The medical side of skincare has long let women of colour down – this is what’s happening to fix it

Written by Ata-Owaji Victor

“For a long time, healthcare professionals and researchers have been missing a simple tool in their toolboxes: an evidence-based approach to describing skin colour,” says Dr Ophelia Dadzie, chair of the British Association of Dermatologists’ Lexicon Group.

For women with dark skin, finding accessible and accurate skincare advice that goes beyond over the counter treatments can be a difficult process. Whether you’re suffering from a cystic acne flare-up or looking for a way to even out signs of hyperpigmentation, it can be a convoluted and confusing path. 

Wading through the long-standing myths about melanin, often bolstered by idioms like “Black don’t crack” and the widespread misunderstanding (and misuse) of SPF, can lead to feelings of overwhelm and confusion. When seeking out professional help for skin concerns, these feelings only become heightened. 

Within clinical, medical and cosmetic settings, there are myriad issues facing women with dark skin tones. Issues with accurate diagnosing, culturally conscious treatment plans and the overall amount of self-advocacy that is expected of Black and brown women in these spaces have long been documented in communities and online. 

For 27- year-old commercial real estate lawyer Damie, issues surrounding access to a comprehensive diagnosis came to a head after an extreme eczema flare-up.

“It had gotten to the point where parts of my skin were bleeding, but no matter who I saw, I would get the same response – use steroid cream,” she says. “However, even if it would help the flare-up for a few weeks, the conversation about the dark marks left on my skin felt like an afterthought.”

During this time, Damie says she would be left with “dark scars and next to no information on how to fix them or, worse still, be prescribed products that a simple Google search would reveal weren’t the best choice for my skin. It began to significantly impact my mental health.” 

Whilst connecting with Black women online about the issues with accessing treatment, Damie says, “Too often, I’d end up speaking with Black women who, due to both the pandemic and a lack of clinics experienced with darker skin types, had been receiving late-stage diagnoses for serious conditions like melanoma.” Melanoma can be a life-threatening form of skin cancer that is caused by the abnormal development of skin cells.

The root of this inadequate care for dark-skinned women can be traced to the widespread use of a skin typing system called the Fitzpatrick scale.

What is the Fitzpatrick scale?

“The Fitzpatrick scale is a standard first developed in 1975 and has been used in aesthetics and medicine to review and describe different skin tones,” explains Dr Ifeoma Ejikeme, founder and medical director of the Adonia Medical Clinic. 

Despite the fact it has been used as the baseline since its creation, Dr Ejikeme says: “I have always found it challenging because, as it stands, it groups all African/Caribbean, South American/American and Asian skin within just two types – 5 and 6.”

Dr Ejikeme continues: “As the system was originally created for skin types 1–4 and their response to sun exposure – with Black and Asian skin tones added much later, the type 6 description, which typically classifies Black people, is one I have always found to be incorrect. The Fitzpatrick scale describes type 6 skin as never tanning and never burning. I don’t know of any skin type that never tans and never burns.”

This oversight in the skin typing system has an even greater impact on the quality of care for people with darker skin. “The fact is, as it stands, the Fitzpatrick scale doesn’t take ancestry into account. This can lead to cases of people with lighter skin, who are of Asian or African descent, being incorrectly classified on the scale as a tone 2 or 3,” says Dr Ejikeme. 

“This type of skin, when exposed to the sun, can pigment to types 4–6, posing a treatment challenge for inexperienced clinicians and therapists using the scale.”

This long-overdue demand for changes in the approach to caring for dark-skinned women is something Dr Ophelia Dadzie, chair of the British Association of Dermatologists’ (BAD) Lexicon Group, explains, was central to the decision to propose an alternative scale – the Eumelanin Human Skin Colour Scale, built with all skin types in mind.

“For a long time, healthcare professionals and researchers have been missing a simple tool in their toolboxes; an evidence-based approach to describing skin colour,” says Dr Dadzie. “There are often instances in research and in medicine where skin colour, rather than say ethnicity, is an important variable, so being able to objectively describe this feature will help us talk more accurately about who diseases impact, will help us analyse and compare research more easily, and enable us to spot underrepresentation more clearly.”

What is the Eumelanin Human Skin Colour scale?

According to the BAD, the newly introduced Eumelanin Human Skin Colour Scale – named after the most common pigment found in the skin – is a 5-point scale that can be used to describe the full spectrum of possible human skin colours. 

The scale uses a measurement called the melanin index and is calculated by measuring the varying amount of light reflected from the skin. Lighter skin reflects more light and darker skin reflects less. Using this understanding, the researchers created five skin type sections: Eumelanin Intermediate High (darker skin types) through to Eumelanin Low (lighter skin types). 

While the Eumelanin Human Skin Colour Scale has fewer “types” than the Fitzpatrick system, the measuring process is more accurate, measuring the reflection of light rather than how much pigment your skin has and how it reacts on exposure to sunlight. 

However, says Dr Dadzie: “It’s important that we emphasise that this is not a replacement for talking about ethnicity or any other characteristic where ethnicity is the relevant factor. Skin colour should not be used as a euphemism for this, and vice-versa.”

This new scale provides an alternative, more inclusive addition to the clinic-based toolkit, which is something that Dr Ejikeme says “will hopefully allow for more relevant and accurate language when describing skin tones and the response that skin will have to different products and treatments”.

Dr Ejikeme says that this is a crucial step: “It’s something that in my many roles I have advocated for constantly. Accurate care has an undeniably positive impact on health, be that skin health, skin concerns or medical treatments.”

On the frontline in clinics, NHS doctor and skin specialist Dr Kemi Fabusiwa says: “This new scale feels like a real way to cement the hard work and industry change skin health experts have been advocating for years.” 

According to Dr Fabusiwa: “Studies show that Black patients experience greater satisfaction with their overall care when treated by clinicians who are from a similar background or have been noticeably trained in skin-of-colour specific training modules. With the new, more equitable Eumelanin Human Skin Colour Scale, there’s a real potential to reduce colour bias across the field.”

Now, as we enter a new normal alongside coronavirus, there’s even more attention on how to dismantle structural and racial inequality. “There is and continues to be a huge focus in the dermatological world on diversity, equity and greater representation of Black doctors. This comes alongside a global push for more diverse images of skin of colour being distributed throughout medical audiences. I believe the introduction of the Eumelanin Human Skin Colour Scale into clinics will help to continue to push the dial forward until there is, one day, total equity.”

Main image: Getty

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