbook, but exposure in real time during training would help address the gap. The social interaction can help us better understand the cultural trends and values of our patients,” said Dr Obioha.

Getting the in-practice interaction can be difficult on both sides of the patient-provider experience, however. Dermatologists practicing in areas with smaller minority populations can be a barrier to exposure; taking a preceptorship can be helpful to broadening exposure. Dr Obioha added that for patients, access to care can be the largest problem. “Access can be an insurance issue, a communication barrier involving non-English-speaking individuals, or even physical access to a dermatology clinic due to transportation or lack thereof.”

Dr Obioha recommended using the educational resources available to dermatologists. “Every year, at our annual American Academy of Dermatology meeting, a few pre-conference sessions focus on skin of color. Learning from these skin-of-color–specific
lectures can begin to give a feel of what certain ethnic groups might care about, such as facial appearances, product preferences, and more.” The Academy and the Skin of Color Society both offer web-based resources to learn more about treating skin of color.

What is most important at the end of the day, said Dr Obioha, is simply asking your patients of color appropriate questions to understand how their diseases affect them. “Instead of assuming you know the answer, ask the patient ‘How is this impacting you?’ Sometimes, you just have to put yourself out there, and patients will appreciate that you recognize their needs.”

References
1. Grimes P. Beauty: A Historical and Societal Perspective. In: Aesthetics and Cosmetic Surgery for Darker Skin Types. Lippincott; 2008:3-14.

2. Linthorst Homan MW, Spuls PI, de Korte J, Bos JD, Sprangers MA, Wietz van der Veen JP. The burden of vitiligo: patient characteristics associated with quality of life. J Am Acad Dermatol. 2009;61(3):411-420. doi:10.1016/j.jaad.2009.03.022

3. Amer AAA, Gao XH. Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades. Int J Dermatol. 2016;55(6):608-614. doi:10.1111/ijd.13198