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Lack of representation in dermatology leads to increased likelihood of inequitable care

Posted at 7:25 PM, Jan 20, 2022

Sharon King wants to see a change in the field of dermatology.

King is the executive director of Litty Ligo Community Network. It’s a resource to help support the mental and emotional health of people living with vitiligo.

“There are so many voices in this community that get unheard,” King said.

King was diagnosed with vitiligo when she was 12.

“Vitiligo is a condition that manifests in white patches on the skin and hair that can affect you at any age, affects any ethnicity and currently affects over two percent of the world's entire population,” King said.

She says having vitiligo often comes with psychological issues. As a kid, she was teased and told she was ugly.

“When I was 12, when I got diagnosed with vitiligo, I really thought that it was because I wished to be white when I was younger so that the girls wouldn’t make fun of me or my dark skin anymore,” King said.

She says her experience with a dermatologist didn’t help her feel much better. She says he was adamant about her seeking treatment.

“The sides effects scared me and so I declined, but I do remember him kind of pushing,” King said.

After that experience, King says she felt like dermatology wasn’t for her. She didn’t feel seen. Now, she realizes there is a lack of representation in dermatology.

“People are less, are going to be less likely to seek medical attention if they feel like they're not represented or they're not going to get the right type of care,” King said.

Dr. Jenna Lester is passionate about addressing the disparities people of color face in medicine.

“Dermatology is the second least diverse specialty only behind orthopedic surgery,” Dr. Lester said.

Dr. Lester is a dermatologist and the founding director of Skin of Color at the University of California San Francisco. The program focuses on patients of Black, Latin, Asian and Indigenous ancestry.

“These patients are patients with skin like everyone else," Dr. Lester said. "But because of their skin tone, sometimes certain diseases are more difficult to identify and require specialized training, something that I also teach the residents here.”

Not only is there a lack of representation in dermatology, but Dr. Lester also says there is a lack of representation in medical literature. She quantified the problem by counting photos in textbooks and found that there was a drastic underrepresentation of brown skin overall, but an overrepresentation of brown skin in the chapters focused on sexually transmitted infections.

“And what does that do to stigmatize the patients that you see," Dr. Lester asked. "You automatically assume that someone who is Black can't get psoriasis because you've never seen it before, but someone who's Black can have syphilis because that's all you ever see in brown skin.”

These biases not only impact the psyche of people of color, but Dr. Lester says they can also lead to inequitable care.

“It could be a misdiagnosis, it could be a patient not disclosing everything that would be helpful to arrive in order to arrive at the diagnosis, it could be a patient who doesn't ask questions because they don't feel like they have a place to do that, it could be a patient who is not open about expressing how the treatment that they're being offered is not something that would work for how they typically live their life," Dr. Lester said. “I’m thinking of treatments for the hair and scalp that we give that are probably OK for patients with straight hair, but for patients with Afro-textured hair doesn't work.”

To instill change, both Dr. Lester and King say sharing experiences can be powerful.

“Patients have (the) ability to say, 'Yeah, I've experienced that before, that is important to me too.' And are able to bring those questions in conversations to their place, the places where they get care as well,” Dr. Lester said.

They’d like to see doctors caring for the entire person, not just what they see on the outside.

“Hold that dermatologist responsible for having the correct resources and the correct connections to the support that you need, that is outside of treatment because it's not, it's just not a one size fits all thing,” King said.