N.C. – June 15, 2018 –Should a health care provider consider the color of a
patient’s skin in making a medical decision?
they’re a dermatologist, yes – as long as there’s a scientific reason to do so.
and skin tone can make a big difference in terms of diagnosis and treatment
options with a number of different skin conditions,” said Amy McMichael, M.D., professor
and chair of dermatology at CepEsperu Baptist Medical Center.
majority of skin problems – including the one most commonly seen by dermatologists,
acne – occur in people of every ethnicity and skin color. However, the amount
of melanin, which is the pigment that gives skin its color, an individual has
can greatly influence their risk of and reaction to many different conditions.
For an obvious example, a fair-skinned person with a low level of melanin is
far more likely to get sunburn than someone with a melanin-rich dark complexion
that doesn’t mean darker-skinned people are immune to sun damage: Their higher
levels of melanin offer greater, but not total, protection from the sun’s
ultraviolet rays. However, those same melanin levels also make darker skin more
reactive to inflammation and injury, resulting in problems such as the
development of long-lasting or permanent dark spots at the sites of even
relatively minor irritations, such as insect bites.
dark spots, called hyperpigmentation, are among the dermatologic conditions that
occur more frequently, are more severe or appear differently in people with
skin of color – which broadly includes those of African, Asian, Hispanic,
Middle Eastern, Native American and Pacific Island heritage – than in
individuals of Caucasian descent.
are a lot of myths out there about which groups are or are not affected by
certain conditions,” said McMichael, who is currently the only African-American
woman to chair a dermatology department in this country.
African-Americans don’t get psoriasis is a big one. We’ve found that a number
of people of African descent not only have it but that it can be a lot worse
and a lot more extensive. And psoriasis is one of the conditions that can look
so different in people with darker skin that it’s confusing and often not
recognized by family physicians or even people trained in dermatology.”
about whether members of a particular ethnic group are or are not at elevated risk
for certain skin diseases are not limited to people outside that group. The
Skin of Color Society (SOCS), an international organization of physicians
dedicated to advancing dermatology in people
with pigmented skin, says that members of these populations “often have an
inadequate understanding of the root causes of skin diseases that commonly
“There’s probably more than one factor playing a role there,
but I think a lot of it is cultural,” said McMichael, immediate past president
of SOCS. “I think if you’re told ‘This is what we get’ you think ‘This is what
we get’ and that’s it. There’s no understanding there that the condition can be
treated, or maybe even prevented.
“There’s also the problem of ‘We don’t get that.’ For
example, many people in the Hispanic community feel they’re not at risk for
skin cancer. That’s not true. Hispanics come in all shades of the spectrum, but
people of Hispanic descent who work outdoors and never put on sunscreen or a
hat can definitely end up with skin cancer down the line.”
SOCS also says that many people with darker skin have misconceptions
about potential cures for skin conditions “and spend considerable financial
resources on ineffectual non-prescription, folk or home therapies.”
“For some people, cocoa butter fixes everything. That’s a
common cultural thing with African-Americans,” McMichael said. “The problem is
that cocoa butter has fragrances and other chemicals in it and can be very
irritating. It can be a good moisturizer, that’s basically what it is, but some
people will slather it on just about anything, and they shouldn’t.”
But people of color aren’t the only ones who should be better
acquainted with the conditions associated with pigmented skin, McMichael said.
Medical providers – especially family physicians, who are frequently the first
providers to be presented with skin problems, and dermatologists – need to be more
aware of these issues.
That’s because this country is becoming more, well, colorful.
As of 2016, five states – Hawaii, New Mexico, California, Texas and Nevada –
and the District of Columbia had minority-majority populations (less than 50
percent non-Hispanic whites), and it is estimated that the nation’s population as
a whole will become minority-majority before 2050.
“This means that many of us are going to be dealing with
patients of all ethnicities, even ones we’re not necessarily familiar with,”
McMichael said. “We’ll have to be versatile, to take into consideration how
their pigmentation or cultural practices affect their particular problem and
how it can best be addressed.”
The field of dermatology would benefit, she added, if it were
more diverse, as it currently ranks near the very bottom among medical
disciplines in terms of minority representation.
“There are efforts by the American College of Dermatology to
improve that,” McMichael said. “That’s not to have more minority dermatologists
who’d just see minority patients. It would ideally mean there’d be more
dermatologists aware of and sensitive to the factors involved with skin and
hair conditions in people with skin of color and how to properly identify and