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Closing the gap in dermatology training: Introducing Skin of Colour Training UK
Dominique Dao, Oluwadamilola Jagun, Shahd Elamin, Dijon Millette, Hannah Wainman, Cher-Han Tan, Marisa Taylor
First published: 02 June 2024
Read more: https://doi.org/10.1002/jvc2.468
ARTICLE
The 2021 UK census revealed that the skin of colour (SOC) population increased from a little over 7.8 to 10.9 million in the last 10 years.1 Despite this, SOC images are underrepresented in medical education,2 and research has shown that 54% of Dermatology trainees in the UK lacked confidence in managing SOC-related conditions, echoing similar findings amongst Dermatology trainees in the US and Australia with similar population shifts.3-5 Additionally, 86% of UK dermatologists felt inadequately trained in managing hyperpigmentation, a prevalent concern in SOC.6
The Skin of Colour Training Day UK: training the medical workforce in ethnic dermatology
O. Jagun, P. Banerjee, D. Thompson, M. Taylor
Clinical and Experimental Dermatology, Volume 47, Issue 2, 1 February
2022, Pages 245–246
Read more: https://doi.org/10.1111/ced.14800
ARTICLE
It is with great pleasure that we introduce this special Skin of Colour issue following our first virtual Annual Skin of Colour Training Day, which took place on 29 January 2021. The event was hosted in collaboration with the recently formed British Association of Dermatologists (BAD) Skin Diversity Sub‐Committee and The Dowling Club.
Skin of colour (SOC) is an umbrella term used to describe individuals with 'non' white (Fitzpatrick IV–VI) skin types. These skin types are prone to hyperpigmentation and scarring [1]. Although imperfect and vague, the term is often used in the literature to describe people from various racial and ethnic groups including those of African descent as well as Asian (Indian subcontinent, East Asia, Southeast Asia), Middle Eastern, Native Americans and Hispanics [2].
Structural and functional differences in skin of
colour
C. Iwuala, S. C. Taylor
Clinical and Experimental Dermatology, Volume 47, Issue 2, 1 February
2022, Pages 247–250
Read more: https://doi.org/10.1111/ced.14892
SUMMARY
The term ‘skin of colour’ (SOC), refers to individuals of African, Latinx, Asian, Native Hawaiian, Pacific Islander and Indigenous descent. These individuals typically have darker skin tones compared with white individuals and they often present with unique disorders of the skin or with common disorders that have a unique appearance. Certain skin conditions commonly associated with SOC patients, in contrast to individuals with lighter skin tones, are explained by structural and functional differences between this population and the white population. Variations in functional differences between these two groups are dependent on structural differences in melanosomes, stratum corneum, epidermis and dermis. Understanding the structural distinctions between white populations and SOC populations will provide insight into common disorders in SOC patients, including hyperpigmentation, hypopigmentation, dry skin, scaliness, xerosis, sensitive skin and keloids. Furthermore, understanding structural and functional skin difference will encourage more research regarding aetiology of disease and therapeutic interventions.
Differential diagnosis and management of
hyperpigmentation
J. Yoo
Clinical and Experimental Dermatology, Volume 47, Issue 2, 1 February
2022, Pages 251–258,
Read more: https://doi.org/10.1111/ced.14747
ABSTRACT
There is an increasing recognition of ethnic dermatology to reflect the increase in skin of colour (SOC) populations in the UK. Hyperpigmentary disorder is one of the commonest skin concerns in SOC but there has been limited training available in this field of dermatology. Variations in skin colour are genetically determined by the amount of melanin content, the eumelanin/pheomelanin ratio and the size of melanosomes, but is also influenced by other factors such as hormones and extrinsic factors such as ultraviolet radiation. Hyperpigmentation is a broad term to describe increased pigmentation in the skin, and making a correct diagnosis is an important first step in the successful management of hyperpigmentary disorders. A systematic approach based on the disease pathogenesis (e.g. reactive vs. nonreactive, increased melanin vs. increased number of cells or epidermal vs. dermal pigmentation) aided by a detailed history and clinical examination is the best way to diagnose a hyperpigmentary disorder. Based on its pathogenesis, management can be planned. For epidermal hyperpigmentation caused by increased melanin, topical skin‐lightening agents targeting inhibition of tyrosinase or melanosome transfer and promotion of keratinocyte turnover can be used. Hydroquinone‐containing cream is the gold‐standard treatment for epidermal hyperpigmentation. Alternative treatments include laser toning or chemical peels. However, increased dermal pigmentation is more challenging to target with topical treatments. If hyperpigmentation is due to increased numbers of melanocytes or keratinocytes, high‐fluence laser is the most appropriate treatment method.
