The demographics of the United States are shifting, with one in three Americans projected to be a race other than white by 2060. Dermatologic research has not historically kept pace with this change, but a growing movement toward skin of color dermatology — focused on the unique dermatologic needs and conditions affecting individuals with darker skin tones — is beginning to have an impact.
By acknowledging and addressing gaps in research, diagnosis, and treatment, the skincare industry has started to better reflect the diversity of human skin. These efforts help clinicians understand common conditions, recognize diagnostic differences, and apply specialized treatments to provide effective care to all patients.
Diagnostic Differences
Individuals with skin of color represent a diverse population encompassing many racial and ethnic backgrounds, including Black or African American, American Indian or Alaska Native, Asian American or Pacific Islander, Hispanic or Latino, and Middle Eastern or North African.
Dermatologic health disparities continue to affect patients with darker skin tones, driven in part by systemic racism, but also by inadequate clinician training and a lack of high-quality research focused on conditions that disproportionately affect people with skin of color.
Individuals with skin of color may experience conditions such as postinflammatory hyperpigmentation, keloids, dermatosis papulosa nigra, pseudofolliculitis barbae, and acne keloidalis nuchae. These conditions can significantly impact the quality of life and are often underdiagnosed or undertreated. Ultimately, improved management of these and other conditions begins with greater diversity at the research stage.
“Historically, studies including clinical trials related to hidradenitis suppurativa, scars, and psoriasis have shown a predominance of white participants,” said Jared Jagdeo, MD, MS, associate professor of dermatology and director of the Center for Photomedicine at SUNY Downstate Health Sciences University, and a member of the dermatology service at the Veterans Affairs New York Harbor Healthcare System.
Dr. Jagdeo added that studies for conditions primarily affecting patients with skin of color must implement more inclusive measures. He pointed out that individuals with skin of color are underrepresented in dermatologic clinical trials, with Black or African American patients consistently the most underrepresented, regardless of disease prevalence. Representation in clinical trials, he concluded, is critical to providing high quality care to patients from all backgrounds.
Dermatologic Disparities
In recent years, skin equity emerged as a defining theme across dermatology, reflecting growing recognition that equitable care requires more than expanded treatment options — it also demands inclusive research, culturally competent practice, and attention to the psychosocial and structural factors that shape patient outcomes.
Data continue to reinforce dermatologic disparities across age, race, geography, and socioeconomic status. In pediatric atopic dermatitis, for example, studies show higher disease prevalence and worse outcomes among children of color, compounded by limited access to pediatric dermatologists and the influence of social determinants of health.
Delayed or missed diagnoses in skin cancer, hidradenitis suppurativa, and nail disorders in skin of color further highlight how differences in disease presentation and gaps in clinician training contribute to inequitable outcomes. These challenges are often amplified in rural and underserved areas where patients face longer wait times and fewer specialty resources.
Multiple research studies have shown that although the reported incidence of skin cancer is lower among people of color, the morbidity and mortality are higher, largely because diagnoses often occur at more advanced stages with poorer prognosis.
Culturally Competent Care
“Despite the increasing diversification of the US population, medical education largely features skin disease in lighter skin tones,” said Nicole A. Negbenebor, MD, FAAD, clinical assistant professor of Mohs micrographic surgery and cutaneous oncology and director of the Skin of Color Clinic in the Department of Dermatology at the University of Iowa. “Clinical images in dermoscopy and Kodachromes of pigmented lesions in darker skin types are underrepresented in textbooks and lectures.”
Dr. Negbenebor stressed the importance of integrating more comprehensive training on the varied presentations of skin cancer in patients of color during residency programs. Programs such as Skin of Color Dermatology clinics provide specialized care for Black, Latinx, Native American, and Asian patients, ensuring thoughtful evaluation and treatment. In addition, organizations like the Skin of Color Society offer resources and advocacy aimed at achieving health equity in dermatologic care.
For dermatologic professionals in practice, continued education and increased familiarity with the needs of patients with skin of color are essential to improving outcomes across patient populations.
“Certain conditions are of highest concern to patients of color, and this knowledge, along with the most frequent diagnoses seen in skin of color, can allow dermatologists to be better prepared to serve patients of color,” said Nada Elbuluk, MD, MSc, associate professor of dermatology at University of Southern California and founding director of the Skin of Color and Pigmentary Disorders Program at Keck School of Medicine. “Knowing the needs of this population, additional attention can also be placed on addressing gaps in knowledge that exist for diagnostic and therapeutic care of the most commonly seen conditions and concerns.”
Sources:
- Diversity in melasma trials sets precedent for inclusive research in other indications
- Student led initiative improves skin of color inclusion in educational dermatologic images
- Common Dermatologic Conditions in Skin of Color
- Dermatological clinical trials lack racial, ethnic diversity
- Skin of Color Society releases new educational video series
