In dermatology, health disparities can be skin deep

Sara Berg
Senior Staff Writer
AMA Wire
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About half of patients will have skin of color by 2050, the U.S. Census Bureau projects. Of the many ways this demographic change will affect American society, there is one medical implication that is not widely appreciated. Dermatologists and the primary care physicians who refer to them will be faced with cutaneous diseases that happen more frequently in patients of color. Such skin conditions may be unique to patients with pigmented skin, present differently than in white patients or not be understood adequately.

Patients of color come from diverse racial and ethnic backgrounds. These groups include African-Americans, Asians, Hispanics, Native Americans and Pacific Islanders, as well as individuals from these groups who have intermarried. These changes in national and regional demographics, as well as international population shifts, highlight the need for an improved understanding of skin of color, according to Seemal R. Desai, MD (@SeemalRDesaiMD).

Dr. Desai is president of the Skin of Color Society (SOCS), an international professional dermatologic organization dedicated to promoting awareness of, and excellence in, the area of skin of color. Committed to wide-ranging educational and investigational pursuits, the SOCS strives to ensure the success of dermatologists in serving these individuals, as well as greatly enhancing care for patients with skin of color.

“We want to raise awareness so that physicians and dermatologists know that skin of color can be different to treat,” Dr. Desai told AMA Wire®. “There is an increase in diversity across the country, and we want to go on and service these communities.”

Together, Dr. Desai and the SOCS are working to raise awareness globally for patients with skin of color, while also helping physicians gain a better understanding of the differences in prevalence and treatment options. Dr. Desai is the founder and medical director of a dermatology practice in Plano, Texas, and the incoming director of the American Academy of Dermatology’s (AAD) board of directors. He was appointed to the Food and Drug Administration’s Pharmacy Compounding Advisory Committee, and will be the only practicing physician on this committee when his term begins this fall.

Variations in disease prevalence, treatment

A recent JAMA Dermatology study stated there is little known about cutaneous disease and skin cancer risk in patients with skin of color. While the risk for skin cancer is well characterized in white organ transplant recipients (OTRs), most patients on the waiting list were not white.  

Results from the study indicated treatment of nonwhite OTRs should focus on inflammatory and infectious diseases while sun protection should continue to be emphasized in white, Asian and Hispanic patients. Nonwhite OTRs should also be “counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity,” says the study.

Malignant melanoma accounts for 75 percent of all skin cancer deaths and is potentially curable if identified early, reported another study. While melanoma is rare among black patients, it is associated with a worse prognosis than in Caucasians, such as “deeper tumors, more advanced stages of disease and higher rates of ulceration and lymph node positivity,” the study says.

Cancer-specific mortality was also significantly higher among African-Americans, which prompts the need for physicians to increase their understanding of the needs posed by patients with skin of color. With differences in prevalence and treatment options, further literature and research is needed, the study says.

The SOCS offers educational videos to provide physicians with further help and guidance for treating patients with skin of color. One video, “Under the Physician’s Watchful Eye: Skin of Color Patient Safety,” examines treating various pigment disorders in patients of color and details why dermatologists should the intricacies of these conditions because there are many different causes and nuances in the presentation and appearance of hyperpigmentation.

Mentorship matters

The society’s foundation arm—the Skin of Color Society Foundation (SOCSF)—has developed educational initiatives designed to advance the understanding of relevant issues, research, trends and developments in the field.

“One of the initiatives we are working on is, at the student level, offering mentorship early on in their first and second years,” Dr. Desai said. “Not only to work with a mentor of the Skin of Color Society, but a mentor in the medical field.”

Current mentorships offer early career dermatologists the opportunity to connect with, and be mentored one-on-one by, Skin of Color Society experts. This aims to help tomorrow’s dermatologists gain invaluable experience and training in the area of skin-of-color dermatology. The SOCSF also offers a program for high-school students that provides physician outreach to heighten awareness of the dermatologic specialty in general and introduces skin-of-color dermatology in an attempt to attract diverse students to the profession.

Dispelling myths

“Common myths among patients with skin of color can lead to delayed diagnosis and an increased risk of morbidity, and even mortality,” Dr. Desai said.

People with “darker skin types are often under the myth that they don’t get skin cancer,” he said. “We want to work with the media to help spread awareness and address the issues.”

Another skin condition of concern among patients of color is psoriasis.

“Psoriasis doesn’t look the same in patients of color and is a public health issue because it is associated with other systemic diseases,” said Dr. Desai.

Another example is vitiligo, which can have a psychosocial impact on people. That is  because, in many parts of the world, affected individuals may be treated as though they have an infectious disease, even leprosy, even though it is not a contagious disease, Dr. Desai said. Many people with vitiligo suffer psychologically, and some even commit suicide because of the impact it has on them.

“We need to increase awareness for these diseases that affect skin of color,” Dr. Desai said.

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Jun 22, 2018
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