Doctors must get better at diagnosing patients with darker skin: dermatologists

About a month ago, a frustrated Emma Schmidt turned to Google for help. The 28-year-old Regina teacher was tired of the acne-related dark spots on her face. A few keystrokes later, she found a remedy: a dab of lemon and honey on each spot before bed each evening.

But she managed to stick to the routine for only a couple of days before she developed painful sores.

"I was panicking," Schmidt said. "I pretty much killed the first layer of skin."

Schmidt said the doctor she consulted for her acne five years ago didn't seem to know how to treat her black skin.

"We didn't talk about spots or how to prevent them," she said.

The spots that Schmidt developed are common in patients with acne and can be treated by dermatologists who have training in treating dark-skinned patients. Schmidt's experience highlights mounting concern that Canadian doctors don't know enough about the special needs of dark-skinned people.

According to the 2016 Canadian census, more than 7.5 million people belong to a visible minority such as South Asian, Chinese or black, and the number is steadily growing. Yet many doctors appear unaware that visible minorities are at much higher risk than Caucasians of some skin conditions, ranging from relatively harmless dark spots to more serious problems, like late-stage melanoma. Dermatologists are urging family doctors and others to learn more about these conditions.

The approach to dermatology has been one size fits all.- Mitchell Shannon

Mitchell Shannon, head of the Chronicle Companies, which organize an annual conference on skin ailments in people with different complexions, confirms Schmidt's concern.

"The approach to dermatology has been one size fits all," he said. "Health-care providers know that's not the case."

'In dark skin, it doesn't look red'

The symptoms of skin conditions in patients with darker complexions are often different from those who are white, said Dr. Bolu Ogunyemi a resident in dermatology at the University of British Columbia. For example, doctors are typically trained to look for redness as a sign of skin inflammation. Yet black and other dark skins mask lighter colours, such as red.

"In dark skin, it doesn't look red," said Dr. Ogunyemi, a Nigerian-Canadian who has received special training in London for skin conditions in patients with darker skin. "Sometimes it can have a purple hue. Sometimes it can look brown, like the rest of their skin colour," he notes.

If a doctor is unfamiliar with the symptoms of inflammation in darker skin, it can mean an incorrect diagnosis, with potentially serious consequences, said Dr. Marissa Joseph, a pediatric dermatologist at Sick Kids Hospital in Toronto.

Dr. Joseph has treated many dark-skinned children who turned out to be suffering from eczema after being diagnosed as simply having dry skin.

"It's really inflamed and it causes a lot of problems for the child," she said.

Skin cancer misconception

The condition is severe enough to disrupt sleep and can develop into a skin infection if it is left untreated.

Doctors can also miss lethal skin cancers in visible minority patients. One reason is a common misconception that these patients don't get skin cancers.

"That's simply not true," said Dr. Joseph. "They get it to a lesser degree, but still can get it."

Doctors may also not be looking in the right places. In white patients, potentially deadly melanomas tend to show up on the torso, limbs and face, but in people with darker skin they are often found in fingernails, soles of the feet, and hands.

Dr. Ogunyemi published a review last year highlighting the inadequate training that doctors receive to identify and treat skin conditions in dark-skinned patients.

There are signs, however, of change. Resident physicians are now encouraged to do elective rotations in neighbourhoods with diverse populations, said Dr. Kerri Purdy, director of Dalhousie University's dermatology training program.

A growing number of practising physicians have signed up for the annual Skin Spectrum Summit conferences put on by Shannon's company in Toronto, Montreal and Vancouver. More than 130 people registered for the latest conference in Toronto earlier this month.

The hope is that as more doctors learn about darker skin, patients like Ms. Schmidt will have less to worry about. Her sores have healed, and she's been advised to see a specialist with expertise in her skin type. She's now hopeful that the spots can be treated, when just weeks ago she wasn't.

"I thought they were scars and no one can help me," she said.

Dr. Tola Afolabi is a plastic surgeon and reconstructive surgeon praticising in southwestern Ontario who is also a fellow in global journalism at the Munk School of Global Affairs at the University of Toronto.