Skin of Color Dermatology Substantially Improved in Last 20 Years
Over 20 years since skin of color dermatology was introduced, researchers explored advancements and what is yet to come in the future.
Advancements in skin of color (SOC) dermatology have markedly improved over the past 20 years, according to an analysis from the Journal of the American Academy of Dermatology Reviews.1 Despite notable improvements in the understanding and management of skin conditions among minority populations, researchers believe more advancements need to be made.
“Defining pigmented skin or [SOC] obviously entails a discussion of the various races and ethnic groups of our species, Homo sapiens,” wrote Susan Taylor, MD, in her 2002 article introducing the idea of SOC dermatology.1,2 “Skin color and the skin's reaction to such environmental factors as sunlight, as well as other obvious phenotypic manifestations, were originally used to categorize the subspecies (ie, races) of H sapiens. More recently, molecular analysis has identified genetic differences between races and ethnic groups.”
SOC dermatology achieved substantial progress, improving the understanding and management of dermatologic conditions in diverse populations, according to study authors. | image credit: TheVisualsYouNeed / stock.adobe.com
For individuals with SOC, their ethnic backgrounds can be some variation of non-White, including Black/African, Hispanic, Asian, Native American, Middle Eastern, Mediterranean, or multiracial. In the last 20 years, dermatologists have used the term to further advance the therapeutic area by separating SOC populations from White patients and addressing disparities within dermatology.
READ MORE: Pharmacists Successfully Implement Independent Roles at Dermatology Clinics
Amid increased education and research into SOC dermatology, researchers of the current review aimed to gain a significant understanding of the past 20 years’ advancements among minority, SOC populations.
“Variations in color, morphology, location, and severity are often underrecognized due to insufficient SOC-focused medical education, training, research and imagery,” wrote authors of the study.1 “Recent enhancements in education, image availability, and SOC-focused research have improved clinical practice and health equity. Herein, we present a review of advancements in SOC dermatology since Taylor’s seminal 2002 article introducing [the idea].”
In their review, researchers explored 3 different types of diseases or disorders related to the health outcomes and treatment of patients with SOC. Those conditions included SOC skin diseases, hair and scalp disorders, and nail disorders. From atopic dermatitis and alopecia to now-common cosmetic procedures, researchers provided a detailed scope of SOC dermatology from 2002 until now.
They began their review by exploring the skin’s characteristics in relation to patients with SOC, exploring the scientific facts behind the skin of individuals with various ethnic backgrounds and skin colors.
“Differences in structural and functional skin characteristics in SOC include variations in melanosomal packaging, larger fibroblasts, increased dermal papillae, and thicker dermoepidermal junctions in Black skin,” they continued.1 “Differences in skin barrier-related parameters of the stratum corneum include lower ceramide levels and higher protein cohesion in the stratum corneum of African-American skin, and increased trans-epidermal water loss in East Asian skin.”
They then explored all types of skin conditions impacting SOC populations, including atopic dermatitis (AD), psoriasis, hidradenitis suppurativa (HS), acne vulgaris, melasma, post-inflammatory hyperpigmentation, and acquired dermal macular hyperpigmentation. Discussing how some conditions disproportionately impact various SOC populations, or vice versa in White populations, researchers provided a breakdown of recent advancements, including diagnostic, treatment, and guideline updates for the aforementioned dermatological conditions.
Of these conditions, researchers identified AD and HS as disproportionately impacting Black patients, while psoriasis was the only disorder affecting White populations the most (3.6%). Furthermore, they found melasma is most prevalent among women with SOC. While they also identified significant SOC findings regarding Hispanic and Asian patients, disparities and overall incidence of skin disorders were most prominent among the Black population.1
The discovery of disproportionate occurrences among patients with skin disorders may be alarming for some. However, the last 20 years of advancements in treatment have been achieved to quell the issues that persist in SOC dermatology. Some of these advancements include constant research of dermatological medicines, notable improvements in clinical trial diversity, updated treatment guidelines from dermatology professionals, an overall increase in the public’s understanding of SOC dermatology, and more.
“Over the past 2 decades, SOC dermatology achieved substantial progress, improving the understanding and management of dermatologic conditions in diverse populations; however, much work remains,” wrote the authors.1 “In the next 20 years, we anticipate advancements in personalized medicine, genetic research, and artificial intelligence, deepening our understanding of the unique pathophysiology of dermatologic conditions that primarily affect SOC populations, leading to more effective, SOC-specific treatments.”
In the meantime, experts and providers are urging for more health equity across states, countries, and continents. While SOC dermatology is just one sector of health care, its focus on diversity and various perspectives may be able to inform other areas of health care.
However, for now, study researchers are calling on dermatologists to bolster health equity advocacy.
“Dermatologists must continue advocating for health care equity, ensuring that scientific progress translates into accessible care for all,” they concluded.1 “As we move forward, a more inclusive, data-driven approach to research and care delivery will help reduce the health inequities that persist, ultimately leading to improved dermatologic outcomes for SOC populations.”
READ MORE: Dermatology Resource Center
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