This story is a part of The Melanin Edit, a platform in which Allure will explore every facet of a melanin-rich life — from the most innovative treatments for hyperpigmentation to the social and emotional realities — all while spreading Black pride.
More than 13 percent of the U.S. population is made of people who identify as Black or African American — but only about 3 percent of U.S. dermatologists consider themselves to be a part of that group, according to a 2016 report published in the Journal of the American Academy of Dermatology. The result: A wide swath of the population isn't always getting the proper care for skin, hair, and nail conditions.
Let's be clear: All dermatologists should have the education to treat any skin they come in contact with. However, with such a small part of the dermatology population being people of color, the textbooks, research, and drug trials are controlled by the majority.
For The Melanin Edit, Allure wanted to sit down for a conversation with the dermatologists working to change this reality. Valerie Callender, Chesahna Kindred, and Michelle Henry are all board-certified dermatologists with between 10 and 30 years of experience. They are all very involved in teaching the next generation of dermatologists as well as leading professional organizations like the Skin of Color Society and the National Medical Association dermatology section. Howard University College of Medicine medical student Micah Brown and SUNY Downstate third-year dermatology resident Cula Dautriche also joined to give us a view into what the future of the field could be.
While the world is lasered in on the treatment of Black people, it's clear from our conversation that dermatology — just like the criminal justice system — still has a few steps to take to reach equality for all. However, these five women have already seen changes for the better in the last year and they are each fighting for even more Black voices to be heard.
Allure content director Jessica Cruel: The first thing I want to talk about is perception. I grew up in a small town in the South and both my parents are doctors, but I never saw a dermatologist until I became a beauty editor. I think there's still a lot of fear among Black people of even going to the doctor. I would love to hear some of your thoughts about how the Black community perceives the field of dermatology?
Chesahna Kindred, a dermatologist in Columbia, Maryland: Well, part of what we're seeing is the aftermath of the historical context. Dermatology was considered a luxury and Blacks simply did not have access to it. So as a result of not having access, when a Black person finally did see a dermatologist, usually a white one, the white one wasn't even trained appropriately on our hair and skin.
And even to this day, there's inappropriate treatment of skin of color. Then Black people get the sense that, well, they don't really know my hair, they don't really know my skin. And they're like, "Well, a dermatologist isn't really for [me]." And I think that's also a reason why so many concoctions and myths are so widely present. One very obvious case is the rampant hair loss in the Black community and hairstylists are still considered the hair expert because they played that role for centuries.
Cula Dautriche, a third-year dermatology resident at SUNY Downstate Medical Center: I also feel like there's a lack of education in our community on what exactly dermatologists do. A lot of patients that come to me have problems with their nails and, "Oh, I didn't know I was supposed to see a dermatologist for that. Well, you guys do hair stuff also?"
Cruel: Dr. Kindred, when you said that seeing a dermatologist is a luxury, I really thought about that, because I think the perception in the community is that, Oh, dermatologists do Botox so I don't need that. Therefore, why would I go see a dermatologist? But you're right, there's a disconnect between the actual care and conditions that can be treated by a professional that's not a hairstylist or your aesthetician or your auntie's Vaseline.
Micah Brown, a medical student at Howard University College of Medicine: Cocoa butter.
Kindred: Vaseline. The most popular dermatologists do cosmetics, but the most common dermatologist does medical dermatology. So there's a misconception there too.
"Dermatology was considered a luxury and Blacks simply did not have access to it."
Valerie Callender, a dermatologist in Glenn Dale, Maryland: Most of us do both. And so you can see your patients as a medical dermatologist, but then when they do say, "Oh, I saw something on TV about getting rid of these laugh lines. Do you know anything about that?" Who're they going to trust? They're going to trust the dermatologist who had been treating them for eczema or psoriasis or seborrheic dermatitis or hair loss.
Brown: For so long Black people have had anxiety about going to the doctor. So it definitely starts off with a culturally competent physician. And that starts with medical school education. Even now when I do question banks and things like that, all of the pictures are of white skin or lighter skin. And it's hard because if you want to go into an area and serve an area where there are a lot of Latinos or African-Americans, you're kind of at a disadvantage because you're only seeing white skin [in the textbooks].
