Dermatology is failing Black patients – here’s what to know before your next visit
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All skincare needs are not the same. While there’s a focus on categories such as skin type (oily, combination and dry skin), your skin shade actually plays a huge role in what products you may need to address particular concerns. However, as a Black woman, I have constantly struggled to find Black dermatologists who can answer the skin-specific questions I have on taking care of and maintaining healthy skin.
Unfortunately, the statistics around Black representation in the skincare field show that there is a huge gap in diversity: Data shows that only three percent of dermatologists are African American, although the African-American population makes up about 13.4 percent of the American population.
If you think it gets better when you open it up to a global applicant pool, it doesn’t: Black physicians only make up six percent of the entire medical profession, and among the specialties within the medical field, dermatology is seemingly one of the least diverse.
Now, this may not seem like a huge issue when we think of common topical concerns such as rashes, acne, skin irritation, etc., but considering the five-year survival rate for Black patients diagnosed with melanoma is only 70 percent compared to a 94 percent rate for white patients, there’s a larger conversation that exists on the need for more doctors who can properly and accurately diagnose red flags for a variety of ethnic groups.
Having a doctor who looks like you is not simply an act of vanity. Sometimes it’s the distinguishing factor between life and death.
Unfortunately, dermatology poses its own barriers to entry, making the task of recruiting and training more Black dermatologists more complicated than it appears. “Getting into derm is like ‘The Amazing Race’ or ‘The Apprentice’. It’s a constant hustle,” Heather Woolery-Lloyd, MD, who serves as the Director of Ethnic Skin Care for the University of Miami Department of Dermatology and Cutaneous Surgery, told Refinery29. “You can be a straight-A student and not get in. Some people have to try three times to get in, and that is discouraging.”
There are a plethora of other obstacles marginalized students endure while trying to pursue dermatology, including lack of resources, access to mentors and crippling student debt and debt repayment.
In fact, many ethnic dermatology clinics have been founded by Black dermatologists in response to the lack of pre-existing resources.
The first dedicated skin of color clinic was created by John A. Kenney, Jr, who was born in Alabama in 1914. Kenney later went on to become a distinguished dermatologist and pioneer in the study of skin diseases afflicting non-white populations.
Yet, despite medicine’s progress over the years, there still remains a huge disconnect for ethnic education in mainstream residencies.
A study in 2017 found that 47 percent of dermatologists and dermatology residents reported that “their medical training (medical school and/or residency) was inadequate in training them on skin conditions in Black [people],” with many admitting that they needed more exposure to diverse patients and training materials to help them better assess potentially serious and deadly skin concerns.
Most recently, a third-year medical student in Canada wrote a Twitter thread about feeling unprepared to spot skin changes in a Black patient. “My search (and my medical school lectures) had only showed me these findings on white skin. Second, I failed my patient by falling into the trap of my own privilege—I assumed they would look like me,” he wrote.
Thankfully, organizations like the Skin of Color Society now serve as a resource, providing lectures and information on how to treat certain disorders that are common among those with melanin-rich skin tones.
However, if you are a member of a marginalized community and can not get in to see a doctor who looks like you, all hope is not lost. It’s important to do your own research and speak up when something doesn’t make sense or doesn’t feel right.
Here are four things you should know about Black skin to better inform you on questions you should ask your dermatologist.
1. People of color are more prone to skin concerns like hyperpigmentation, keloids, flesh moles.
“When somebody comes in, you always have to understand the risks of scars and hyperpigmentation,” Dr. Mona Gohara, a board-certified dermatologist and an associate clinical professor of dermatology at Yale School of Medicine, told the Coveteur. “Those qualifying questions aren’t usually asked of Caucasian patients, but certainly important to ask of our brown skin patients. Hyperpigmentation and scarring are extremely important to consider when putting together a treatment regimen for brown and Black skin.”
Issues like hyperpigmentation are caused by abnormal increases in the production of melanin (the pigment that darkens skin), so for those who already have more melanin in their skin, they’re more likely to develop hyperpigmentation after an inflammatory moment.
First, understand that hyperpigmentation is completely normal and depending on its source, also treatable. Ask your doctor about ways to improve your hyperpigmentation or scarring, including specific products or supplements to try as well as topical sunscreens to help aid against skin cancer.
2. People of color are more likely to deal with textured skin.
Following behind remedies, it’s important to ask about ways to prevent hyperpigmentation in the first place. For instance, using a physical exfoliant instead of a chemical exfoliant may cause extreme dermabrasion to the skin and actually increase scarring, uneven skin texture and hyperpigmentation.
This is often referred to as post-inflammatory hyperpigmentation (PIH), which can cause dark spots to appear after an inflammatory event, like acne, a bad breakout or eczema.
Swapping out harsher procedures or products may be the answer to helping prevent some skin discoloration, but talking to your dermatologist and asking the right questions can help curate a customized recommendation list for you and your needs.
3. People of color can still get skin cancer. It is important to ask questions about the signs.
While we should all know by now to wear sunscreen and sun-protective clothing (I wrote an entire story on how Black people still can get skin cancer), check-ins with your dermatologist are imperative to flagging any spots or lesions on your body that could potentially be cancerous.
Although people of color, particularly non-Hispanic Black people, are less likely to develop melanoma than other racial groups, they are more likely to be diagnosed at a later stage (a major reason why melanoma is more deadly for Black people compared to white people).
Even if your dermatologist does not do or suggest a yearly skin check, you can request it as well as ask any follow-up questions you may have. Remember, it’s your body and you deserve to have peace of mind that everything is healthy.
4. Black women are prone to particular types of hair loss.
Although certain types of hair loss are simply genetic, other types of hair loss can be brought on due to stress and a poor diet. Additionally, health conditions like low levels of vitamin D, abnormal thyroid hormones and anemia can all affect the health of your hair.
Black women, in particular, are prone to traction alopecia, which can be caused by external factors like excessive heat, chemicals and tight hairstyles that pull at the root of the hair.
Other than being proactive about the type of hairstyles you choose to wear and using nourishing products to stimulate growth, it’s important to ask questions to your dermatologist if you notice any changes in your hair.
For me, I learned that a rash around my hairline was actually caused by too much tension from my satin bonnet. Although this did require a bit more personal insight into my nighttime beauty routine, I was able to ask my dermatologist specific questions to yield a proactive result.
Although this list is in no way exhaustive, it is a starting point to understanding your skincare needs and knowing what to ask your dermatologist.
If you liked this post, you should also check out some of our favorite beauty buys from the Nordstrom Anniversary Sale.
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