Improving Representation of Skin of Color in Dermatology

Miranda Uzoma Ewelukwa, MD, FAAD

“About 3% of practicing US-based dermatologists are African American, which is not reflective of the current population balances within our country... Our population within this country is becoming more diverse with many different phototypes. It's very important to know how certain conditions look in different skin colors and types,” said Miranda Uzoma Ewelukwa, MD, FAAD, in an interview with Dermatology Times.

In honor of Black History Month, Ewelukwa, a board-certified dermatologist at US Dermatology Partners Sugar Land in Sugar Land, Texas, provided insight into the current state of skin of color representation in dermatology in the US. Ewelukwa reviewed how representation has improved in the last few years in textbooks and educational materials, yet more work is still needed to raise the number of skin of color dermatologists in communities.

Ewelukwa recommended colleagues to refer to the American Academy of Dermatology’s (AAD) resources and initiatives.

Q&A

Dermatology Times: In your opinion, what is the current state of skin of color representation in dermatology?

Ewelukwa: In my opinion, it's not great. But I will say that it's getting better. About 3% of practicing US-based dermatologists are African American, which is not reflective of the current population balances within our country. Just in that aspect, there is a deficit. There are things being done to address these issues, such as different diversity initiatives that are being done to increase skin of color dermatologists in the workforce. But, because the number of dermatologists doesn't match the number of patients within our communities, representation isn't where it needs to be. But it is slowly getting better.

Dermatology Times: What aspects of dermatology are better at including skin of color representation?

Ewelukwa: The American Academy of Dermatology, which is the association of associations for dermatologists, is the main organization that does its best to represent dermatologists to the fullest capacity in the ways that we practice and teach materials, advocacy, and many different types of initiatives. They've been intentional over the past few years of putting out diversity initiatives to increase the enrollment of skin of color dermatologists and residency slots to increase the number of African American dermatologists in the practicing workforce. They've done a good job of making sure that they're including studies, case reports, and clinical trials that are more representative and include more patients with skin of color. They've been very intentional about increasing these efforts to not only make sure that practicing dermatologists are taking better care of their patients, but that patients are also being included in the study materials and work materials so that we learn better about this specific subgroup of patients.

Dermatology Times: How does the lack of misrepresentation of skin of color relate to or cause the misdiagnosis of skin conditions?

Ewelukwa: It does a lot. For a long time, many of the texts that were used to train trainees did not include photos of skin of color patients. Just in recent years, they've done a better job of making sure that photos from diverse backgrounds are included. But when you're learning about specific conditions on just one specific color of skin, it's very hard to apply what you learn to a more diverse population. Our population within this country is becoming more diverse with many different photo types. It's very important to know how certain conditions look in different skin colors and types.

When you have a thought or vision of what something should look like on one certain skin, and then you have a patient who is a different skin type with that same condition and it doesn't quite look the same, you're bound to make mistakes. You're bound to make a diagnosis mistake, which could lead to a therapeutic mistake. And that means that that patient may suffer additional days, weeks, months, or years of whatever issue that they're dealing with, with their skin because from a primary standpoint, the correct diagnosis was not made.

At my practice, I see a lot of patients with skin of color. Many patients have explicitly told me "Look, Doc, you're the first one that was able to tell me what I had and treat this correctly. I was going to a Caucasian dermatologist who wanted to help, but they just didn't know what this was because I don't think they really understood my skin." I think it's really important that we're putting out more educational materials, textbooks, journal articles, and images that show a wide variety of skin types and phototypes with certain conditions, so we learn more, we understand more, and we're able to apply what we know, to diverse populations.

Dermatology Times: What can fellow clinicians do to become more involved or encourage more representation of skin of color?

Ewelukwa: The American Academy of Dermatology is an amazing resource. They have a website that has all their initiatives listed there clearly and many different diversity initiatives on local and national levels to include involvement. Many medical schools within local communities have an organization called the Student National Medical Association, which is an association that primarily caters to skin of color medical students. Dermatologists can become involved in recruiting students from those organizations and including them in ways to teach dermatologists about those populations. The way I learned and the way I understand what's happening within our community is through the AAD, which is our main body that supports us as practicing dermatologists, and in all aspects of practice. All of their diversity initiatives are listed on their website.

I encourage my fellow clinicians to really take a step back. If you've been practicing for a while and you're seeing a patient in front of you who is a patient with skin of color, and they have a condition that's been troubling them, really take a step back and think. If it means that you have to reference certain texts and think outside the box to not conclude with something that's a little bit too narrow, you can do justice by that patient. A lot of newer reference materials that are out now include a lot of skin of color pictures that are very educational for our clinicians. I really plead with them to have an open mind and purchase additional textbooks that show these conditions and diverse populations, so they're able to better take care of their patients.

[Send us your thoughts on skin of color representation in the US by emailing DTEditor@mmhgroup.com.]