INTRODUCTION
We read with great interest the Cartwright et al paper "The Psychosocial Burden of Skin Disease and Dermatology Care Insights Among Skin of Color Consumers".1 Within dermatology, there is now a greater awareness regarding the need for exposure to skin of color in educational resources and training during medical education.2 The results from Cartwright et al indicate that even as recently as 2022, almost half of patients felt their dermatologist did not know how to treat their skin, and nearly all believed dermatologists are not trained to treat people with darker skin.1 We believe the solution to addressing patient dissatisfaction is rooted in improving the cultural competence and knowledge of physicians and health care providers. Racial and ethnicconcordant patient interactions, while preferred by SOC patients, are not a requirement nor practical for every dermatologist visit.3 A requirement however for all dermatologists is adequate training to provide excellent care for patients of all backgrounds.
As the demand for dermatologic care quickly outpaces the dermatologist workforce, there is a pressing need to ensure all dermatologists and members of their team feel well-equipped to identify and treat diseases of all skin colors.4 Yet beyond diagnostic identification and treatment, cultural competency is crucial to ensuring patients feel respected and understood. In one study, knowledge of Black hair and skin was most important to Black patients, regardless of race-concordance.3 The historical legacies of racism are directly intertwined with the perception of skin of color and are reflected in terminology like colorism, texturism, and featurism. Even if some skin diseases such as psoriasis in the Black population, have a lower incidence in SOC, patients report more severe psychosocial stress compared to their White counterparts, as evidenced by the 79.6% of patients in Cartwright et al who rated their skin complaints as moderate to extremely bothersome.1,2
As the demand for dermatologic care quickly outpaces the dermatologist workforce, there is a pressing need to ensure all dermatologists and members of their team feel well-equipped to identify and treat diseases of all skin colors.4 Yet beyond diagnostic identification and treatment, cultural competency is crucial to ensuring patients feel respected and understood. In one study, knowledge of Black hair and skin was most important to Black patients, regardless of race-concordance.3 The historical legacies of racism are directly intertwined with the perception of skin of color and are reflected in terminology like colorism, texturism, and featurism. Even if some skin diseases such as psoriasis in the Black population, have a lower incidence in SOC, patients report more severe psychosocial stress compared to their White counterparts, as evidenced by the 79.6% of patients in Cartwright et al who rated their skin complaints as moderate to extremely bothersome.1,2
A 2011 survey indicated that 47% of dermatologists felt their training was inadequate to confidently treat skin of color.5 A decade later, the patients surveyed in Cartwright et al's study continue to doubt the competence of their physicians. While SOC-focused curriculum updates may benefit trainees and physicians in academic spaces, there is inevitably a population of the workforce that has already completed their training and does not benefit from this learning. Moreover, medical resources seldom discuss concepts such as colorism and texturism which are often considered non-medical issues. For example, alopecias such as central centrifugal cicatricial alopecia (CCCA) can be contextualized through knowledge of Black hair, texturism, and protective styles.6 These valuable contexts can be gleaned by examining texts that focus on skin and hair phenotypes that are historically perceived and treated within Black, Hispanic, and Indigenous communities. When asking physicians to take time out of their work to learn new concepts, it is easiest to integrate these concepts into existing requirements for medical practice such as continuing medical education (CME). We suggest a proactive approach to understanding SOC through 1) engaging with CME topics on SOC dermatology and 2) encouraging dermatologists and trainees to understand the historical context of racism in the Western Hemisphere, and how it impacts people of color's perceptions of their skin and hair. There are multiple valuable resources to guide dermatologists and members of their team on skin of color, cultural competency, and health equity-based CME (Table 1).
