Dercated skin dermatoses: the need for more inclusive medicine

In May. Consequently, a congress dedicated to so -called “black skins”, organized by the French Photodermatology Society, was held in May. Therefore, While dermatoses. In addition, the skin/sun relationship has so far only been, or almost, apprehended, depending on the prism of clear phototypes, it is important to focus on the darkest skin phototypes. Moreover, Objective: equality of care. Similarly, What are the specifics of dark skin? However, How to educate health professionals about these issues? Nevertheless, Answers from Pr. For example, Antoine Mahé. Therefore, dermatologist at Civil Hospitals in Colmar, expert in so-called “black” skins and initiator of the university diploma “Medicine of diversity” at the Faculty of Medicine in Strasbourg (Bas-Rhin).

“Black skins”, scientifically what does this term mean? Furthermore,

Pr. Furthermore, Antoine Mahé : The Title Black Skin dercated skin dermatoses: need more is misleading. Therefore, It is just dark because it is rich in melanic pigment which is brown in color, not “black”. For example, Scientifically, the term “black skin” is therefore not valid. In addition, there is no formal distinction between two types of skins, “white” and “black”, it is actually a continuum. In addition, In dermatology, what matters is therefore the degree of pigmentation. Moreover, There are 6 phototypes: phototypes 1 to 3 concern clear skin, 4 to 6, dark skins. Similarly, Whether the skins are dark. However, very dark, the problems are the same, once again causing the terminology of “black skin” once again, which remains devoted by use – including in medicine.

However, dark skins have specificities? For example,

One of the major specificities of dark skins is the importance of secondary pigment disorders. Therefore, A dermatosis like acne on a clear phototype manifests itself by redness dercated skin dermatoses: need more and “pimples”. In addition, But in dark phototypes, 4,5,6, dark spots are found in the foreground. For example, Because these skins synthesize much more pigments in the event of inflammation, inflammation that is found in acne. Furthermore, This changes conventional symptoms, in any case essentially described by European or North American specialists and works. Therefore, Secondary pigment disorders are not part of the symptoms described since they are nonexistent in clear skin. Nevertheless, We are not faced with the same symptomatology and not knowing it can harm the diagnosis.

And that will also change the care?

Yes, absolutely, because the management is focused on this due to the priority demand for patients concerning this parameter! Nevertheless, It is essential to treat pigment disorders while classic treatment, for clear skin, does not take into account. In addition, there is a poor understanding on the part of the caregivers of these pigment dercated skin dermatoses: need more disorders. Therefore, When we look at the gradation scales of severity of acne. pigment disorders are considered as sequelae, scars, which would mean that there is no longer much to do at this stage. But the pigment disorders of dark skins are in fact correlated directly to inflammation and are therefore not scars. Treaty with the right medication, inflammation disappears and pigmentation disorders with, without using more or less well tolerated depigmentants.

Dercated skin dermatoses: need more

“One of the major specificities of dark skin is the importance of secondary pigment disorders.”

Do we find these pigment disorders in other dermatoses?

The most frequent chronic diseases are accompanied by pigmentation disorders. Atopic dermatitis. psoriasis are also accompanied by pigmentation disorders which are not taken into account in the usual scales and are therefore not treated. However, we begin to evoke these symptoms in a few rare studies, but dercated skin dermatoses: need more we are still at embryonic stage.

And can these pigmentation disorders have a psychological impact, linked to stigma?

Yes of course. Let’s talk about vitiligo, obviously much more stigmatizing because it is much more visible on black skin. And the new treatments. in particular anti-jak creams, are considered to be effective, but here again there is almost no data on their action on the darkest skin, while these treatments have been widely studied on clear skin. On a phototype 2. an 80 % efficiency will be completely acceptable because the vitiligo will be almost invisible, but on dark skin, it is 100 % efficiency that we are looking for, not 80 %!

And what about skin cancers? Are there also differences there?

First of all, you should know that the melanin of dark phototypes is a very good protector against skin cancers. The closer the skin, the less dercated skin dermatoses: need more skin cancer. This is why sun protection does not have the same challenges on dark skin or on clear skin. On clear skin, protection against skin cancers is a priority. On dark skin. it will rather be protection against dermatoses pigmentation in order to prevent light from stimulating the synthesis of pigments. And you should know that the spectrum of light which stimulates pigmentation (visible light) is not the same as. that which is responsible for skin cancers (UV rays). So. we will not use the same solar creams to protect ourselves from the sun depending on whether you have a clear phototype or a dark phototype.

