April Reding started finding painful, walnut-sized boils on her armpits and in her groin during her teenage years, an outbreak that stressed her out and made it difficult to sleep. Dermatologists gave her confusing diagnoses and ineffective treatments as the lesions continued to grow and burst.
That ended when Reding, now 34, started seeing Dr. Oma Agbai, a UC Davis dermatologist who specializes in patients with non-white skin tones. Agbai was able to identify the rare chronic condition hidradenitis suppurativa, which is found more commonly in African American women. She came up with an aggressive treatment plan that includes steroid injections and a new pill prescription called Accutane.
“It makes a huge difference,” Reding said of dermatologists trained to work with African American women. “You can really be honest in telling them what works, and they’re really responsive.” For one thing, she said, Agbai listens more closely to her than any doctor she’s seen before.
Agbai is part of a new wave in dermatology offering services to people with diverse skin tones. A member of the American Academy of Dermatology’s Skin of Color Society, Agbai began advertising her multicultural dermatology practice at a UC Davis clinic in East Sacramento this spring.
Skin structure varies from person to person, Agbai said, and a condition that looks a certain way on a white person can look completely different on someone with tan, brown or black skin. If a dermatologist isn’t trained in that range of presentations, he or she might take longer to diagnose a patient, which can result in less-effective care.
“You look in your textbook, you look up psoriasis, most likely you will see it in a very light skin type,” she said. “There’s nothing wrong with that – it just happens to be what that textbook offers. But it’s important to look at the images when you’re studying, and look at a wide spectrum of skin types.”
Multicultural dermatology is growing more prominent as physicians anticipate a shift in racial demographics. California is already a “majority minority” state, meaning more than half of residents are non-white. By 2044, people of color will represent over half of the U.S. population, increasing the demand for trained experts in pervasive skin, hair and nail disorders, according to the Skin of Color Society.
You look in your textbook, you look up psoriasis, most likely you will see it in a very light skin type.
Dr. Oma Agbai
Dr. Susan Taylor, founder of the society, said in an email that the field has come a long way over the past decade.
“Unfortunately, the general awareness was poor,” she said. “It has been rewarding to see the progress with many programs as well as conferences offering specific courses devoted to skin of color concerns.”
This spring, Agbai began offering a special lecture series to UC Davis dermatology residents to teach the importance of considering skin color in clinical care. She hopes that in the future, all dermatologists will be equally qualified to treat all patients – regardless of ethnic background.
Some skin conditions are particular to people of certain ethnic backgrounds. Pseudofolliculitis barbae, for example, is a form of skin irritation that occurs after shaving, especially in people with very textured or curly hair. It is much more common in African American men than white men, Agbai said.
Some forms of skin discoloration, such as post-inflammatory hyperpigmentation and melasma – both of which result in dark spots or patches – are more common in people of color.
Though people with darker skin are at lower risk for skin cancer than whites, studies shows that doctors catch it in patients of color much later than they do in white patients. The Skin Cancer Foundation reports that 52 percent of black patients and 26 percent of Hispanic patients receive an initial diagnosis of advanced stage melanoma, compared with 16 percent of white patients. The estimated five-year melanoma survival rate for black patients is 70 percent, compared with 93 percent for white patients.
That may be because some people with dark skin are less likely to take precautionary steps such as applying sunscreen and seeking out skin cancer screenings, Agbai said. While people with darker skin might not get wrinkles, they are susceptible to photo-aging, or dark, patchy spots that develop with too much sun exposure over time.
“People of color don’t wear sunscreen as much as they should because they don’t think they can get a skin cancer that’s sun-induced, or they don’t think there’s anything they can do to prevent skin cancer,” she said. “This is a misconception that needs to be corrected.”
Agbai gives her non-white patients recommendations for sunscreens that work well with their skin tones, especially with some mainstream brands causing an ashy or chalky look on dark skin, she said. She recommends that people of all colors wear sunscreen with an SPF of at least 30, and that they reapply the sunscreen every two hours and within one hour of exposure to water.
“It’s really important for patients of color to realize that everyone needs to protect their skin from the sun regardless of race, color or age,” she said.
How to spot skin cancer in dark skin
There are three types of skin cancer – basal cell carcinoma, squamous cell carcinoma and malignant melanoma – and each can appear differently in people of color than those with lighter skin tones.
Basal cell carcinoma can appear as a dark or brown spot on a sun-exposed area of the body, such as the face, neck or hands. The spot may not seem to heal, or it may bleed or feel sore to the touch.
Squamous cell carcinoma doesn’t just occur in sun-exposed areas of the body. People with dark skin may notice a crusty bump on their face or head, or they may discover a slow-healing ulcer on their legs or even in a covered area such as the genitals.
Melanoma: In people with darker skin types, melanoma can appear as pigmented or dark spots on sun-exposed areas of the body, including on the bottom of the feet, the lips or even inside the mouth.
Dr. Oma Agbai