In the evolving field of dermatology, a critical and often overlooked reality is the unique characteristics and needs of skin of color. “Skin of color” broadly refers to individuals with darker pigmentation, typically encompassing people of African, Asian, Latino, Native American, and Middle Eastern descent. Historically, dermatological research, diagnostic criteria, and treatment protocols have predominantly been developed using data from lighter-skinned populations. This bias has led to significant gaps in understanding and managing skin conditions in people of color, emphasizing why skin of color deserves its own dermatological standards.

The Unique Biology of Skin of Color

Skin color is primarily determined by the type and amount of melanin produced by melanocytes in the skin. Melanin provides some natural protection against ultraviolet (UV) radiation and gives skin its color. However, this pigmentation also means that skin of color behaves differently in response to injury, inflammation, and environmental factors.

For instance, darker skin tends to have a thicker dermis and more compact collagen fibers, affecting wound healing and scar formation (Taylor, 2018). Additionally, increased melanin can mask early signs of certain skin conditions, making diagnosis more challenging. Hyperpigmentation and hypopigmentation—areas of darker or lighter skin—are more common sequelae of inflammation in skin of color and require specialized management strategies to prevent long-term cosmetic and psychological impacts (Dlova et al., 2019).

Differences in Disease Presentation and Prevalence

Many skin diseases present differently or have different prevalence rates in people with skin of color. For example:

  • Eczema (Atopic Dermatitis): Often presents with more papular, follicular, or lichenified lesions rather than the classic redness seen in lighter skin, which can lead to underdiagnosis or misdiagnosis (Chaudhari & Silverberg, 2021).
  • Acne: Post-inflammatory hyperpigmentation is a common aftermath in skin of color, often causing more distress than the acne itself (Halder & Bridgeman-Shah, 1995).
  • Keloids and Hypertrophic Scars: More prevalent due to differences in fibroblast activity and collagen deposition, requiring tailored preventive and therapeutic approaches (Bayat et al., 2003).
  • Melasma and Other Pigmentary Disorders: These conditions are far more common and often more severe in darker-skinned individuals (Grimes, 2009).

Because standard dermatological textbooks and training materials predominantly feature lighter skin tones, clinicians may miss or misinterpret these subtleties in skin of color.

The Problem with Universal Standards

Current dermatological guidelines and clinical trials frequently exclude or underrepresent people with darker skin tones. This lack of diversity means that many treatments have not been rigorously tested for efficacy and safety in these populations. For example, laser therapies and chemical peels, commonly used for acne scars or pigmentation issues, may carry a higher risk of complications such as post-inflammatory hyperpigmentation in skin of color (Taylor et al., 2018).

Furthermore, many diagnostic tools rely on visual assessment of redness, scaling, or erythema, which appear differently or are less apparent in darker skin. This can delay diagnosis or result in inaccurate disease severity assessment.

Psychological and Social Implications

Skin diseases can significantly affect quality of life, self-esteem, and mental health, especially when they result in visible pigmentation changes or scarring. For people of color, the lack of recognition and understanding in medical care can compound feelings of neglect or frustration. Addressing the unique dermatological needs of skin of color is not just a clinical imperative—it is a social and ethical one, promoting equity in healthcare.

Moving Toward Specialized Dermatological Standards

To improve outcomes, dermatology must:

  1. Increase Representation in Research: Clinical trials need more participants with skin of color to validate treatments across diverse populations (Callender & Alexis, 2016).
  2. Develop Skin Tone-Specific Diagnostic Criteria: Visual scales and assessment tools should be adapted to accurately identify and grade conditions in all skin tones (Taylor et al., 2018).
  3. Educate Clinicians: Medical education must incorporate comprehensive training on recognizing and managing skin diseases in diverse skin types (Halder & Bridgeman-Shah, 1995).
  4. Create Tailored Treatment Protocols: Understanding how skin of color reacts to medications and procedures can minimize adverse effects and improve patient satisfaction.

Skin of color deserves its own dermatological standards because the biology, presentation, and treatment response differ significantly from lighter skin tones. Acknowledging and addressing these differences is essential for accurate diagnosis, effective treatment, and equitable healthcare delivery. As the global population grows increasingly diverse, dermatology must evolve to ensure that all skin, regardless of color, receives the specialized attention it deserves.

References

  1. Bayat, A., McGrouther, D. A., & Ferguson, M. W. J. (2003). Skin scarring. BMJ, 326(7380), 88–92. https://doi.org/10.1136/bmj.326.7380.88
  2. Callender, V. D., & Alexis, A. F. (2016). Skin of color: Biology, structure, function, and implications for dermatologic disease. Journal of the American Academy of Dermatology, 74(4), 666-675. https://doi.org/10.1016/j.jaad.2015.07.040
  3. Chaudhari, L. M., & Silverberg, J. I. (2021). Racial and ethnic disparities in atopic dermatitis and eczema prevalence and management: A systematic review. Dermatologic Clinics, 39(2), 157-165. https://doi.org/10.1016/j.det.2020.11.003
  4. Dlova, N. C., Hamed, S. H., Tsoka-Gwegweni, J., & Grobler, A. (2019). Skin lightening and its adverse effects among African and Indian women in Durban, South Africa. Journal of Cosmetic Dermatology, 18(3), 809-815. https://doi.org/10.1111/jocd.12741
  5. Grimes, P. E. (2009). Management of hyperpigmentation in darker racial ethnic groups. Seminars in Cutaneous Medicine and Surgery, 28(2), 77-85. https://doi.org/10.1016/j.sder.2009.03.004
  6. Halder, R. M., & Bridgeman-Shah, S. (1995). Skin cancer in ethnic minorities. Dermatologic Clinics, 13(2), 325-332.
  7. Taylor, S. C. (2018). Skin of color: Biology, structure, function, and implications for dermatologic disease. Journal of the American Academy of Dermatology, 78(1), S1-S5. https://doi.org/10.1016/j.jaad.2017.10.006
  8. Taylor, S. C., Cook-Bolden, F., Rahman, Z., & Strachan, D. (2018). Dermatology in skin of color: Practical applications. Journal of the American Academy of Dermatology, 78(1), 33-40. https://doi.org/10.1016/j.jaad.2017.08.053

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