Cruel: So that segues into my next question. And this is for Cula and Micah, do you feel that in your education you are being served the appropriate information for darker skin tones? That your classmates who are not brown or Black, are getting the right information to be culturally competent, based on the curriculum not based on you going outside and seeking mentors and things like that?
Brown: I'm lucky to be at Howard where that's their goal. And they really drive that home. You need to know what certain things look like in certain types of skin tones and things like that. I actually just published a book chapter in the ethnic skin textbook with Dr. Kindred.
Dautriche: The majority of the patients that we serve [at my hospital] are underserved. But there is a disconnect between the textbook and the patient population that we see. Because of that dichotomy, all the residents [in my program] are more culturally competent because, even if the book is showing type one or type two skin, the majority of your patients are type five. Over your three years by just the clinical expertise, you're kind of just trained to recognize [conditions in different skin tones].
Brown: I agree with Cula. At Howard, we get doctors giving us talks about eczema in darker skin and things like that, which is a blessing. But then we have books that we're supposed to be looking through to help us study for these board exams that we have to take and it's all white skin. In 2021, this is unacceptable. You think we're progressive, but then when you really look at it all, it's like, "How much has it really changed?" because the books are still the same.
Michelle Henry, a dermatologist in New York City: To have a lot of the textbooks tell it, we [Black people] only suffer from syphilis, lupus, and sarcoidosis.
Callender: Every picture of an ulcer or herpes was on a Black man's penis.
Brown: That's true. Yep. Absolutely.
Henry: Then I was in residency, we were studying for the boards and they put up a Kodachrome — what we call these photos that we do teaching around. It was a Black person, and I think it was… it may have been discoid lupus or something. And then [someone] said, “Well, something that helps you is that if it's a Black patient, you know it's either syphilis or lupus.” I was just floored. I was the only Black person in the program. At that point, I wasn't courageous enough to stand up for myself and say, “This is obscene.” But I really never forgot it.
Brown: Right, the textbooks are very strategic in what they're putting out, but at the same time it's the people that are providing these resources and the other dermatologists that are teaching this. I'm like, it doesn't take much to look up something. If I'm going out of my way to look up other things in skin of color, then these white dermatologists can do the same and start teaching those.
Kindred: We have to have publishers and editors of journals and textbooks that say this is unacceptable. As long as they're willing to publish garbage, we'll be teaching and learning garbage. They have to be the ones that say, "Your photos are not diverse enough," or "Actually, your article is racist."
When those people in a decision-making capacity adjust, we'll see change. So no matter how many med students like Micah try to learn on their own, everyone won't learn it until it's in the text. If you get the text-maker to make it unbiased, then people will study what's unbiased.
Cruel: Dr. Callender and Dr. Kindred, what was it like for you all? If, in 2021, we still don't have textbooks with Black people in them, when you all were first coming out of school and going into residency, how did you make sure to have that information to serve the communities that you now serve?
Kindred: Well, we were spoiled. We trained at Howard. Part of the discussion at Howard's department of dermatology is, okay, this research article says this, but what are we seeing in the clinic? How is what we're seeing in Blacks different? Like we're taught scientifically and intentionally and didactically on all skin, especially where Blacks fall through the cracks.
Callender: Howard was a wonderful environment for medical school, for residency, and I'm so glad and happy that that's where I trained. But knowing about Black skin was always an issue because I didn't do a fellowship after I finished my residency. I went right into private practice in the D.C. area. And what I found was, medications and treatment modalities were always studied in white skin. They didn't really have Blacks as part of the research protocol, so we were kind of always doing our own research by just saying, "Oh, wow! This Retin-A just came out on the market. It's tearing up white skin because they want to peel and do all that stuff for their wrinkles and everything. But how is it going to act on Black skin? Brown skin?"
I mean, we don't know. They didn't study us. So we would have to do our own clinical trial just by giving a patient a prescription and seeing how they would do, and be ready on the phone in case they needed us because it just burnt their whole face up. We had to find ways to take those medications and use them safely on brown skin.
