Why You Should Find A Dermatologist With Your Skin Tone

For many people of color, finding a dermatologist who looks like them can be a challenge, but one that’s worth pursuing.

“Of course doctors with darker skin are going to be more attuned to cultural aspects surrounding care, because they’re reading their own skin every day,” said dermatologist Dr. Michelle Henry, who is Black.

She also acknowledged that the pool is limited. “There’s a shortage of us, and fewer than 3% of dermatologists in the United States are Black,” she said. (Current data indicates that 5.7% of doctors nationwide are Black, though Black people account for 14.4% of the population. Similarly, while Hispanic people represent 18.5% of the overall population, only 4.2% of dermatologists are Hispanic.)

The relatively small cohort of doctors of color will soon be encountering an increasingly changing national complexion, and people with skin of color are expected to become at least half of the country’s population by 2044.

”I did my general dermatology program at Mount Sinai and my MOHS surgery program at Harvard,” said Henry, who is based in New York. “Our textbooks severely underrepresented skin of color and different conditions. I had to buy special textbooks to understand darker skin better, because my textbooks were insufficient. I made a significant effort to learn on my own, because our curriculum didn’t focus on skin of color.”

Her fellow derms agree. “Many textbooks and teaching resources don’t have many images of skin conditions in darker skin tones, which poses a challenge in terms of educating future physicians and dermatologists,” said dermatologist Dr. Janiene Luke, a clinical professor of dermatology at Loma Linda University in Loma Linda, California.

“While all dermatologists treat hair, skin and nails, finding someone who has special training and interest in skin of color is beneficial,” Luke said. “We are keenly aware of the nuances of melanated skin and textured hair and can understand not only your skin and hair care needs, but also the unique challenges you may encounter as well.”

She named some examples: “While many common skin conditions occur in all skin types, the clinical presentation may appear differently in the context of skin of color. Some of the classic signs dermatologists are taught to recognize, like erythema, also known as redness, may look more purple, dark brown or even gray with some skin tones.”

Henry also explained some key differences. “Darker skin has larger fibroblasts that are creating more collagen,” she said. “This is part of the reason that we don’t see accelerated aging in darker skin tones, because the collagen stays a little higher. However, this can also be a double-edged sword, because those fibroblasts making the collagen are also hyperactive and can lead to keloidal scars, which darker skin types are more prone to getting.”

“Also, as a function of having more melanin present, darker skin tones are more prone to hyperpigmentation,” she said. “On the flip side, because the skin at its baseline is darker, hypopigmentation is more obvious and more disfiguring in darker skin.”

Dermatologists of color are often able to finally help patients who’ve been dealing with frustration and disappointment elsewhere. Henry mentioned seeing patients who have already received intense pulsed light treatment, which uses light energy to address a variety of skin conditions.

“I’ll see patients who say that lasers don’t work on them, either because their previous doctor was too afraid to use a laser on their dark skin, so they used a frequency that was too low, which wasted the patient’s time and money, or the doctor didn’t understand the adjustments that need to be made for darker skin types and they ended up burning the skin,” Henry said.

Another serious — and misunderstood — issue for patients of color is hidradenitis suppurativa, which causes small, painful lumps to form under the skin, said dermatologist Dr. Abrahem Kazemi, who graduated from Howard University’s medical school and completed a research fellowship in ethnic dermatology.

“I’ve found there to be a significant delay in disease identification, diagnosis, treatments and interventions for patients of color who have HS, which is a truly debilitating condition,” he said. “With the wrong diagnosis or, for example, undertreatment, by those who are not skin of color experts in dermatology, patients will also not have knowledge about their disease or how to treat it optimally.”

Post-inflammatory hyperpigmentation, also known as skin darkening after active inflammation, is a common concern of patients with darker skin tones, said dermatologist Dr. Regine Mathieu. “This discoloration is often mistaken for acne scarring, but it’s so important to know that there are treatment options that exist,” she said. “The most important treatment goal with acne is to stop the disease process so that more dark spots don’t appear. However, in darker skin types it’s important to address hyperpigmentation and active acne simultaneously.”

Some missed opportunities for care extend beyond skin to hair, Henry said. “I’ve had patients come in with kinky or curly hair and they may have seborrheic dermatitis, but because the prior doctor didn’t understand their hair, they told them to wash their hair more frequently. But those doctors didn’t realize that washing kinky hair every day is quite damaging.”

“It is so important to seek care from a dermatologist who has an understanding and genuine interest in the nuances in skin of color,” Mathieu said.

Often, these dermatologists say, patients are greatly relieved to finally find them. “I’ve been practicing for over a decade and I can’t tell you how many times patients have told me they were so happy to see me,” Luke said. “I’ve heard countless stories of other dermatologists not understanding — or even wanting to touch — their hair, not listening to or discounting their concerns, or providing them with recommendations or treatments that were not culturally sensitive.”

There are more resources out there now than ever, Luke said. “When I was a medical student pursuing my interest in dermatology, I knew there was a great need for caring for skin and hair that looked like mine. I was thankful to develop this interest further with great mentors and was fortunate to complete my residency training in New York City at Mount Sinai-St. Luke’s Roosevelt, the first Skin of Color Center.”

Luke said there are currently around 30 Skin of Color Centers in the United States, operating as centers of excellence committed to performing research and providing innovative treatments for patients of color.

To find a center or a doctor in your area, contact the Skin of Color Society, a nonprofit dedicated to the advancement of education on dermatologic health issues related to skin of color. They maintain a searchable directory of dermatologists, as does the Black Derm Directory.