Identifying Racial Disparities in Dermatology Literature

The global spread of the COVID-19 pandemic has uncovered several gaps in healthcare education. And while some of these are newly discovered barriers, others are decade-long obstacles that remain unsolved.

In the field of dermatology, the fact that patients present with rashes on the skin and toes as a symptom of COVID-19 has exposed a massive racial disparity. Because according to the latest research, black and brown skin is almost entirely unaccounted for in medical literature.

A thought-provoking piece from Stat News dove into this disparity and how the healthcare field has been responding. Here are a few measures dermatologists are taking to develop skin color-inclusive education.

Skin Color Diversity in Images of COVID-19 Symptoms

Assistant Professor of Dermatology at the University of California Dr. Jenna Lester investigated the absence of images portraying black and brown skin in publications featuring COVID-19 skin manifestations.

Dr. Lester and her team analyzed several articles and journals, collected images of cutaneous manifestations associated with COVID-19, and categorized them based on Fitzpatrick type I-VI. The 116 photos included in the study almost exclusively demonstrated COVID-19 manifestations on light skin.

This disparity poses a significant roadblock for dermatologists; manifestations that present as redness or pinkness on light skin can look different on dark skin, and the lack of educational material makes it difficult for dermatologists to identify COVID-19 in people of color—a patient population that has been disproportionately affected by the pandemic.

Based on the results of her study, Dr. Lester believes that finding ways to better incorporate a broad representation of different races in medical literature can lead to early diagnoses and better health outcomes.

Creating Adverse Associations Through Restricted Diversity

This disparity, however, goes beyond the COVID-19 pandemic. In another analysis, Dr. Jules Lipoff, an Assistant Professor of Dermatology at the University of Pennsylvania, uncovered that images of dark skin were included in just 4 to 18 percent of medical textbooks. And even when those images were included, black skin was often used to depict sexually transmitted diseases (STDs).

Not only does the lack of images create room for dermatologists to misdiagnose, but the association between black skin and STDs can create stereotypes and biases against people of color.

“In the textbooks I used in medical school, every penis was a Black penis showing an STD. We’ve got to stop that,” said Dr. Susan Taylor, Professor of Dermatology at the Perelman School of Medicine at the University of Pennsylvania.

Identifying Solutions to Shortcomings in Inclusion

Awareness campaigns, such as Black Lives Matters and others, have extended into healthcare operations, and healthcare professionals are recognizing ongoing shortcomings in management and care.

Dr. Taylor, for instance, established the nation’s first “Skin of Color” dermatology clinic in the late 1990s at Mount Sinai in New York. She also founded the Skin of Color Society in 2004 to push for research and encourage the inclusion of people with darker skin in clinical trials. Dr. Taylor aims to educate fellow dermatologists on how to treat patients of color and encourage medical students of color to enter the field of dermatology.

And to help address the disparity seen in textbooks, Dr. Jean Bolognia, Professor of Dermatology at Yale School of Medicine, has spent two decades editing “Dermatology,” a widely used resource for dermatologists. Dr. Bolognia emphasizes the importance of providing a wide spectrum of skin color. And while working on the fifth edition of the textbook, she has tried to include illustrations of the same condition in both light and dark skin, including conditions that disproportionately affect black populations, such as cutaneous lupus or scarring folliculitis.

Drs. Taylor and Bolognia are just two of the dermatologists who are taking action to further research and develop education for skin of color, which has become even more crucial amid the COVID-19 pandemic.

Resources

https://www.statnews.com/2020/07/21/dermatology-faces-reckoning-lack-of-darker-skin-in-textbooks-journals-harms-patients-of-color/

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19258