Medical students drive equity initiative
Student-launched project created a database aiding the teaching of pathology in diverse skin tones (Issue #230, 1,400 words, 7 minutes)
Students and faculty at the Hackensack Meridian School of Medicine in Clifton, N.J., collaborated with librarians to address the shortage of pathology images on diverse skin tones in medical educational materials. The team developed a database of dermatologic conditions in people with darker skin tones.
In a paper describing the project (Journal of the Medical Library Association Oct. 2024; 112(4):350-356), the authors note that a shortage of pathology images on diverse skin tones has been recognized for decades in health professions education.
Curriculum leaders at the school had been engaged in discussions around structural racism and its impact on health outcomes, evaluating the curriculum to address this ongoing public health crisis. At the same time, a student of colour observed that his skin tone was not represented in the images of skin pathologies presented during dermatology sessions.
A group of like-minded students seeking to improve subsequent versions of the course and enhance integration across all segments of the Phase 1 curriculum sought guidance from the school's faculty and staff. This led to the creation of a student-led task force that included the expertise of course directors, medical librarians, and the director of the Office of Diversity, Equity, and Inclusion.
A series of meetings with faculty determined the best approach to address and enhance the representation of diversity in disease images within the curriculum. The students performed a literature search and created a database of images of skin pathologies in people with darker skin tones.
As part of developing the database, students generated a list of diseases they wanted to see more diversely represented in session materials, focusing on infectious and inflammatory conditions. They prioritized more commonly seen conditions, such as atopic dermatitis, and more severe conditions, such as toxic epidermal necrolysis. There is a plan to add non-dermatologic manifestations of disease, such as jaundice, hyperpigmentation, and petechiae, to the database.
Course directors and lecturers used the database to enhance their teaching materials for the next cohort of students. The database is now an easily accessible resource for faculty to create lecture slides or other educational materials.
Bottom line: A student-led initiative, in collaboration with faculty, was able to develop and implement an educational resource database for the Hackensack Meridian School of Medicine. The database provides image resources that can be used to reduce disparities in the representation of skin types in course materials. The school faculty are now using the database to improve their course materials, and updates to the database are ongoing.
From the literature on dermatology in skin of colour
Adapting pediatric dermatology textbooks in South America: Enhancing visual representation for skin of colour patients
Researchers conducted a prospective documentary study on the skin colour of clinical photographs from five pediatric dermatology books, including four Brazilian books and one Argentinian book. Three investigators evaluated the photographs and classified them using the Massey-Martin scale (1-2 White, 3-5 light Brown, 6-8 dark Brown, and 9-10 Black).
Of 3,471 photographs, the researchers excluded 1,000 and determined skin colour in 2,471.
They identified White skin in 1,403 (56%) photographs, light Brown in 1,044 (42%), dark Brown in 24 (1%), and 0 (0%) Black. Atopic dermatitis, contact dermatitis, and psoriasis were the most common diagnoses; however, no dark Brown or Black skin was represented.
It is worth noting that despite most (55.5%) of the Brazilian population identifying as Black, as well as 0.7% of the population of Argentina, representation of skin of colour in the textbooks was less frequent.
“This disparity undermines education, highlighting the need to increase representation of skin of colour in educational materials to improve healthcare for these populations,” the authors conclude.
Skin colour representation in infectious disease textbooks
This study was conducted to determine whether skin colour is unequally represented in infectious disease textbooks and advocate for more equitable representation. The authors included a focused analysis of skin colour depiction in conditions associated with social stigma, which they write may perpetuate implicit biases among healthcare professionals.
The investigators chose four infectious disease textbooks in wide circulation for analysis: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease (2020), Manson's Tropical Diseases (2023), Comprehensive Review of Infectious Disease (2019), and Netter's Infectious Diseases (2022). They categorized conditions as socially stigmatized if they were linked to sexually transmitted infections, intravenous drug use, poverty, or incarceration.
Of the 285 included images, most portrayed conditions associated with social stigma (58.6%), and the images were predominantly of lighter skin (60.4% of photos Fitzpatrick skin types 1 to 3, 39.6% skin types 4 to 6.
The authors found images depicting conditions associated with social stigma were more likely to be represented on dark skin tones, and more stigmatized conditions than non-stigmatized conditions were shown in the pictures of darker skin tones.
Exploring pediatric dermatology in skin of colour: Focus on dermoscopy
This review evaluates the clinical and dermoscopic presentations of common pediatric diseases among children with skin of colour (SoC). It also addresses potential variations based on racial backgrounds.
