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Dermatology has a skin color problem

COVID-19 has created an overwhelming health care crisis in the United States and around the world. Hundreds of hospitals in the U.S. are at or near capacity treating patients with the most severe symptoms affecting their ability to breathe.

But the virus has also exposed a disparity when it comes to skin disorders and a lack of diagnosis in people of color. One international registry contains more than 700 cases of coronavirus skin manifestations, but just 34 Hispanic and 13 Black patients were involved.

Difficulties of diagnosing skin conditions

So-called “COVID toes” were one of the first dermatological infections caused by the coronavirus. While they presented as bright pink lesions on white people, they show up differently on dark skin, making them more challenging to find. Some of the other skin disorders frequently undiagnosed or misdiagnosed in people of color include:

  • Melanoma and other forms of skin cancer
  • Lyme disease
  • Psoriasis
  • Eczema
  • Kawasaki disease

Dermatology lacks diversity

While skin cancer is seen less in Hispanic and Black patients, it is more deadly and frequently diagnosed at a late stage. The five-year skin cancer survival rate for white people is 90%, but only 66% for non-Hispanic Black patients, who are much less likely to see a dermatologist.

Nearly half of all dermatologists in the U.S. say they are not properly trained to treat skin conditions in people of color. Many Black patients prefer to see Black dermatologists, who may have a greater understanding of conditions affecting nonwhite skin, but only 3% of all dermatologists are Black.

Delays and insurance denials

The U.S. has a widespread shortage of dermatologists, and some patients can wait for weeks or even months to get an appointment. Research shows that Black and Hispanic patients are more likely to go to hospital emergency rooms for skin conditions than whites. All of these factors can have serious consequences.

Another barrier is a lack of health insurance. One study shows dermatology is one of the specialties not inclined to accept Medicaid coverage. The survey found only about one out of four dermatologists were willing to take Medicaid payments, compared to nearly two-thirds of cardiologists.

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