Skin Deep: Unveiling the Essence of Diversity in Medicine

As our world is becoming increasingly aware of the systemic biases plaguing the lives of ethnic minorities, the field of medicine has emerged relatively unscathed in the wake of this new movement. Statistics from the NHS show that a promising 45% of hospital doctors in the UK come from minority groups; yet, when it comes to educating the next generation of doctors, the feeling of inclusivity falls miles short. The issue is perhaps glaringly obvious in dermatology, a field that relies on a clinician’s ability to diagnose conditions based on their appearance/pattern.

As such, a medical student who is in the most rudimentary stage of his career is left to cater for the masses when he finds the lack of black/brown skin in his textbooks and lectures. That’s how Malone Mukwende felt while studying at St. George’s Medical School in London where he ended up creating his own handbook titled Mind The Gap as a resource for dermatological symptomatology seen with black skin. In his interview with Google, he detailed how healthcare disparities across the UK are being perpetuated in the form of a vicious cycle because medical professionals are not receiving adequate training.

This begs a closer look at the history of dermatology and how it regards skin of color in terms of diagnostic accessibility. The Fitzpatrick scale, a renowned system employed by dermatologists worldwide to classify skin color, has an intriguing backstory. When the Fitzpatrick scale was initially introduced in 1975, it lacked comprehensive representation for individuals with darker skin tones. Types V and VI, which encompass these skin tones, were not initially included in the classification system. It was only after 13 years that these additions were made, acknowledging the need for a more inclusive approach.

Nevertheless, even with the inclusion of Types V and VI, the usage and validity of the Fitzpatrick scale as a definitive categorization tool for skin of color remain subjects of debate among professionals. Numerous articles published in reputable medical journals have shed light on the scale's racial limitations and have suggested reevaluating its role. Some experts argue that the Fitzpatrick scale should be primarily utilized as an indicator of UV sensitivity, aligning with its original purpose, rather than as a comprehensive measure of skin color.

The concern stems from the recognition that relying solely on the Fitzpatrick scale may overlook the unique characteristics and diagnostic considerations specific to individuals with black or brown skin. Conditions such as skin cancer, dermatitis, and other dermatological issues can manifest differently on darker skin tones, often presenting with atypical symptoms or subtle visual cues. By relying solely on a scale that was not initially designed to encompass the full diversity of skin types, there is a risk of misdiagnosis or delayed treatment for individuals with skin of color.

Moreover, as mentioned before, dermatology textbooks have been notoriously unwelcoming in publishing photographs of ailments affecting black and brown skin. According to an analysis conducted by Jules Lipoff, a clinical dermatologist in Pennsylvania, only 4-18% of pictures in medical textbooks are of the darker skin type. Additionally, a stark divide becomes apparent with Lipoff’s inspection of images on sexually transmitted diseases like syphilis, which overwhelmingly depicted black skin as examples. Consequently, these depictions end up reaffirming the racist ideologies linked with black minorities and infectious diseases while contradicting the equality of care promised by healthcare providers. For the average medical student, contact with dermatology is already limited but couple this with the segregationist beliefs echoed in these books and we put our future doctors in a moral conundrum.

While it's not all despair and desolation, a glimmer of hope shines through as renewed interest emerges in integrating skin of color as a vital component of the curriculum in UK medical schools. Professors are beginning to grasp the significance of addressing this issue at its grassroots, laying the foundation for progress. Personally, I've observed a remarkable shift in my dermatology lectures, with a greater emphasis on showcasing diverse skin images and lecturers consciously highlighting variations in appearances across different skin types. Undoubtedly, change is underway, but there remains a substantial journey ahead for our future doctors to develop confidence in diagnosing conditions on black/brown skin.