Unveiling Racial Disparities in Dermatology: A Call for Inclusive Dermatological Care and Medical Education

Mishika Bhatia

Introduction

The field of dermatology has long overlooked a significant challenge: racial disparities in diagnosis and treatment. Skin conditions affect individuals of all ethnic backgrounds, yet medical education in dermatology often falls short of addressing the unique nuances of conditions manifesting on darker skin, or SOC (skin of color). This oversight contributes to a higher likelihood of misdiagnosis for people of color, thereby perpetuating a cycle of unequal care. Research showed, “a survey of program directors (PDs) and chief residents (CRs) reported that only 25.4% of the CRs and 19.5% of the PDs reported having lectures on SOC from an acknowledged expert. Only 14.3% of CRs and 14.6% of PDs recognized an expert at their institutions who conducted a SOC clinic. Finally, only 30.2% of CRs and 12.2% of PDs reported a specific rotation in which residents gained experience in treating SOC”. 2 Such gaps in medical education contribute to misdiagnoses, underscoring the urgent need for a more inclusive approach to dermatological education.

Dermatological Education & Cultural Competency

The origins of racial disparities in dermatology can be traced back to practices that focused on dermatological conditions as they appeared on lighter skin tones. 9 Traditional medical literature and educational materials predominantly feature images and descriptions of skin disorders based on observations made on individuals with lighter skin, with “fewer than 5% of the pictures in dermatology textbooks featuring dark skin”. 6 This bias has perpetuated a systemic lack of understanding and awareness of the symptoms of dermatological conditions on darker skin. Medical students and practitioners are frequently educated using materials and textbooks that predominantly showcase conditions on lighter skin, leaving them unprepared to identify the same conditions in individuals with darker skin. 9 Consequently, this signifies the increasing importance of cultural competence in dermatology, especially in a society that is becoming increasingly diverse. A myriad of studies published in the Journal of the American Academy of Dermatology revealed that clinicians were more likely to misdiagnose skin conditions in patients with darker skin compared to those with lighter skin. 7 This lack of accuracy emphasizes the urgent necessity for medical education to evolve to account for a society that is rapidly increasing in diversity. When skin conditions are misidentified or dismissed, patients of color frequently face delays in receiving appropriate treatment. Moreover, misdiagnoses can lead to unnecessary procedures or medications, resulting in avoidable healthcare costs and potential adverse effects, and in some cases, malpractice. 9 Additionally, certain dermatological conditions are more common in specific ethnic groups, and a failure to recognize and treat these conditions can contribute to healthcare disparities, especially in dermatological care, with conditions encompassing everything from sores to skin cancer. For instance, keloid formations are 15 times more likely in dark-skinned individuals than in patients with lighter skin. 1 Without adequate training in recognizing these conditions in all patients, healthcare professionals misdiagnose or inadequately treat these conditions. 7

Improvements in Medical Education

To rectify such significant racial disparities in dermatology, medical education must undergo a transformative shift. Incorporating more diverse representations of skin conditions in educational materials like textbooks, question banks, case studies, and clinical training is essential. 8 Medical schools and residency programs must include curriculum that specifically addresses conditions on darker skin and accounts for variances in different ethnic groups. Furthermore, increased representation of healthcare professionals from diverse backgrounds in leadership positions and academia can allow for a more inclusive and equitable medical education system.

Conclusion

Substantial racial disparities in dermatology remain due to systemic issues in medical education that fail to address the variances of dermatological conditions on darker skin, and educational organizations like the AAD (American Academy of Dermatology) have only recently begun addressing the issue. 4 The consequences of misdiagnosis are significant, leading to delayed treatment, increased healthcare costs, and potential harm to the well-being of patients of color, serving as a barrier to equal medical care. A concerted effort is needed to reform dermatology education and as such, the medical community has a moral and medical obligation to tackle racial disparities in medical care. To achieve this, we must provide more culturally inclusive medical education to future generations of healthcare professionals, a transformation that is vital to ensure that all individuals, regardless of their skin color, receive the highest quality of dermatological and medical care. Now is the time for change, and it begins with a healthcare system that truly reflects and serves the diverse needs of its patient population.

References

  1. Chike-Obi CJ, Cole PD, Brissett AE. Keloids: Pathogenesis, Clinical Features, and Management. Seminars in Plastic Surgery [Internet]. 2009 Aug 1 [cited 2020 Apr 23];23(3):178–84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884925/
  2. Narla S, Heath CR, Alexis A, Silverberg JI. Racial disparities in dermatology. Archives of Dermatological Research. 2022 Dec 12;315.
  3. McFarling UL. Lack of darker skin in textbooks, journals harms patients of color [Internet]. STAT. 2020. Available from: https://www.statnews.com/2020/07/21/dermatology-faces-reckoning-lack-of-darker-skin-in-textb ooks-journals-harms-patients-of-color/
  4. Rabin RC. Dermatology Has a Problem With Skin Color. The New York Times [Internet]. 2020 Aug 30; Available from: https://www.nytimes.com/2020/08/30/health/skin-diseases-black-hispanic.html
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  6. https://www.facebook.com/WebMD. Why People of Color Are Commonly Misdiagnosed [Internet]. WebMD. 2023. Available from: https://www.webmd.com/skin-problems-and-treatments/psoriasis/features/poc-misdiagnosis-plaq ue-psoriasis
  7. Hooper J, Shao K, Feng H. Racial/ethnic health disparities in dermatology in the United States, part 1: Overview of contributing factors and management strategies [Internet]. JAAD. Journal of the American Academy of Dermatology; 2022 [cited 2023 Dec]. Available from: https://www.jaad.org/article/S0190-9622(22)00194-3/fulltext
  8. Evans A. Strengthening the chain of care [Internet]. www.aad.org. 2023 [cited 2023 Dec 26]. Available from: https://www.aad.org/dw/monthly/2023/December/feature-strengthening-the-chain-of-care
  9. Hassanein N. Images of darker skin are absent from medical texts. Dermatologists are changing that. [Internet]. USA TODAY. 2022. Available from: https://www.usatoday.com/story/news/health/2022/12/05/dermatologists-skin-of-color-underrepr esented-medical-training/10748390002/
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