Dermatology depends on visual assessment, yet clinicians often lack precise vocabulary to characterize skin colour and instead rely on race, ethnicity, and crude classification schemes. These proxies flatten nuance, obscure underlying contributors to disease, and compromise patient care. Race and ethnicity are social constructs without biological determinism, but they are routinely used in clinical trials and care guidelines, producing misinterpretation of data and masking causal factors. Race-based corrections in clinical algorithms can systematically misestimate health measures, delaying care. Conflating pigmentation with race leads to biased clinical decisions, including underestimated pain in Black patients and inadequate management.
Dermatology is a profoundly visual specialty. Diagnoses are rooted in the observation of hue and pattern. Yet, despite our reliance on these visual cues, dermatologists lack the ability - and vocabulary - to meaningfully characterize one of the most defining human features: skin colour. Instead, we have relied on proxies such as race, ethnicity and a crude skin-classification scheme. These frameworks are deeply entrenched and seriously flawed. They flatten nuance, obscure true contributors to disease and ultimately compromise the provision of care.
Race and ethnicity are social constructs, not rooted in biological fact. Yet these categories are routinely included in clinical trials and embedded in care guidelines. This leads to misinterpretation of data and failure to identify the factors that contribute to disease - not only in dermatology, but also in other fields. Race-based corrections in algorithms that estimate kidney health, for example, lead to the systematic overestimation of kidney function in Black people, delaying referrals and reducing transplant eligibility.
Skin colour, which is often perceived as the physical embodiment of race, is conflated with race itself - even though pigmentation varies widely in racial categories. These ideas can influence clinical decisions. One study found that medical trainees who endorsed false beliefs about biological differences between racial groups were more likely to underestimate pain in Black people than in white people, leading to inadequate pain management for Black patients.
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