The (German) dermatology and its problems with dark skin

Illustration of Abbysoul 

Dermatology has a problem with dark skin, which has different needs than light skin. Common conditions such as acne, liver spots, and melanoma manifest differently on dark skin than on light skin. Nevertheless, dermatologists are trained to diagnose precisely these conditions on fair skin.

Dermatology as a medical branch deals with the structure and function of the skin, skin care and skin pigmentation as well as with the diagnosis and treatment of skin diseases. Skin experts know that the care and treatment needs of people with dark skin color differ from the demands of light-skinned people. However, there is a lack of or incomplete representation of dark skin types in dermatology. Both light-skinned and dark-skinned people can experience the same symptoms but look different. Dark or black skin is hardly an issue in textbooks. There are hardly any photos that show the effects of skin diseases on dark-skinned people. The risk of misdiagnosis is high.

The wrong view of black skin is worrying, because studies only deal with diseases such as tumors, moles and melanomas on light skin. Skin changes on dark or black skin are more difficult to detect and, due to the natural UV protection, are also much rarer than in people with light skin. Furthermore, many people with dark skin often have inadequate access to the health system due to their social conditions. The result is that they fall through the medical grid and their skin changes are not photographed.

A good example of this undesirable development is the Google health app, which hardly takes dark skin types into account. The reason given by Google is that the whole of dermatology has a problem with the availability of data from people with dark or black skin color. Only about 3,5 percent of the underlying images showed images of Fitzpatrick class V and VI patients who included dark to black skin. The skin classification I to VI according to UV sensitivity goes to the dermatologist Dr. Thomas Fitzpatrick, who dealt with the typification of human skin in 1975.

While dark-skinned people suffer less from malignant melanoma and sunburn due to the natural UV protection, they are more prone to inflammation and certain types of skin injuries such as keloids. These are excessive, sometimes very itchy scars. The darker the skin, the more often there is a risk of keloid formation. These symptoms can lead to depigmentation, i.e. lighter skin areas. The problem of depigmentation also exists in acne, a skin condition that affects dark-skinned people more often than people with light skin. The German dermatologist and Woman of Color Ephsona Shencoru has recognized this problem and runs the blog https://www.thequestionnaire-official.com/lessons1 to provide information about dark skin types.

With appropriate medical research, skin diseases such as acne, inflammatory processes and melanomas can usually be treated very well. However, the situation is different for people with dark to black skin, as they are underrepresented in dermatology. Studies mainly deal with the skin diseases of fair-skinned people, there are hardly any photo documentation of skin changes on dark or black skin. It is therefore difficult for dark-skinned people to find dermatologists who know the needs of their skin and who can correctly diagnose and treat changes or diseases.

Dark-skinned people are less likely to suffer from malignant melanoma and hyperpigmentation, but when this skin disease occurs, the mortality rate is significantly higher than that of fair-skinned people, as there are no corresponding studies and photo documentation that can also provide orientation for an initial self-assessment. The dermatologist Jenna Lester has also recognized this problem and, as a pioneer, has opened a "Skin of Color" dermatology clinic.