Institutional racism in medicine is well documented and pervasive. According to several studies, Black patients face increased risk for misdiagnosis, mismanagement of their pain, and death, particularly in maternal health care. Nonwhite populations are underrepresented within vital medical data that’s used to standardize care across all medical fields. It’s an issue that becomes painfully visible in dermatology, the branch of medicine that deals with skin.
Medical photos of skin conditions aren’t hard to find. A Google search for “chicken pox” yields thousands of images. But scroll through the results, and you’ll start to notice something: Virtually all of the photos are of chicken pox on white skin.
This trend holds true even in reference materials for medical professionals. A recent analysis published in the Journal of the American Academy of Dermatology found only 4 to 18% of images in textbooks for dermatology medical students included dark skin. This absence of images makes it difficult to diagnose and treat dark-skinned patients with mild complications, like rashes, as well as life-threatening conditions like skin cancer. That lack of diversity contributes to ineffective treatment and lower levels of patient-provider satisfaction — and can be a matter of life or death. Black melanoma patients, for example, have nearly 24% lower survival rates than white patients.
Brown Skin Matters is a crowdsourced Instagram database curated by Ellen Weiss, who began the project after she noticed a lack of images available online to help her identify a rash on her mixed-race son.
Launched in 2019, the @brownskinmatters account has just over 100 posts — the majority of which are user-submitted photos that show what different ailments look like on nonwhite skin. The images range from common afflictions, like chicken pox and eczema, to less-discussed conditions like gangrene and Kawasaki disease. Occasionally, Weiss, who is white, posts some of the latest medical findings on skin of color as well.
While providers of color are underrepresented in the field of medicine, dermatology is particularly white.
“I created it as a casual resource for parents,” she says, “but the people I hear from most are med students, doctors, and nurses telling me how poorly they were trained and how badly such a resource is needed.”
The feed’s comments reflect that impact and range, which has surprised even Weiss. “I’m a nursing student whose textbooks’ photos are predominantly of white people, and I really appreciate and learn a lot from your posts,” writes one commenter.
That wider usefulness has helped the site gain a broad audience: Brown Skin Matters’ Instagram feed has grown to nearly 68,000 followers in less than two years.
Brown Skin Matters is one of a limited but growing number of resources that are challenging the colorblind approach to skin care. For the most part, they exist outside — and without the endorsement of — the medical community. One of the biggest challenges Weiss faces is the inability to verify that user-submitted photos are confirmed diagnoses.
But the obstacles to more equitable dermatology care go beyond reference photos, says Hope Mitchell, a medical and cosmetic dermatologist and the founder and CEO of Mitchell Dermatology in Ohio. She believes the field’s diversity problems start with the caregivers. While providers of color are underrepresented in the field of medicine, dermatology is particularly white.
And that affects patient care. When Mitchell was in her residency nearly 30 years ago, she says, she “did not see how conditions presented on Black skin in textbooks, nor did I have pamphlets or brochures to pass out to Black patients with people in them that looked like them.” Little has changed since then, she says.
The Bigger Picture
Weiss is fundraising to expand Brown Skin Matters from an Instagram feed to a searchable website, with an editorial panel that would include medical professionals to help vet images. “I would like the eventual resource to be of a quality that makes it useful to both laypeople and physicians,” she says.
The medical industry, too, has publicly prioritized reducing the medical “blind spots” that intensify health disparities. Medical leaders in 145 cities and counties in the U.S. have declared racism as a public health issue. The American Medical Association recently announced its commitment to recognize racism as a public health crisis and push for increased research on racism’s health impacts, better medical education on how to treat diverse patients, and the prevention of racial bias in new health technologies.
Weiss sees Brown Skin Matters as an important piece of those efforts. “I wish to send my son out into a world that is fully prepared to meet his needs with the same expertise and dignity with which mine are met,” she says. “I want every other parent of a child of color to know they will be able to do the same.”