Skin of Color: Bridging the Knowledge Gap
As the patient population becomes more diverse in the United States, it is becoming increasingly important for dermatologists to be comfortable counseling patients with darker skin. Historically, patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC) were not sufficiently mentioned in textbooks, resources, and clinical trials. The main areas that many dermatologists struggle with patients with darker skin are counseling on skincare (especially sun protection for FPS 4-6 patients), discussing clinical trials, and one of the most pressing concerns is the lack of online resources.
While most dermatologists advocate relatively basic skincare, including sunscreen, this can become difficult for patients with darker skin. White casts are a concern that can prevent patients with FPS 4-6 from using sun protection altogether. To address this concern, Callender et al provide a robust discussion of the literature surrounding sunscreen use in SOC patients. While there has been an overall increase in literature, this review highlights the overall lack of sufficient attention to photoprotection in SOC patients.
Additionally, there is natural friction in recruitment for clinical trials in vulnerable populations and patients with SOC due to historical injustices. As such, numerous clinical trials often underreport SOC patients. This is particularly clinically relevant, as many inflammatory conditions can lead to more dyspigmentation than in patients with lighter skin. Dinkins et al specifically examine the racial diversity of hyperpigmentation and post-inflammatory hyperpigmentation trials in the United States to provide further insight.
Almost every modern dermatologist has experienced a patient bringing insights from an Artificial Intelligence (AI) platform. This can be incredibly helpful for empowering patients; however, it is important to consider the real likelihood of misdiagnosis due to insufficient clinical materials of pathologies in SOC. Patel et al specifically examined the SOC dermatology content on YouTube, examining the prevalence of common conditions ranging from seborrheic dermatitis to eczema. Koninsky et al further this point by examining Google image searches of common dermatologic conditions, finding an overall scarcity of images.
Taken together, it becomes clear there is a need for increased attention to skincare, clinical trials, and resources for SOC patients.
References:
Sunscreen Use for Photoprotection in Skin of Color: A Literature Review
