Does Your Dermatologist Look Like You?
Materia Johnson felt as if her skin were on fire. It started one day in the fall of 2019 with red lesions on her chest. Her skin was itchy and irritated, and the rash was spreading. “It felt like I was being bitten by ants,” she recalls. “It was terrible.”
She saw her primary care physician, who referred her to a dermatologist. That doctor prescribed medication, but it didn’t ease the itching or spread. She saw another dermatologist who wasn’t able to help either, despite prescribing topical medication. After four months of living in pain, she was diagnosed with a form of eczema that is often harder to spot on people of color and got proper treatment from Corey L. Hartman, MD, founder of Skin Wellness Dermatology in Birmingham, Alabama. (She knew Dr. Hartman socially and decided to see if he might have an answer.) She hasn’t had a breakout since.
Starting at the Source
What made Johnson’s condition so tough to identify? For one, only 10 percent of images in dermatology textbooks show diseases on dark skin, leading to underdiagnosis. What’s more, doctors of color are woefully underrepresented in the field of dermatology: According to the U.S. Census Bureau, just over 3 percent of dermatologists are Black, and less than 5 percent are Hispanic. So the majority of medical students (most of them white) see skin conditions in textbooks on predominantly white patients. That’s what spurred London-based medical student Malone Mukwende to create Mind the Gap in 2020, a handbook of images and descriptions of signs and symptoms in Black and Brown skin. That’s also why other resources such as the Black Derm Directory and Skin of Color Database (a global dermatology organization dedicated to dermatologic health issues related to skin of color) now exist.
“Dermatology is a visual specialty, and we should be trained to recognize skin conditions in all skin hues, and it should be reflected in our textbooks,” says Alicia Barba, MD, a dermatologist in Miami. “Who writes the chapters in the textbooks, who takes the photos, who publishes them? If you think there’s a lack of practicing BIPOC dermatologists, the representation in faculty in university departments is even more dire.”
Being exposed to different skin tones during early training is key because many conditions present themselves differently on darker skin—eczema, rosacea, and psoriasis, to name a few. Additionally, there are differences in how skin care performs, how peels should be administered, and how devices like lasers are used on skin of color.
“We need training programs that make dermatologists feel equipped to step out into the world and be able to handle all patients,” Dr. Hartman says, pointing out recent research that found new dermatology grads do not feel equipped to serve patients of different backgrounds. The good news is that derm departments across the U.S. are taking note and evaluating their courses. Plus, there are more opps for budding docs to learn about treating skin of color through lectures and other resources.
Finding Common Ground
Discovering a derm who looks like you is about more than just diagnosing skin condition—it can also be about the cultural connection. “As a Mexican American growing up in California, it was important our physicians speak Spanish, as my mother didn’t speak English well,” Dr. Barba says. Trying to understand medical jargon can be tough no matter what, so imagine that barrier when you’re not as familiar with the language.
Now, patients seek out Dr. Barba for her language skills. “People trust a compassionate physician who also looks like them. It’s a bonus when the physician shares a cultural background or speaks the same language.” Proof positive: Cultural competence is in fact tied to higher-quality health care, according to research in the Journal of the National Medical Association.
Advocating for Yourself
Though having a dermatologist with a similar background can make things easier, it isn’t absolutely necessary in order to receive life-changing care. “Given that less than 5 percent of U.S. dermatologists identify as POC, chances are you may not have access to one if you’re not in a metropolitan area,” Dr. Barba says.
If that’s the case, don’t fret. Look for a dermatologist who has good training with a diverse patient population. “Sometimes it’s as simple as asking around in the community to see who’s good with certain conditions or with dealing with various populations,” says Dr. Hartman.
Another option is a virtual consult. Thanks to the telemed boom, it’s easier to access dermatologists with expertise in skin of color. (Sweet!) “It may be a good investment if you feel other derms in your area have not addressed your situation properly or you’d like a second opinion from a dermatologist with a similar background,” Dr. Barba says.
Getting a skin check with a new dermatologist is a great way to explore if they’re the right doctor for you. “While they’re scanning your skin—looking for precancers or atypical moles—talk with them,” Dr. Barba says. Ask questions, such as if they’re comfortable taking care of patients with darker skin and whether their dermatology training exposed them to a diverse patient population. “These are all valid questions that your dermatologist will be happy to answer,” says Dr. Barba.
Embracing the Future
Change won’t happen overnight, but even just having these conversations is a positive step forward. “[The medical community is] definitely discussing it more, which is always a good first step,” Dr. Hartman says. “People are more receptive to it.”
Ultimately, whether or not you and your dermatologist have a similar background, it’s about finding a doctor you feel comfortable with, who can provide you with solid care. “I have both Black and white doctors, but I find that when you are working with someone who looks like you, they understand better what is going on,” says Johnson. “They tend to be more attentive and know what you’re saying and how you’re feeling. I felt more comfortable talking to Dr. Hartman.”
She also believes better representation in the dermatological community might encourage BIPOC patients to seek help. “People would be more apt to go in to see specialists rather than trying home remedies to get some relief from whatever is going on with them,” Johnson says. “If we have more doctors who look like us, then we will feel comfortable, and feel they are really taking our case seriously.”
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