Skin bias is real, and it puts skin of color at risk.

By Tonya Russell
August 04, 2020
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Imagine suddenly developing a painful or itchy rash, then heading to Dr. Google to find out if a trip to urgent care is warranted. If you're a person with darker skin, the rash photos that come up may not give you a clear picture of what's ailing you. Why not? Because those diagnostic images will likely show only white skin. And skin conditions present differently depending on skin color. 

Malone Mukwende noticed this lack of skin diversity on health websites. The second-year medical school student at St. George’s University of London also realized that it's not necessarily helpful for doctors to ask a patient with darker skin to look for symptoms like bruising, redness, and paleness. “When I’d ask about how to identify these signs and symptoms, I never really got an answer,” Mukwende tells Health.

So Mukwende, along with two instructors, set about creating a guidebook called Mind the Gap. When the guidebook is published, it'll be one of the few resources for medical students and practitioners that show various skin conditions on a wide range of complexions, with language that describes symptoms in darker skin. 

Mukwende is not the only person of color in medicine who is working toward fixing the lack of skin diversity in photos. Lavanya Krishnan, MD, dermatologist and the founder of San Francisco-based Arya Derm, is also addressing this bias. “Dermatology is a very visual field,” she tells Health, confirming that the diagnostic images for doctors and research are overwhelmingly white. 

It's not just a lack of diagnostic images of brown and black skin that is a problem—there may also be fewer brown and black patients who can teach dermatologists about the wide range of symptoms. People with dark skin are more likely to have health  insurance that isn't always accepted by many practicing dermatologists. Not only is their access to care decreased, but it reduces the real-world experience that dermatologists can obtain by evaluating and diagnosing more patients with skin of color,” says Dr. Krishnan. 

Not being seen by dermatologists as often as white patients ultimately decreases the chances of creating diverse visuals. And these visuals matter. A recent example: One symptom of COVID-19 is a skin condition dubbed "COVID Toes," yet all of the reported images show white or pink feet, Dr. Krishnan says.

Dr. Krishnan adds that almost every skin condition looks different on darker skin. “Conditions as common as acne and eczema can look differently, and this can extend to certain skin cancers and rashes associated with infectious diseases,” she says. (One example: On a page about melanoma on the Skin Cancer Foundation website, the images of what this type of skin cancer looks like only shows white skin.)

So what's the fallout? Without diagnostic images showing diverse skin tones, patients of color may be misdiagnosed and treated incorrectly. “This can sometimes cause the original condition to get worse, or morph in a manner that makes it even more difficult to diagnose down the road,” says Dr. Krishnan.

Mukwende’s Mind the Gap manual doesn’t have an official release date yet, but it will be a comprehensive guide that he hopes will become part of the medical school curriculum. It will also provide language to help practitioners better describe the appearance of different skin conditions on darker skin. For more information on its release, visit this website to sign up for updates. 

Where to find diverse skin images

Until then, social media is trying to fill in the gaps. Accounts like Brown Skin Matters on Twitter show side-by-side photos of different skin conditions on brown versus white skin. One example from the site is this photo of shingles; the man whose skin is shown here did not know he had shingles because his case did not look like the images that he found online. 

Dr. Krishnan believes that battling white skin bias will take constant learning: “It is important for all practitioners to gain experience in how conditions present differently in various skin types. This takes practice, experience, and keeping up-to-date with the most recent journal articles and literature."

"As a practicing dermatologist in San Francisco who also has brown skin," she continues, "I find that I have a higher percentage of patients with skin of color.  This valuable experience has helped improve my diagnostic skills in this patient group.” 

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