Skin colour diversity: why doctors need to be trained to identify medical conditions in darker skin tones
- Many dermatology textbooks and journals do not have a wide range of skin colours, leaving future physicians less prepared to serve diverse populations
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Skin conditions will not always look the same on different skin tones. Photo: ShutterstockToxic epidermal necrolysis. Acanthosis nigricans. Pityriasis versicolor. Even if these skin diseases look like word salad to you, doctors should be trained to identify them in everyone.
But a challenge comes when dermatology textbooks and journals lack photos and resources to train doctors in treating people with diverse skin colours.
According to Dr Sonal Hattangdi-Haridas, a Hong-Kong based doctor of homeopathic medicine trained at the University of Mumbai, skin colour is a significant factor in diagnosing skin conditions.
If doctors were not trained to recognise conditions on different skin colours, they could misdiagnose patients and delay vital treatment, she said. For diseases like acanthosis nigricans, which darkens the colour of skin, people with darker skin could be particularly challenging to diagnose, Hattangdi-Haridas said.
“If the skin is naturally beige or darker to begin with, it’s very hard to catch light brown patches unless one really pays attention,” she explained.
Importance of diverse skin tones in medicine
A study published in 2021 in the International Journal of Women’s Dermatology examined how often dermatology journals had publications featuring non-white skin. Research and higher-impact journals were among the lowest, with less than 5 per cent of their articles related to darker skin tones.
Based on their criteria, 46.58 per cent of articles in the Hong Kong Journal of Dermatology and Venereology from 2018 to 2020 were related to skin of colour.
But Dr Yeung Chi-keung, a deputy editor for the journal, questioned the methods used in the study to decide if an article featured skin of colour.
“The research [in our journal] may not [explicitly] highlight skin of colour or Asian skin because it’s already for local readers,” said Yeung, president of the Hong Kong College of Dermatologists. “Most of our cases are data from Hong Kong residents.”
The dermatologist noted that the journal also occasionally featured cases from people who were not Chinese.
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According to Hong Kong’s 2021 Population Census, about 91.6 per cent of the population is ethnically Chinese. The city’s non-white ethnic minority groups equal about 558,000 people, with the three largest non-white groups being Filipinos, Indonesians and Indians.
Diverse skin representation is also important elsewhere, for example in the US, where about a quarter of the population is not white.
“I personally have observed only a few photos that present skin conditions [on skin of colour] in medical textbooks and literature in the US,” said Dr Angela Kim, a US-based dermatologist.
The under-representation of diverse skin tones could have other consequences besides misdiagnosis.
“There can be a delay in diagnosis and treatment, which can also break the trust between a physician and a patient,” Kim said, adding that patients might then turn to untrustworthy sources for medical advice.
Making medicine more equitable
“Hong Kong is multinational,” said Dr Kingsley Chan, a Hong Kong-based dermatologist who studied in the city and was trained in the United Kingdom. “We need to learn how to treat all our patients ... no matter if they are the minority or majority.”
Chan noted that Hong Kong medical schools trained students mostly with textbooks from the United Kingdom and the United States, though there were increasingly more resources from other parts of Asia.
Many experts say darker skin is under-represented in medical textbooks from the UK and US, but Chan noted that Hong Kong teaching staff often used photos of local patients to supplement students’ learning.
“Patients admitted to [hospital] wards come from many different groups, so students receive training and knowledge based on that,” Chan explained.
Training and conferences in other countries could also benefit students and practising dermatologists, Chan said. “Overseas, they can meet specialists from all over the world and learn the latest knowledge.”
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In addition, local seminars about ethnic diversity in diagnosis could address the issue, said Hattangdi-Haridas. She studied in Mumbai and cited textbooks in India as an example of integrating cases with skin of colour into medical literature.
“In India, the literature does have specific local photographs and details,” she said, adding that educational resources in the country typically had special editions with information specific to South Asians. “In the global village that the world is today, it would benefit all healthcare fields to be exposed to common conditions in different ethnicities.”
In recent years, resources have been created to fill this void. In 2021, the Journal of Drugs in Dermatology published “The Full Spectrum of Dermatology”, an atlas with images that show how dermatological conditions manifest on an array of skin tones.
Kim said textbooks everywhere needed to include more images of medical conditions on skin of colour.
“Pictures are worth a thousand words,” she said.
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