Dercated skin dermatoses: need more

“Faced with a patient with a dark phototype, the doctor who is not used to it may encounter difficulties in making the diagnosis due to pigmentation, in particular because redness is less visible.”

So melanomas dercated skin dermatoses: need more do not exist in dark skin?

They are rare and when melanoma occurs, it is very often at the level of the soles of the feet. And they are often serious because there again. there is an ignorance on this subject and these skin cancers are detected at an advanced stage with sometimes metastases, in particular due to a general ignorance of this pathology, especially on the part of the populations concerned. Specific information of these populations would be welcome.

Can there also be prejudices on the part of caregivers?

When you have no knowledge of the specificities of a certain type of population, certain prejudices sometimes come into account. Thus. faced with a patient with a dark phototype, originally from an African or West Indian country, the doctor who is not used can encounter difficulties in making the diagnosis due to pigmentation, in particular because redness is dercated skin dermatoses: need more less visible. Messers, for example, is more difficult to diagnose. This caregiver can also be influenced by the works he has read on tropical medicine. immediately evoke an “extraordinary” diagnosis, like a leprosy or other, which would actually be rare or even exceptional. There will be a tendency to overvalue the importance of tropical diseases. Yet current pathologies are the same. regardless of latitudes: acne, eczema, psoriasis…

Is there not also a problem with learning works whose iconography is essentially centered on clear skin?

Yes, there are specialized works but in general learning works, dark skins are very little represented. Consequently, how, for doctors to recognize clinical signs when they have never been confronted during their studies? In the United States. a study was conducted on the representation of people with dark skins in medicine books and they found it only for exotic pathologies … or STIs! And not dercated skin dermatoses: need more at all for cancer pathologies. And this is obviously likely to create a cognitive bias among students.

Dercated skin dermatoses: need more

“Our approach ultimately aims, completely legitimately, to a universality of the quality of care.”

Is it training that poses a problem?

Dermatology on dark skin is not more complicated than dermatology on clear skin but knowledge is not innate. Important point, which is true for dermatology is also for many other areas of medicine. An example with pulse oximeters that measure oxygen saturation. We now know that there is an interaction between melanin. the infrared that distorts the data, which involves the risk masking hypoxemia (decrease in the amount of oxygen in the blood). So you have to learn and know it. And it is also necessary that the effectiveness of these pulse oximeters is tested on dark skin.

It is for this reason that dercated skin dermatoses: need more you have implemented the DU of diversity medicine in Strasbourg?

Yes. as we have just seen with the oximeter of pulse, we can decline dermatology on “black skins” to other medical specialties. Another speaking example is that of the physiological figures of neutrophils, white blood cells that fight against infections. There are global standards, established from a Western average. But it turns out that in a significant proportion of people from sub -Saharan Africa. the Middle East, physiological figures are significantly lower, 30 to 40 % less. If an unsected doctor analyzes blood test, he will diagnose neutropenia. He will seek the cause while the patient’s condition is normal. But this can lead to even more serious consequences because neutropenia can be induced by chemotherapy. So we will lower the dose of chemo. or even prevent the cure, in these patients who do not suffer from neutropenia! It has been dercated skin dermatoses: need more shown in an American study that African-American women had a less good prognosis in breast cancer. due to doses of attenuated chemotherapy. There are necessary scales of adaptation of the different doses. And examples like that, there are others! And this is precisely this that is discussed in the courses of this.

If the general similarity of medicine indifferently of the populations remains of course the norm. a ignorance of the specificities of which we have spoken, as well as others, indeed involves in an unptly questionable way a risk of defective care. Our approach ultimately aims, completely legitimately, to a universality of the quality of care.

Note: For Pr Mahé. “il It seems as important as caregivers are made aware of a large -scale trend, which consists in certain populations to cleare the skin using dangerous products, often creams based on corticosteroids which are very powerful. We must be dercated skin dermatoses: need more able to take care not only the complications. dermatological, which are multiple, but also systemic, such as a impact on the balance of a diabetes, or hypertension … so you have to think about it, ask the question to treat well.”