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Seeing the Spectrum: Including and Embracing Skin of Color Education in Everyday Dermatologic Practice

Seeing the Spectrum: Including and Embracing Skin of Color Education in Everyday Dermatologic Practice

Dr TaylorIn 2004, racial disparities in medicine were becoming increasingly apparent to dermatologist Susan Taylor, MD. Dr Taylor completed her dermatology training working with a diverse patient population at New York-Presbyterian Columbia Medical Center in New York City. When she began practicing, however, she noticed a distinct lack of skin of color images in textbooks and at conferences.

To help fill these gaps, Dr Taylor came up with a list of 14 physicians of all racial and ethnic backgrounds, calling them individually to invite them to form a new collective. To her surprise, each accepted, sharing her vision of furthering education on skin of color dermatology and mentoring young trainees. With this first step, the Skin of Color Society, now a growing society with more than 800 members from across the world, was born.

“You can do a lot more when you’re united with a group of people than you can individually,” Dr Taylor said.  

 The need for increased representation, research, and education of skin of color in dermatology began long before the Skin of Color Society’s inception and continues to exist today. Diversity in the field of dermatology struggles to keep up with the racial makeup of the United States, and only 3% of all dermatologists identify as Black while 4.2% identify as Hispanic.1 These numbers have remained largely unchanged since 2005, a statistic that makes sense when considering dermatology is the second least diverse field in all of medicine. 

While several dermatologists like Dr Taylor have dedicated their careers to addressing the lack of representation in dermatology, a call for change has sharply come into focus in recent months. Dr Taylor believes a combination of COVID-19 and subsequent stay at home orders, coupled with brutal recorded examples of police brutality, has brought about new awareness of systemic racism for individuals who may not have been aware of it before. 

“For the first time, they could see the images of the murders of Black men and women,” Dr Taylor said, of Americans who usually work but were now at home during quarantine. “They saw them over and over again, day in and day out. Different people, different parts of the country. It was presented in a way that could not be ignored.” 

Now, while a wave of reflection and reckoning occurs in all fields—fashion, sports, journalism, and academia—some dermatologists find themselves searching for ways to learn about skin of color. Skin of color textbooks, many which have existed for years, help fill this gap. 

Dr Taylor’s own textbook Dermatology for Skin of Color was coauthored with another dermatologist, Dr A. Paul Kelly, and was originally published in 2008. It is what Dr Taylor called a “serious and sustained undertaking” that had her working between 4 AM and 6 AM every day during the writing process to write and review textbook chapters.

“I wish some of the well-known standard textbooks had included significant skin of color images and sections where my textbook would not have been needed,” she said. “But there was a need that we needed to meet.”

Crystal Aguh, MD, FAAD, another dermatologist, is a coauthor of Fundamentals of Ethnic Hair-The Dermatologist’s Perspective and author of 90 Days to Beautiful Hair. Like Dr Taylor, Dr Aguh first noticed gaps in her own knowledge about Black hair conditions while looking for resources. 

As a resident, Dr Aguh recalls patients asking her about their central centrifugal cicatricial alopecia, a progressive scarring alopecia often seen in middle-aged Black women. Patients asked questions Dr Aguh realized she was not equipped to answer. 

“There was nowhere in Bolognia where I could tell patients about what extensions they should wear, the difference between sisterlocks and dreadlocks or chemical relaxers,” Dr Aguh recalls. “That did not and continues to not exist in the dermatology curriculum.” 

After putting together a presentation on these topics for residents, Dr Aguh and her mentor Ginette Okoye, MD, decided to write the first dermatology book on Black hair, making sure the information was evidence-based and incorporated hair practices from other parts of the world. 

Today, many landmark skin of color textbooks like these have been written on the topics of pediatrics, hair, cosmetics, general dermatology, and more. And although these textbooks are needed, their authors note that skin of color should not be categorized as a separate field. 

“I really want to stress that this is the responsibility of everyone,” Seemal Desai, MD, FAAD, another textbook author and the immediate past president of the Skin of Color Society, said. “Everyone in dermatology should be involved in increasing their awareness of skin of color.”

Dr Aguh agreed, adding, “Right now, people think skin of color is a subspecialty.” But she says all dermatologists should know how to care for patients with Black and Brown skin who walk into their clinic. 

So how does the field of dermatology catch up?

Dr Taylor, who is the director of diversity at the University of Pennsylvania Department of Dermatology, says there are many possible steps dermatologists can take. First, she encourages residency programs and private practice physicians to purchase and use skin of color textbooks as a part of their training, while simultaneously calling on traditional textbooks to integrate their educational materials. Next, including skin of color cases into each didactic lecture can help trainees identify diseases as they appear all skin colors. She also stresses the importance of learning from patients of color, noting if a skin of color population does not exist at a particular residency, residents should have electives through which they can be exposed to those diseases. Finally, personal antiracism education through reading lists available on the internet and self-study are key. 

“You don’t have to be a part of an academic center to explore and become knowledgeable about antiracism,” she said. “Learning how to be an ally is learning how to deliver the best care to all patients.” 

