Intersectionality in Dermatology: Skin of Color & Sexual and Gender Minorities

The number of people identifying as sexual and gender diverse (SGD) continues to rise in the United States. Within the SGD community, the number of people who also identify as belonging to a racial/ethnic minority group continues to expand as well. However, intersectional dermatologic research concerning individuals who identify as both a sexual and gender minority (SGM) and a racial/ethnic minority has not kept pace with their respective community growth rates. To deliver compassionate, culturally humble care to these communities, current and future dermatologists should be informed about the importance of an intersectional approach to clinical care.

 What is Intersectionality?

The concept of intersectionality was first introduced by Black feminist Kimberlé Crenshaw in her work exploring the complexities of oppression and the interactions of both race and gender. Intersectionality has evolved into the idea of holding multiple social identities (eg, Black and gay, Asian and transfeminine) and understanding how these multiple identities impacts the way one moves through the world.

Defining Sexual and Gender Minority (SGM)

SGM refers to sexually and gender-diverse individuals and encompasses the entire LGBTQIA+ spectrum. As medical professionals, we should be aware of the disproportionate health disparities that burden SGM individuals, including substance use, mental health issues, and chronic health conditions. Certain dermatologic diseases may also disproportionately affect members of this group. For example, there is a higher incidence of HPV and anal dysplasia in men who have sex with men (MSM). Additionally, transgender individuals receiving gender-affirming hormonal therapies may experience a higher incidence of acne and alopecia.

Why Does Intersectionality Matter?

The multiple components of one’s identity—including but not limited to sexual orientation, gender identity, race, ethnicity, culture, socioeconomic status—do not exist in a vacuum. These aspects are intimately connected, influencing how an individual perceives and experiences the world. To address the issues faced by individuals with multiple marginalized identities and to enact change, each facet of one’s identity should be considered, especially within the context of medicine and health disparities. For example, the health issues and experiences of a White gay man are likely to be greatly different from that of a Black or Brown transwoman.

Dermatologic disparities that specifically burden people of color have been increasingly discussed in medical literature. Similarly, more research to address these issues has been conducted over the last decade. Conversely, although recent studies have highlight the increasing rates of certain dermatologic disease among the SGM population, the inclusion of sexual orientation and gender identity within dermatology research has been lacking over the last 10 years. Therefore, it’s reasonable to conclude that intersectional dermatology research examining the direct impact of both racial/ethnic and sexual/gender identities on dermatologic disease is likely minimal.

Consider the case of HPV and anal dysplasia in MSM. While some studies have characterized disease occurrence rates in MSM and stratified the data by race/ethnicity, researchers may find it impactful to explore this one step further by examining potential differences in disease severity and burden at time of diagnosis in White patients versus patients with skin of color. However, performing such studies are arduous due to lack of existing intersectional data.

Moving the Needle Toward a More Intersectional and Equitable Approach

Intersectionality as it pertains to dermatology has been understudied for far too long. Continued collaboration, persistence, and advocacy efforts at all levels of medical training are key to minimizing these deficits.

Clinicians must always practice culturally humble care. Understanding the multiple identities a specific patient holds and how those identities contribute to the patient’s overall health is imperative. Providers should respectfully note an individual’s current gender identity, name, and pronouns. Additionally, creation of a non-judgmental and an affirming atmosphere is equally important.

Routine data collection of patients’ sexual orientation and gender identity should be normalized and systematic in both a clinical practice and clinical trials. These data collection efforts can help promote culturally humble care and improve clinical outcomes for these patients. Routine data collection may also allow us to more effectively identify and address the health disparities of SGD patients and their subgroups by providing the data points to conduct future studies.

Lastly, increasing intersectional efforts within medical curricula and training is necessary for lasting change. Integrating sexual and gender diverse-specific curricula will allow for better preparedness in providing care for this community. Expanding the number of medical students, residents, and faculty with intersectional identities is imperative, as these individuals are the most equipped to identify gaps, teach others, and advance care for patients belonging to the same communities.


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