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Sladen Blog

Skin Color Issues in Dermatologic Health

by Juliet Mullenmeister on 2021-05-17T12:00:00-04:00 in COVID-19, Health Care Equity, Dermatology, Education | Comments


Cutaneous presentations of COVID-19 were a nasty surprise to many practitioners as the pandemic hit different shores, and clinicians scrambled to locate any helpful information to treat patients suffering from a whole host of disease-related manifestations. Given the particular nature of the vascular involvement in the disease, it’s not a surprise that there would be skin issues that might occur as a result of the infection. As more symptoms were documented in the literature, on question boards, and even on Twitter, it was clear that it wasn’t a few isolated cases. This was a complicated issue as there were not a lot of resources that showed a clear example, and the vast majority of them were in lighter skin tones. This is just one example of how skin color could affect accuracy and/or timing of a diagnosis in a range of patients. The presentation of a patient with “Covid Toes” could vary wildly, and patients with a range of skin colors might look very different in terms of evaluation.

Even devices designed to monitor symptoms of disease that are widely recommended for consumers, such as simple commercial pulse oximeters, could create an issue as they may not accurately measure rates in darker skin tones. Skin cancers are diagnosed at later stages on average in people with darker skin tones as well. That there were few examples of manifestations of Covid-19 in skins of color to assist with diagnosis is part of a much larger discussion about the representations of skins of color in clinical medical practice, publication, and pedagogy.

It is also an issue as we move into more Sim/Virtual learning environments.  We are at a point where the “we don’t know what we don’t know” conversations need to include more diverse viewpoints in curriculum development and judgement of mastery. If the people developing the AI upon which modern medical education is leaning don’t make certain that a large and diverse stratum of examples are used, the learning environments aren’t adequate. And we are doing a disservice to our graduates and the communities upon whom their expertise is reliant.



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