Written by: Ashley Tibebe
Colorism is defined as the prejudiced or discriminatory treatment of typically same-race people based on skin color, favoring people with lighter skin over those with darker skin. The practice of colorism is deeply rooted in slavery, where lighter-skinned African-American enslaved people were valued and treated significantly better as house-enslaved people compared to darker-skinned African American enslaved people. In addition, at the time, lighter-skinned enslaved people were associated with higher prestige, increased social mobility, and beauty, which made lighter skin a status symbol for wealth and beauty. However, this belief of lighter skin superiority was not limited to the United States and often revealed itself in countries across the globe as more people became desperate to achieve Eurocentric beauty standards that often idealized lighter skin. It is easy to imagine that these colorist beliefs that lighter skin is more beautiful and desirable than darker skin are still persistent today and have entered a field concerned with the skin, such as dermatology. For instance, in educational curricula regarding the skin, such as textbooks, there is a severe lack of images depicting different skin conditions in people with deeper skin tones. Within the dermatology field, colorism presents issues by creating unattainable, damaging beauty standards that patients become preoccupied with adhering to, which often causes them to risk or ignore their skin and overall health. To make matters worse, like all healthcare fields, dermatology lacks a diverse workforce that can adequately represent deeper skin tones and improve issues regarding colorism. Additionally, many factors contributing to colorism in dermatology are the effects of underlying racism. Although it may not be overt, colorism exists in dermatology and affects the quality of education medical professionals receive and the mental and physical health of patients seeking to achieve unrealistic beauty standards.
One example of colorism infiltrating the field of dermatology is in skin-related educational material provided for medical students. Depending on skin tone, certain skin diseases may present differently, which becomes an issue when many academic materials do not account for this difference. To show the severity of the underrepresentation of darker skin in educational curricula, Archives of Dermatological Research conducted a systematic review of 130 clinical photos featuring COVID-19-related skin lesions and concluded that 92 percent (120 of 130) of them showed patients with very light skin tones, 6 percent of them showed patients with medium skin tones, while there were no images representing dark skin tones. This lack of representation for darker-skinned individuals can lead to misdiagnosis and possibly worsened skin health conditions. Additionally, researchers examined 4,146 textbook images from four general preclinical anatomy textbooks used in top medical schools and determined that only 4.5 percent of the images depicted dark skin tones. Especially in dermatology, where images are instrumental in diagnosis, an underrepresentation of darker skin tones can cause poor health outcomes and affects the accuracy of medical care provided for darker-skinned individuals. Furthermore, a previous study has shown that 47 percent of dermatologists felt under-qualified to diagnose skin disease on skin of color. In addition to providing evidence of the lack of adequate coursework regarding darker skin that medical professionals receive, this uncertainty in dermatologists’ ability to properly diagnose darker skin exposes the dangers all darker-skinned individuals face when visiting a dermatology clinic. Dermatologists’ being unequipped to accurately treat and diagnose a large portion of the population is unacceptable and contributes to medical neglect and dangerous misdiagnosis for people with dark skin.
Similarly to the dangers of misdiagnoses, some darker-skinned individuals are more likely to risk their skin health while attempting to achieve beauty standards influenced by colorism.
Under European beauty standards, light skin is seen as the most attractive skin tone and the beauty industry capitalizes on that colorist belief while endangering its consumers. One of the most apparent examples of this endangerment is the multi-million dollar skin-lightening product industry. Skin-lightening products are marketed to victims of colorism in dermatology as a cure for their insecurities regarding their dark skin. In fact, according to the Women’s Dermatology Society international review, an estimated 75 percent of women in Nigeria bleach their skin, which contributes to many health issues. Skin lightening products often contain mercury that can lead to rashes, inflammation, discoloration, and damage to the eyes and organ systems. Many dark-skinned people worldwide risk their eyesight, skin, and organ well-being in order to appease unattainable Eurocentric beauty standards. Additionally, this practice creates physical and mental health disparities for darker-skinned individuals as it damages people’s self-esteem and self-image concerning their skin tone. As of today, certain skin-lightening products have been banned from African Countries such as Nigeria, Ghana, and Ivory Coast. However, this measure has been largely unsuccessful since black market sales of skin-lightening products persist in these countries.
Likewise, the systemic racism present in the United States healthcare system that disadvantages minorities seeking a profession in the dermatology field furthers the influence of colorism in dermatology. Historical racial disparities and biases toward racial minorities have resulted in a workforce with a severe underrepresentation of African (Black) Americans and other racial groups who represent darker skin tones. In fact, in 2015, in a study conducted by Elsevier Inc, researchers found that dermatology ranked 35th out of 46 possible residencies for attracting a diverse applicant pool. Additionally, out of the 1,259 dermatology medical school applicants, only 7.5 percent were African American, 0.7 percent were Native American, and 8.4 percent were Hispanic, which is drastically less than their white counterparts, with 48.9 percent. In addition to creating a healthcare field with a largely culturally insensitive interaction style, a workforce that misrepresents darker-skinned patients can risk discomfort and feelings of misunderstanding while patients receive care from physicians unfamiliar or unsympathetic to colorism. Furthermore, a workforce that does not accurately represent darker skin tones causes darker-skinned individuals to become less likely to seek dermatologic care for their skin-related ailments, which results in more severe medical outcomes. This overlap between racism and colorism hinders efforts made for health awareness and equity programs and improvements in cross-ethnic understanding.
In summary, colorism, which discriminates against darker-skinned individuals while idolizing lighter-skinned individuals, has infiltrated the dermatology field and caused a multitude of issues, including underrepresentation of darker skin tones in skin-related educational curricula, creating and upholding colorist beauty standards that are impossible to achieve and dangerous to skin health, and fostering a community of dermatologic healthcare professionals who do not represent of darker skin tones and are ignorant to patients who are experiencing the effects of colorism. For these reasons, society is responsible for unlearning colorist biases to foster a community that accepts deeper skin tones. Similarly, educational institutions are responsible for diversifying their teaching curriculum to include deeper skin tones and more accurately diagnose darker-skinned individuals. If these measures are achieved, the dangerous effects of colorism in dermatology can be greatly minimized, and millions of darker-skinned people in the United States can improve their skin health and feel more comfortable while receiving dermatologic care.
Image Source: Rachel Gunawan
References:
Martin, Eva. "Colorism in Beauty Industry Endangers Women." SJSU News, 8 Apr. 2022, sjsunews.com/article/colorism-in-beauty-industry-endangers-women.
McFarling, Usha Lee. "Dermatology Faces a Reckoning: Lack of Darker Skin in Textbooks and Journals Harms Care for Patients of Color." STAT, 21 July 2020,
www.statnews.com/2020/07/21/dermatology-faces-reckoning-lack-of-darker-skin-in-text books-journals-harms-patients-of-color/.
Monk, Ellis P., Jr. "The Unceasing Significance of Colorism: Skin Tone Stratification in the United States." Daedalus, Apr. 2021,
www.amacad.org/publication/colorism-skin-tone-stratification-united-states.
Narla, Shanthi et al. "Racial disparities in dermatology." Archives of dermatological research vol. 315,5 (2023): 1215-1223. doi:10.1007/s00403-022-02507-z
"Racial Disparities in Dermatology Care." LivDerm, Derm Appeal Blog,
www.livderm.org/livderm-deep-dive-program-racial-disparities-in-dermatology-care/.
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