Dr Desai, who is of Indian descent, adds that an important component to this conversation is allyship. He became interested in skin of color more than 20 years ago when his brother was diagnosed with vitiligo. In medical school, he realized he wanted to go into dermatology and make a difference in pigment disorders of darker skin. 

“The key is to be a thoughtful listener,” he said, of working alongside physicians and patients of different skin colors and backgrounds. “It is ok to relate experiences without claiming you understand and acknowledging that there is no way you will truly understand.” 

The Skin of Color Society, where Dr Desai is still involved as leadership, has many upcoming initiatives for students and dermatologists at all levels of training. Dr Desai said they are planning a large expansion of their media initiatives, partnering with industry companies to fund skin of color research projects, and developing medical school initiatives, opportunities, and mentorship at medical schools without dermatology departments. Anyone from any background can join by visiting the website’s home page, and the website also has educational resources and handouts.   

Dr Taylor said the increased attention on health disparities in medicine has dermatologists like her receiving emails with questions asking how to help every single day. And she’s excited about it. 

“I am thrilled to get these calls and have conversations about people becoming aware of systemic racism. This is a time of possibility where things can change,” Dr Taylor said about the future. “I’m here to support it and move it forward.”


Skin of Color Resources

Compiled by Taylor Jamerson, Contributing Writer

Note: By no means is this a comprehensive list of all of the resources that exist on skin of color; however, these are excellent resources to use as a starting point to fill knowledge gaps for trainees and physicians. For patient-centered education resources, please visit the Skin of Color Society’s Education Resource page (https://skinofcolorsociety.org/dermatology-education/).

Academic Textbooks

  • Taylor SC, Kelly AP, Lim HW, Anido Serrano AM. Dermatology for Skin of Color. McGraw-Hill Education; 2016.
  • Alexis AF, Barbosa VH. Skin of Color: A Practical Guide to Dermatologic Diagnosis and Treatment. Springer; 2012.
  • Silverberg NB, Durán-McKinster C, Tay YK. Pediatric Skin of Color. Springer; 2015.
  • Love PB, Kundu RV. Clinical Cases in Skin of Color. Springer; 2016.
  • Dadzie OE, Petit A, Alexis AF. Ethnic Dermatology: Principles and Practice. Wiley-Blackwell; 2013.
  • Aguh C, Okoye GA. Fundamentals of Ethnic Hair: The Dermatologist’s Perspective. Springer; 2017.
  • Kinai M. Dark Skin Dermatology Color Atlas: Clinical Dermatology. CreateSpace Independent Publishing Platform; 2012.
  • Jackson-Richards D, Pandya AG. Dermatology Atlas for Skin of Color. Springer; 2014.
  • Lugo-Somolinos A, McKinley-Grant L, Goldsmith LA, et al. VisualDx: Essential Dermatology in Pigmented Skin. Lippincott Williams & Wilkins; 2012.
  • Alam M, Bhatia AC, Kundu RV, Yoo SS, Chan HHL. Cosmetic Dermatology for Skin of Color. McGraw-Hill Education; 2009.
  • Taylor SC, Badreshia-Bansal S, Callender V, Gathers R, Rodriguez D. Treatments for Skin of Color. Saunders; 2011.
  • Grimes PE. Aesthetics and Cosmetic Surgery for Darker Skin Types. Lippincott Williams & Wilkins; 2007.
  • Desai SR. Therapeutic Hotline: New Developments in Dermatology. Elsevier; 2019.
  • Vashi NA, Maibach HI. Dermatoanthropology of Ethnic Skin and Hair. Springer; 2017.
  • Goh CL, Chua SH, Ng SK. The Asian Skin: A Reference Color Atlas of Dermatology. McGraw-Hill; 2004.
  • Yong-Kwang T, Yuin-Chew C. Textbook of Laser and Light Dermatology in the Asian Skin. World Scientific Publishing Company; 2011.

Academic Articles

  • Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;45(suppl 2):S41–S62. doi:10.1067/mjd.2002.120790.
  • Halder RM, Ara CJ. Skin cancer and photoaging in ethnic skin. Dermatol Clin. 2003;21(4):725-732. doi:10.1016/s0733-8635(03)00085-8
  • Haskin A, Aguh C. All hairstyles are not created equal: what the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). J Am Acad Dermatol. 2016;75(3):606-611. doi:10.1016/j.jaad.2016.02.1162
  • Taylor SC, Barbosa V, Burgess C, et al. Hair and scalp disorders in adult and pediatric patients with skin of color. Cutis. 2017;100(1):31-35.
  • Callender VD, Barbosa V, Burgess CM, et al. Approach to treatment of medical and cosmetic facial concerns in skin of color patients. Cutis. 2017;100(6):375-380.

Reference
1. Pandya AG, Alexis AF, Berger TG, iwntroub BU. Increasing racial and ethic diversity in dermatology: a call to action. J Am Acad Dermatol. 2016;74(3):584-587. doi:10.1016/j.jaad.2015.10.044

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