How My Skin Condition Was Finally Diagnosed
This story is a part of The Melanin Edit, a platform in which Allure will explore every facet of a melanin-rich life — from the most innovative treatments for hyperpigmentation to the social and emotional realities — all while spreading Black pride.
Black is beautiful.
This phrase is echoed in Black households, rooted in the broad embrace of Blackness in America in the late 1960s; really, it's a cultural movement more than a phrase. It’s whispered by Black mothers to their babies, reminding them that their Blackness is good, is worth celebrating, that the melanin washed over their skin is so much more than the radical statement some people take it to be. To exist as a Black person, particularly in America, can feel at times like an act of civil disobedience. It can often feel like the powers that be would like to ignore how our melanin makes us different, and that is true even in dermatology.
After years of learning about and having my own experiences with medical racism, it wasn't a surprise to find that, historically, identification of conditions on darker skin tones has not been included in dermatology training, which has led to misdiagnoses and a large assortment of other issues. Many skin ailments can appear differently in more melanated skin. More often than not, changes in darker skin tones caused by a skin ailment can be signified by hyperpigmentation, the darkening of skin that occurs when an excess of melanin forms deposits in the skin, or the opposite, hypopigmentation, which is the lightening of skin due to a reduction in melanin production. Changes in color can also occur naturally in patients with darker skin, so it can be difficult to tell normal from abnormal, especially if a provider does not have much experience with Black patients and patients of color.
“In the past, there was no specific training focused on brown skin, and as a result the dermatologists who are most skilled to treat brown skin were those who had either trained in large, urban areas or those who had personal experience because they themselves had pigmented skin,” Crystal Aguh, a board-certified dermatologist at Johns Hopkins, tells Allure. “In fact, most images featured in dermatologic textbooks focused on patients with only fair skin. This drastically limited the number of dermatologists who felt comfortable treating conditions in those with more pigmented skin tones.”
As a result, many dermatologists still aren’t familiar with facts about dark skin, like how redness and inflammation tend to look more deep pink or purplish in hue instead of the bright orange, fiery red you see on lighter skin, or how difficult it can be to distinguish between light hypopigmentation and complete loss of color in the skin. And of course, it’s not just about the physical: “The psychological aspect of color loss is much greater in patients with darker skin because it can be so obvious that people may comment on the change in a public setting,” says Shauna Diggs, a Michigan-based board-certified dermatologist.
When treating any of these conditions, seek assistance from a board-certified dermatologist trained and experienced in diagnosing and treating skin of color. “Currently, we are seeing more effort from multiple dermatologic societies to increase the representation of images in dermatologic textbooks so that more dermatologists feel comfortable identifying conditions in a range of skin tones," say Aguh. "Additionally, more and more training programs have developed skin of color centers to address disparities in care.”
Beyond representation in the medical field, representation and visibility in all forms of media can help people with similar conditions find community, and the encouragement to seek treatment can lead to more diverse medical knowledge for everyone. Below, we talk to seven Black women with a wide range of skin conditions, including acne, keloids, keratosis pilaris, and a lot in between, about their Black skin, the path to diagnosis, and what makes them feel like their Blackness is beautiful.
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