The review identified seven studies on nevi subtypes, 24 on skin infections, six on inflammatory dermatoses, 10 on hair diseases and disorders, and 14 on miscellaneous disorders that also satisfied their SoC- and race-specific criteria.
In cases where no results showed differences, investigators assumed that dermoscopic findings are similar between SoC adults and children, confirming the hypothesis with dark-skinned Indian child patients.
The authors found inflammatory dermatoses such as psoriasis, eczema, and cutaneous mastocytosis, as well as skin infections such as cutaneous leishmaniasis, appear with brownish backgrounds or exhibit dark structures more frequently than the respective dermoscopy images of Caucasian populations.
Dermoscopy traits such as erythema in tinea capitis are uncommon or absent on a dark-coloured scalp. At the same time, a dark skin tone often obscures many characteristic features, such as dark and yellow dots in alopecia areata and even parts of an intradermal parasite in the case of scabies.
Investigators also observed race-specific traits, including corkscrew hair in tinea capitis, primarily seen in patients of African origin.
Many of the dermoscopic images were consistent between SoC and non-SoC in various skin lesions, including vascular anomalies, juvenile xanthogranuloma, mastocytoma, and viral skin lesions such as molluscum contagiosum, as well as across multiple hair disorders such as trichotillomania. At the same time, tinea capitis displayed the most diverse reported dermoscopic features across SoC- and race-specific studies.
VIDEO: Hue-man Dermatology
Dallas-based general and pediatric dermatologist Dr. Nnenna Agim shares her expertise in providing dermatologic care sensitive to colour and cultural considerations in pediatric patients.
At the intersection of skin and society
The prorogation of the Canadian parliament, spurred by Prime Minister Justin Trudeau's resignation, could impede a bill intended to ensure that First Nations have clean water and wastewater services on par with Canadian cities.
This news was reported by Canada’s National Observer on Jan. 9, 2025.
Bill C-61, the First Nations Clean Water Act, is one of several bills the event could impact. Under a prorogation, all bills that did not reach royal assent are wiped off the board and must be reintroduced once parliament returns. Parliament will be prorogued until March 24, and it's unclear if the First Nations Clean Water Act will be brought back onto the legislative table before an election is triggered, the news outlet reports.
John P. Brown, the executive director of the First Nations Advisory Committee on Safe Drinking Water, calls the bill “imperfect” but essential. C-61 would have legislated “for the very first time that Canada had the duty and obligation to provide adequate access to clean water to First Nations across the country,” he said. The bill would have also ensured the federal government had a legal obligation to fund the development and maintenance of water infrastructure and mandated minimum quality standards for that infrastructure.
This week
January is World Health Esteem Month
January is National Slavery and Human Trafficking Prevention Month in the U.S.
Jan. 17 is International Mentoring Day
Something to think about in the week ahead . . .
—Viktor E. Frankl, Austrian psychologist (1905–1997)
Next week
In a presentation at the Great Lakes Immunodermatology Exchange (GLIDE) 6.0 meeting in Niagara-on-the-Lake, Ont. on Nov. 2, 2024, Toronto-based dermatologist Dr. Marissa Joseph detailed some of the differences in prevalence and severity of hidradenitis suppurativa among patients of different racial backgrounds.
Register now for the first Global Indigenous Skin Spectrum Summit in Montreal
Happy New Year to the readers of Skin Spectrum Weekly. The first Indigenous Skin Spectrum Global Summit will be held in Montreal on April 5, 2025, and it is only a few short months away.
We invite you to attend the summit to consider the unique dermatologic challenges facing Indigenous populations worldwide. It is an opportunity to learn from experts on how physicians can support equitable health for these populations.
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty that includes Dr. Rachel Pugh (Australia), Dr. Carsten Sauer Mikkelson (Denmark), Dr. Monique Mackenzie (New Zealand), Dr. Anna Chacon (Florida), Dr. Dana Slape (Australia), Dr. Carolyn Jack (Montreal), and other thought leaders.
More details on the Global Summit will appear in future editions of Skin Spectrum Weekly.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Ilya Shoimer (Calgary), Michael Stevens (Bedford, NS.), and Mark Lupin (Victoria, BC) discuss the current strategies for managing actinic keratoses, including identifying the risk of progression to squamous cell carcinoma.
Dr. Irina Turchin (Fredericton, NB) describes findings from recent research on the safety and efficacy of topical roflumilast 0.3% in treating psoriasis.
Drs. Yuka Asai (Kingston, Ont.), Benjamin Barankin (Toronto), Fiona Lovegrove (London, Ont.), and Sam Hanna (Toronto) review some of the significant dermatologic treatment approvals of 2024.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.
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