So, for example, with Retin-A, we couldn't write the highest strength, we could only do the lowest strength. We always had to combine it with hydrocortisone cream. That's the way you did it. But things are moving. They're studying conditions in our skin type, and we're actually the principal investigators now for these pharmaceutical companies.
"We have books that we're supposed to be looking through to help us study for these board exams that we have to take and it's all white skin. In 2021, this is unacceptable."
Cruel: Speaking of pharmaceutical companies, I did want to talk about research since I think that is so important. There's still a fight to be the lead researchers on these trials, and things like that. Is it just because they don't know who to call? Why do you think they are so hesitant? Is it hard to find participants because there are only so many Black dermatologists?
Callender: There are not many of us who'll leave our practice, because you take a pay cut when you leave your practice to go educate and represent your university. Those of us who do it, we kind of know how to network and get us all involved, and say, “Well, I can bring in about 15 patients, but this dermatologist, she can bring in about another 15 with skin of color.”
Because pharmaceutical companies, if they don't get that representation in their study, as far as their subjects and the demographics, their drug may only be FDA-approved to treat that portion, those white patients, and then they'll say, "Oh, it wasn't studied enough. There weren't enough Black patients, so it's not really recommended for Black patients. So we still have to fight."
Kindred: What they're faced with is this: If a Black patient isn't going to go to Dr. Joe as a patient, they're definitely not going to go to him as a study participant. But that's who's being picked to run these clinical trials. Black dermatologists have the built-in trust, so we need to be the principal investigators.
Cruel: For those of you who have been practicing for some years, I would love to hear how you think things have changed in the time that you have been practicing, particularly for your patients of color.
Callender: I finished my residency in 1990, 30 years ago. So things are definitely different. When I first started in private practice, everything was strictly medical. I mean, any type of cosmetic procedure really wasn't even thought about at that time. We did a little collagen as a filler or we did large grafts for hair transplants. We even did a little liposuction in the office.
Now women are into their skin, they're into their hair, they're into fillers and lifting and they want to do everything and now they have the money. For a Black dermatologist treating Black patients, it wasn't what we did. We did vitiligo, we did eczema, we did hair loss, but now it's just totally different. Everything is cosmetic. They're reading Allure magazine and they're looking at how they want to look and they want products just like white girls.
Henry: My consult has changed significantly from when I first started, for sure, because you're dealing with a smarter, more active patient, which is good for both me and the patient because they have better expectations. I think that my Black patients now understand that they deserve all the things that white patients have and that beauty and that empowerment that comes with changing something you don't like is not something reserved for white women.
So if they want a laser and I say it's not as safe for brown skin, they don't just sink into their chairs. They're like, "Why? Why is there not one for brown skin? What can we do instead?" Once upon a time, they would just resign themselves to like, "Okay, I get it." I think the market is changing because of that pressure, because we are flexing our muscles a little bit, our financial muscles, and we're educated in the space. I think the industry is understanding that this is an untapped market that they’d better wise up to or they're going to miss out on it.
Cruel: What changes do you think we still need and what does the future look like? What can we do to make it even better for those coming up?
Henry: I think that medical students now are feeling more empowered and realizing that if we have a seat at the table, we need to use that seat. I'm really encouraged by how readily people are willing to use their voice. When I was a medical student, I was probably a little bit more shy, and so it's very heartening to me to see [the younger generation] speak up and ask questions. Now it is seen as the public health crisis that it is, which I think is one of the most powerful things that has happened over the past year or so. I think that a lot of these companies also are being forced to have these diversity and inclusion boards. My concern was that a lot of it was going to be lip service, but it seems like it's not. It seems like people are trying to make a sincere change.
Brown: 2020 and 2021 taught me and my classmates that we do have a voice and we are powerful. There are a lot of physicians who are where we want to be, who are willing to mentor us and willing to sow into us positivity and support and knowledge. So, I'm excited. I'm excited about how things are going to look in a year when I'm trying to get into dermatology. But, like Dr. Kindred said, we really need to put ethnic skin at the forefront of research. And it starts with us being in the room.
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