Dermatology is one of the most visual medical fields. Beginning in medical school, dermatology requires the study of pictures and images. Pattern recognition and visual cues are crucial in making a diagnosis; we learn about the red, scaly rash of eczema, or the “bullseye” rash of Lyme disease.
The downside of relying on images, however, is that when images of lighter skin are much more common than images of skin of color, it makes it much harder to recognize these diseases in people of color.
Defining skin of color
Skin of color, as the name suggests, refers to the skin of individuals of non-White racial and ethnic groups (including but not limited to Asian, Black, Native Hawaiian or other Pacific Islander, and American Indian or Native Alaskan).
Why is a commitment to skin of color crucial?
When a skin of color patient presents to clinic with a purple, itchy rash or a dark red, circular blotch, these “non-classic” presentations may lead to difficulty in diagnosing their eczema or Lyme disease, leading to delays in diagnosis or even misdiagnosis.
This lack of resources in skin of color isn’t just limited to medical schools. When doing a Google images search of relatively common skin conditions like acne or psoriasis, the overwhelming majority of image results depict lighter skin types. Patients of skin of color may be especially confused without having “textbook” reference images. A recent study looked at 74 common skin diagnoses, with the vast majority having only one-tenth of their images being skin of color and one-fourth having no images of skin of color at all. Without images to train on and improve care in patients of color, this scarcity may exacerbate already existing health inequities. Moreover, most patients first see a physician other than their dermatologist, like their family medicine provider, for their skin concern. As the skin can represent a window into one’s health, this lack of images in patients of skin of color affects patients of all kinds of providers.
VisualDx recently launched Project IMPACT, a global effort to reduce disparities in medicine. One aspect of the movement is focused on increasing the resources in skin of color and better recognizing how skin diseases present in patients with darker skin types. One of the main goals of Project IMPACT is to increase this bank of resources. For example, the total number of non-White persons in the US is about 40%; however, a recent analysis of medical school board exam preparatory resources found only 15% of images on average used in these materials depict diseases in skin of color.
Omission of skin of color in dermatology is not a new issue; one of the first dermatology textbooks on skin of color was recognized over 40 years ago. Recently, the issue has gained further acknowledgment, both with the medical and wider community. The rate of publications in skin of color has increased yearly over the past decade, and studies are delving further into topics like representation in medical school curricula as well as further sub-classifying the wide range of skin tones that exist under the “skin of color” spectrum.
The shift in focus toward mitigating this particular disparity in dermatology has been notable. However, it will be important to continue the momentum in achieving true equity in care for patients of color.
One way to participate is by increasing the bank of resource images. Project IMPACT and social media accounts such as @brownskinmatters are focused on increasing reference photos of dermatologic conditions in skin of color. Some diseases (like Lyme disease) are notoriously rarer to find examples of and adding to this library of images may help future dermatologists and their patients.
Finally, if you’d like to educate yourself, Project IMPACT has collated an excellent list of resources as a first step. Participating in this movement will be important as we continuously push toward health equity in dermatology for all.