I wish more dermatologists knew that eczema in patients of color can present differently than it does in white patients.
Instead of having red and visible areas of patchiness and dryness, it is usually more difficult to see symptoms of eczema due to our skin tones. And often, because it’s in the cracks, it may blend into a joint and appear to be a joint or vein line.
Rather than viewing these areas as merely “dry skin” that need to be moisturized, our doctors need to look closer and add in the clinical questions that paint the bigger picture.
Does our skin seem to crack and hurt more when the temperature is higher? Is it painful as well as itchy? Are there products that seem to cause an increase or a decrease in the itchiness of the skin? What did the skin look like before it started to thicken and stay cracked?
Usually, these questions are not explored initially, and the patient is waved off with moisturizer or a combination of a moisturizer and a low-dose steroid.
I wish dermatologists spent time studying what healthy skin of color looks like so they could identify abnormalities more easily. I think it is vital to study what “normal skin” looks like in patients of color, so you know what you are working towards. If you have never seen “normal” how will you know if you are getting closer to it or farther away from it?
Communication is a vital part of successfully treating any illness, and I feel that dermatologists need to be prepared to listen to a narrative of the patient before making a blanket treatment plan that may not fit individual patients.
I also think more dermatologists have to understand that the living conditions of a person of color may not be the same as a white patient. This is an economic difference as well, and it needs to be explored because environmental factors can and do exacerbate eczema in many patients, especially children who cannot control their own environments. Dermatologists need to look at the patient’s medical history and current situation, as these have an impact on eczema.
Instead of creating an adversarial environment where the patient and the dermatologist are clashing, the dermatologist first needs to decide that they even want to treat patients of color, followed in short order by whether or not they can do it and are committed to doing it as successfully as they are to treating other skin types. If at any point, the answer to this question is “no,” then the treatment plan is doomed from the beginning and the dermatologist should be comfortable enough with referring the patient on to someone who can instead of wasting everyone’s time.
Communication and dedication is key. When dermatologists look at the patient of color (or any patient, for that matter) as a whole patient with an individual story that has some overlap with another community of patients, then works as part of the care team along with the patient— only then can we make progress.
I think we might better prepare the doctors of tomorrow for treating patients of color by exposing them more to patients of color.
We first need to assess their desire to actually treat this population. Every business has a target market and so should every doctor. If skin of color is not your target market, then it becomes like the fortune cookie that you get with your take-out— you might miss it but you do not drive across town just for the fortune cookie.
So, in short, we need more specialists in this area. We need more research that is dedicated to this exact type of medical practice. You can call it a niche, or whatever you want, but people of color need care tailored to their skin, and we need people who are willing to put in the time and effort as well as care in understanding and treating our skin with a goal in mind. It all starts with a goal and the goal for patients of color is the same as for those who are not of color, and that is to get adequate treatment that someday cures our ailments.