Acne and rosacea in skin of colour
T. Maruthappu, M. Taylor
Clinical and Experimental Dermatology, Volume 47, Issue 2, 1 February 2022,
Pages 259–263,
Read more: https://doi.org/10.1111/ced.14994
SUMMARY
Acne and rosacea are common inflammatory skin conditions present in numerous racial and ethnic groups. There are distinct differences in clinical presentation, exacerbating factors, potential triggers and consequences of both conditions in individuals with skin of colour (SOC), classified as Fitzpatrick skin types III–VI. For example, acne can be complicated by the development of postinflammatory hyperpigmentation and keloid scarring in SOC, and this can influence treatment choice. Although rosacea is reported less frequently in SOC, this may be the result of delayed diagnosis or late presentation due to the difficulty in discerning the classic features of erythema in darker skin tones. In such cases, additional clues in the medical history and clinical examination may assist in making the diagnosis. This review aims to summarize nuances in both the diagnosis and management of these two common skin conditions in patients with SOC to support clinicians in providing an individualized treatment approach.
Skin lightening: causes and complications
M. Sommerlad
Clinical and Experimental Dermatology, Volume 47, Issue 2, 1 February 2022,
Pages 264–270,
Read more: https://doi.org/10.1111/ced.14972
SUMMARY
Skin bleaching, also known as skin lightening, is the deliberate lightening of an individual's skin tone without medical supervision. The causes are complex, multifactorial and often intertwined, although the unifying themes centre around a belief that lighter skin denotes an individual of higher status, socioeconomic background or physical beauty, than their darker‐skinned counterpart. Skin lightening is achieved using agents that block the production of melanin and often contain drugs such as hydroquinone, superpotent topical steroids or mercury. These drugs can cause serious local and systemic complication. Skin‐lightening compounds are illegal in most countries throughout the world; however the industry is worth billions of dollars annually, and the agents can be easily obtained by individuals seeking to lighten their skin. Dermatologists are in a unique position to identify those at risk of using skin‐bleaching agents, manage complications and give advice on the physiological variation in pigmentation and how to avoid using skin‐lightening agents to treat dermatological conditions. To manage the belief that lighter skin is better, societal level change is required to ensure that people of all skin tones are represented in the media.
Bridging the Gap: A Pre- and Post-evaluation of an Online Skin of Colour Dermatology Lecture Series for Medical Students
Vaseharan Suntharan, Charlotte Wilson, Emma Amoafo, Dominique Dao, Ezigbo Iyamah, Marisa Taylor
Read the full publication here
SUMMARY
Medical students often report limited teaching on dermatology in skin of colour (SoC), which may contribute to lower confidence and risk of health inequalities.
The objective of this study is to evaluate a pilot student-led lecture series designed to bridge the gap in confidence between recognising dermatological conditions in fairer skin tones (Fitzpatrick I-III) and darker skin tones (Fitzpatrick IV-VI).
A nine-lecture online series was delivered to medical students. Students completed pre- and post-series surveys measuring self-reported confidence in diagnosing general dermatological (GenDerm) and SoC dermatological conditions on a five-point Likert scale. Changes in confidence scores were assessed with the Wilcoxon signed-rank test, and effect sizes were calculated. For dichotomised outcomes (high confidence ≥ quite confident), McNemar’s test with odds ratios (ORs) and 95% confidence intervals (CIs) was applied.
