Representation of the Black Community in Skin Care and Longevity

Reference Lab

FEB 4, 2022

Disparities exist in all areas of life, especially in healthcare, and — unfortunately— dermatology is not exempt. Dermatology is the study, research, and diagnosis of the skin. And unlike the heart, pancreas, or kidneys, the skin comes in vastly different colors and patterns. (02)

In 2020, the New York Times published an article titled, “Dermatology Has a Problem with Skin Color”, outlining the lack of Black representation in dermatology research. The article focused on incorporating more non-white skin representation into medical training. For example, only 10 percent of current illustrations in dermatology textbooks are that of darker skin. This lack of visual representation greatly hinders a medical student’s ability to diagnose skin conditions on darker skin tones as full-fledged practicing physicians. (03)

To adequately study and diagnose skin problems, dermatologists depend on something called pattern recognition — the ability to detect similar problems through the study of prior events. Dermatologists train themselves to visually recognize particular colors and shapes on skin, alerting them to specific diseases and conditions. However, dermatologists inadvertently receive training to find skin problems on white skin — not darker skin. Moreover, the evidence-based research used for determining skin treatments consists primarily of white participants, making most dermatology treatments most optimally suited for white skin. (04, 05)

A common misconception exists regarding Black skin — that it doesn’t “crack.” While it’s true that the melanin in dark skin helps prevent sun damage, African American skin is not impervious to the sun. Additionally, when the sun does cause skin cancer in Black people, the outcomes are much more dire. Although rates of skin cancer in white people are higher than those of Black people, the five-year survival rate for white people is at 92%. Conversely, when skin cancer appears in Black people, the survival rate drops drastically — to 67%. (06)

Why is there a lower skin cancer survival rate for African Americans? This disparity occurs because of the mistaken belief that dark skin doesn’t experience sun damage and because doctors are less likely to spot skin cancers on darker skin. According to the Skin Cancer Foundation, about 50% of basal cell carcinomas are brown in SoC (skins of color) — while textbook illustrations of these same carcinomas are pink or pearly on white skin.

What does this mean in practice? Doctors are missing early detection of skin carcinomas on darker skin due to a lack of visual representation during their education and training. And when cancer is detected on darker skin, the treatments might not be specific and effective enough due to insufficient levels of research behind treatments of cancer in darker skin. The bottom line? Scientific research into the best treatments for skin disorders on African Americans is inadequate.

When it comes to the representation of skin of color (SoC) in dermatological science, the data is discouraging. A 2021 literature review published in the International Journal of Women’s Dermatology evaluated 52 scientific journals to determine content applicable for SoC. Here’s what they found: (06)

• Out of 52 journals, only 2.04% to 16.8% contained content relevant to SoC.
• The journals with higher rates of helpful content for darker skin were, not surprisingly, from countries with large populations of people with darker skin.
• The more eminent medical journals, such as the Journal of the American Academy of Dermatology and the Journal of Investigative Dermatology, contained less than 5% of articles relevant for darker skin.

The need for African American representation in medical textbooks and scientific research may also play a part in the disparity between the longevity between white people and Black people. From 2018 to 2021, overall life expectancy in the United States saw the most significant drop since World War II.

Among whites people, the life expectancy fell by 1.9 years. For Black people, however, life expectancy dropped by 3.2 years. Health determines a portion of our longevity, but health is also vastly shaped by socio-economic factors. The disparities in socio-economic factors, combined with health disparities, all boil down to one truth—our society does not do enough to incorporate diversity into all aspects of life, scientific and otherwise. (07)

Though there’s much work to be done in eliminating biases and insufficient representation in decades-long research efforts, in recent years, the medical and scientific communities have made great strides to resolve problems within healthcare in regards to African American representation. American universities have adopted more inclusive teaching methods and textbooks, especially for visually dependent specialties like dermatology, hopefully ensuring that the next generation of doctors and dermatologists are adequately trained to treat all patients with the same level of care, regardless of their ethnicity.

• In 2020, for example, the Massachusetts Medical Society held a week-long symposium entitled “The Impact of Skin Color and Ethnicity on Clinical Diagnosis and Research'' to educate healthcare professionals about the ethnic biases and health disparities that come with darker skin. (08)
• In 2015, the first textbook geared towards children with darker skin (“Pediatric Skin of Color”) was released through Springer publishing. Today, medical universities offer classes and curricula that integrate SoC concerns and conditions. (09)
• Established in 2004, the Skin of Color Society (SOCS) is a multinational professional organization that promotes skin of color dermatology through (10)
  • Education
  • Read watch
  • Advocacy

From its inception, OneSkin has been dedicated to ensuring diverse representation during the research and product development processes. A significant portion of OneSkin’s research is performed on lab-grown 3D human skin from various donor cells. These donor cells come from African American, Asian, and Caucasian skins to guarantee a diverse representation in OneSkin’s final product — offering effective results targeting all skin colors.

• Out of 52 journals, only 2.04% to 16.8% contained content relevant to darker skin.
• The journals with higher rates of helpful content for darker skin were, not surprisingly, from countries with large populations of people with darker skin.
• The more eminent medical journals, such as the Journal of the American Academy of Dermatology and the Journal of Investigative Dermatology, contained less than 5% of articles relevant for darker skin.

References

• [1] https://asalh.org/black-history-themes/
• [2] https://www.news-medical.net/health/What-is-Dermatology.aspx
• [3] https://www.nytimes.com/2020/08/30/health/skin-diseases-black-hispanic.html
• [4] https://pharmaceutical-journal.com/article/ld/recognising-common-skin-conditions-in-people-of-colour
• [5] https://www.medicalnewstoday.com/articles/disparities-in-dermatology-visual-representation-of-darker-skin-is-key#1
• [6] https://www.sciencedirect.com/science/article/pii/S2352647521000538
• [7] https://www.aad.org/public/everyday-care/skin-care-secrets/routine/safely-exfoliate-at-home
• [8] https://pubmed.ncbi.nlm.nih.gov/32335181/
• [9] https://link.springer.com/book/10.1007/978-1-4614-6654-3
• [10] https://skinofcolorsociety.org/