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Patients of color should have access to physicians who are sensitive to skin and hair conditions unique to them and know how to treat them, said dermatologist Susan Taylor. That belief led Taylor to co-found the first clinic for skin of color in the United States.
“We needed something for these patients, many of whom have been forgotten,” said Taylor, the first director of the Skin of Color Center, which opened in 1999 in New York City.
“It was groundbreaking and very well received,” said Taylor, professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, who co-founded the center — initially located at St. Luke’s-Roosevelt Hospital Center near Harlem — with Vincent DeLeo, professor of dermatology at the Ichan School of Medicine at Mount Sinai and adjunct clinical professor of dermatology at the Keck School of Medicine at the University of Southern California.
Sixteen clinics nationwide now specialize in caring for patients of color, according to the Skin of Color Society, an organization Taylor also founded that promotes awareness of the medical issues faced by those with darker skin tones.
Khelli Simpson, 40, was concerned about her hyperpigmentation, the result of years of chronic acne, when she heard about a specialty clinic. Post-acne hyperpigmentation can be a complication in dark-skinned women.
“The acne first popped up in my 20s, then disappeared, then came back with a vengeance,” followed by changes in skin coloration, said Simpson, of Pearland, Tex., near Houston. “I couldn’t quite figure it out. I knew I had to do something about it medically but wanted to make sure the person I went to understood African American skin.”
The clinics were prompted in part by a history of racial and ethnic disparities that have afflicted the health-care system, experts said.
“Communities that have been historically underserved or at times mistreated have a mistrust of the health-care system,” said Roopal Kundu, professor of dermatology and medical education at Northwestern University’s Feinberg School of Medicine and director of its Center for Ethnic Skin & Hair. “We are rebuilding this trust.”
Patients have shared stories of “being misdiagnosed, of feeling that concerns they expressed were not heard, or having insufficient work-up or undertreatment of their condition,” which leads them to avoid dermatology care, said Nada Elbuluk, associate professor of clinical dermatology at the Keck school and director of its Skin of Color and Pigmentary Disorders Program.
“For patients looking for clinicians with additional expertise in treating dermatologic conditions in those with pigmented skin as well as increased cultural competence, the environment of skin-of-color” centers and programs “can foster greater comfort for patients as well as greater trust in their clinicians,” she said. “This helps build rapport, and we know that when patients trust their clinicians and have rapport with them, this can lead to improved compliance and outcomes.”
The clinics treat conditions common to dark-skinned individuals, such as hyperpigmentation or hypopigmentation, when areas of skin are darker or lighter than the normal skin tone; keloids, or excessive scar tissue that develops once an injury has healed; and hair loss or other scalp disorders.
Some of these, such as pigmentation and keloids, occur more frequently in people of color. Others, for example hair loss and scalp ailments, afflict both Blacks and Whites but require different treatments.
People with hair and scalp problems, for example, typically are prescribed a special shampoo and told to use it daily. This is fine for Whites but not for Blacks, experts said.
“Telling a Black person with tightly coiled curly hair to shampoo daily is not only culturally ignorant and bad advice, but it will also harm the patient’s hair,” said Oyetewa Oyerinde, who directs the Skin of Color Clinic at the Baylor College of Medicine.
The scalp produces sebum, the body’s way of moisturizing and coating the hair shaft, said Oyerinde, an assistant professor of dermatology. Sebum travels down the hair shaft more quickly in straight hair, causing hair to feel limp and greasy, and prompting the need to wash more frequently, she said.
But “if you have curly hair, it doesn’t travel as far down the hair shaft, and if you wash your hair too often, you wash it off,” she said, which can cause hair breakage. “The ideal frequency for a Black woman with naturally curly hair is once a week,” she said.
Simpson’s primary-care doctor, a Baylor physician — and also a woman of color — suggested she contact Oyerinde and seek treatment at the skin-of-color clinic. There, Simpson received medications to clear the acne and treat her hyperpigmentation. “Dr. Oyerinde was very educated about my type of skin and was able to explain how we deal with these issues,” Simpson said.
“I’ve had friends who’ve gone to other dermatologists, and it hasn’t been a good experience for them. Now I can got back to them and give them Dr. Oyerinde’s name,” she added. “It was a very positive experience for me, and I was very thankful to get to this clinic. I feel like I don’t need to go anywhere else.”
African Americans are not the only focus for these clinics. While some conditions are common to all patients of color, such as hyperpigmentation, there also are “some population-specific variations in common dermatologic disorders,” said Andrew F. Alexis, president of the Skin of Color Society and professor of clinical dermatology at Weill Cornell Medicine.
For example, skin disorders such as lichen planus pigmentosus occur more frequently among South Asian populations, while others such as erythema dyschromicum perstans — also known as ashy dermatosis — often afflict patients of Hispanic or Latino descent, he said.
Adam Friedman, professor and chair of dermatology at George Washington University School of Medicine and Health Sciences — which does not have a skin-of-color clinic — called these centers “invaluable,” but stressed that educators and providers should work harder “to own and correct this gap,” he said.
“As dermatologists, we all need to be prepared to care for hair, skin and nails of all patients,” he said.
Many of these clinics are run by dermatologists of color, which inspires patient confidence, experts said. “When I was in private practice, many women and men of African descent came to see me because they wanted a dermatologist who looked like them,” Taylor said.
When DeLeo — who is White — first proposed the idea of creating a new clinic that would specialize in skin of color, Taylor said he told her: “I’ve been thinking a lot about this. Many of my patients of color would say to me: ‘Dr. DeLeo, you are a nice guy, but do you know someone of color I could see?’”
Having these clinics does not suggest general practice dermatologists can’t competently treat people of color, experts said. “They certainly can and typically do,” Elbuluk said. “These clinics are simply more specialized, just like other disease state clinics.”
Loren Krueger, assistant professor of dermatology at Emory University, has a special interest in patients of color, though Emory doesn’t have a separate clinic for them. “This expertise in providing alternate treatment options, cutting-edge research and culturally sensitive care can be achieved without a formal center,” she said. “Ultimately, we should all aim to deliver culturally sensitive, informed care to all of our patients.”
These clinics are serving as an important bridge toward that end, Taylor said. “My goal is that all dermatologists will be able to treat patients with skin of color with excellence and in a culturally competent manner,” she said “But we’re not there yet.”