International Expert Consensus on Knowledge Gaps in Care for Dermatologic Disorders in Skin of Color
Henry W. Lim, Chengfeng Zhang, Marisa Taylor, Ncoza C. Dlova, Katleen Conceição, Nina Jablonski, Neha Gupta, Janet Wangari-Olivero, Andrew Alexis
Read the full publication here
SUMMARY
Patients with skin of color (SOC) face unique dermatologic challenges that are often underrepresented in research and in dermatological education, creating critical gaps in care. We aimed to identify and explore key gaps in research and clinical management for SOC across four domains: skin diseases, hair disorders, photoprotection, and aesthetic procedures. An international panel reviewed articles retrieved from PubMed using the search terms “skin of color” or “skin of colour” in titles and abstracts from September 2019 to September 2024. Inflammatory skin diseases, including acne, atopic dermatitis, psoriasis, and rosacea, are common in SOC subjects, necessitating tailored diagnostic and therapeutic approaches due to unique clinical presentations and specific challenges such as post-inflammatory hyperpigmentation and erythema detection. Pigmentary disorders such as melasma and acne-induced hyperpigmentation significantly impact quality of life in SOC, requiring cautious treatment to avoid exacerbation, while the unregulated use of skin bleaching agents containing high-potency corticosteroids can pose serious health risks. Skin cancer in SOC often presents at advanced stages with poorer outcomes due to lower awareness and unique clinical manifestations, resulting in delayed diagnosis. Hair disorders in SOC populations require tailored diagnostic and therapeutic approaches due to unique hair properties. Gaps in photoprotection education on SOC exacerbate pigmentary disorders and other dermatologic conditions, with limited research on effective sunscreens for this population. In aesthetic dermatology, misconceptions and knowledge gaps regarding the prevention of complications hinder access to safe and effective procedures for SOC subjects, compounded by inadequate diversity in clinical trials. Inclusive research, improved diagnostic accuracy, and customized procedures are needed to ensure equitable
International Expert Consensus on Defining Skin of Color and Delivering Equitable Dermatologic Care
Henry W. Lim, Chengfeng Zhang, Marisa Taylor, Ncoza C. Dlova, Katleen Conceição, Nina Jablonski, Neha Gupta, Janet Wangari-Olivero, Andrew Alexis
Read the full publication here
SUMMARY
Dermatological practice faces significant challenges in meeting the needs of populations with skin of color (SOC). Patients with SOC face disparities, including misdiagnoses and inequitable treatment outcomes. This expert consensus sought to identify gaps in dermatologic care for these populations and to propose strategies to promote inclusivity. Classification systems for SOC and healthcare disparities were investigated by reviewing English language articles on the subject published in PubMed between 2019 and 2024. An international panel of multidisciplinary experts from four continents (America, Asia, Africa, and Europe) analyzed the findings and developed recommendations. There are limitations in the current skin type classification systems, and gaps persist for SOC populations in research, clinical trials, and education for both providers and patients. Proposed strategies to bridge these gaps include refining classification systems (Dermatology societies), advancing SOC-specific research, enhancing education, and integrating artificial intelligence. Key recommendations from the panel focused on four areas: (1) Research: Achieve SOC numbers in clinical trials and publications that would be a reflection of local and global populations, publish new guidelines on key SOC-related issues, and achieve representative authorship in the said clinical trials and publications; (2) Resources: Create a global library of SOC images for dermatological diseases; (3) Education: Provide training for healthcare professionals and scholarships for students worldwide to improve awareness and expertise; (4) Representation: Ensure SOC representation in images used for patient communication and educational materials.
Alternative descriptors for ‘erythema’ in skin of colour: a UK-based cross-sectional survey
N Farah Mahmood , Emmanuel Toni , Fatimah Khoda , Marisa Taylor
Read the full publication here
SUMMARY
Dear Editor, Textbook descriptions of dermatological conditions are generally given in the context of white skin.1 Erythema, a term used to describe redness of skin and mucous membranes, is an important clinical sign of inflammation. While relevant to lightly pigmented skin, it can be imprecise for richly pigmented skin types2 as redness is masked by background pigmentation. Inflammatory changes are often subtle and can appear more brown, purple or ashen grey.3 Relying on erythema as a sign of inflammation in skin of colour may result in delayed or misdiagnoses.
We surveyed 152 healthcare professionals attending two identically designed Eczema Area and Severity Index workshops at the national, in-person, UK-based Skin of Colour Training Conference. Participants included dermatology consultants, dermatology specialist and specialty doctors, dermatology specialist registrars, resident doctors from other specialties, general practitioners (GPs), GP trainees, dermatology nurses, nondermatology nurses, medical students and pharmaceutical representatives.
The participants worked across the UK, and although ethnicity data were not formally collected, the cohort included healthcare professionals with skin of colour. All participants were anonymously asked to propose a maximum of three words as alternative descriptors for the term ‘erythema’ in skin of colour as freehand text.
Posters
Presented by Dominique Dao at Royal College of Physicians Regional Poster Competition for Wales and Northern Ireland. Winner of the poster competition.
Presented at the 15th Annual Pre-Conference DermSchool Session at the 105th Annual Meeting of the British Association of Dermatologists, June 2025, Glasgow.
Presented at the Annual European Academy of Dermatology and Venereology Congress, September 2025, Paris.
