Lack of specialization in black skin makes diagnoses difficult in Brazil

The small number of black dermatologists and the lack of specialization in black skin in Brazil are seen as obstacles to the diagnosis of diseases. Professionals who serve this portion of the population are usually self-taught and specialize in reading international scientific articles and daily practice.

Considered a reference in the country when it comes to doctors specializing in black skin, Katleen da Cruz Conceição, 50, had to test procedures on herself for a long time, as there were no examples and guidelines.

When she started working in an outpatient clinic, she noticed that many black patients came to her—one of them, she recalls, said that white dermatologists said that she would know how to take care of them, because she was black.

“That year, several doctors were going to a congress in the US. [Pensei] I’m going to this congress, because I feel like I’m going to learn about black skin there,” he says.

And so it was: at the event, he found a society of dermatologists who study black skin. This group, which she joined, was founded in 2004 — in the US, African Americans make up 13.4% of the population. In Brazil, where 56% of people declare themselves black or mixed race, the SBD (Brazilian Society of Dermatology) has nothing similar.

The SBD says, in a note, that it promotes activities at conferences and symposia to address more specific pathologies among people with black and pigmented skin.

Discovering these doctors in the USA awakened in Conceição the desire to dedicate herself to specialization, which made her buy all the books available on the subject abroad.

Eight years ago, she was called to run the black skin clinic at the Santa Casa de Misericórdia General Hospital in Rio de Janeiro. There he created a six-month supervised internship program in which a student sees patients. Ana Carolina Galvão dos Santos de Araujo, 27, was the first participant.

“I didn’t really know how to specifically treat black skin and the differences in clinical presentation, so I thought it would be interesting to go there”, says Araujo. In the program, she should develop research related to this group and this interested her, since there are few scientific articles available in the country.

According to Araujo, during graduation, emphasis was never given to the clinical analysis of black skin. “At university, I didn’t have anything specific, but what also happens is that, when you learn dermatology, you don’t learn everything, because it’s a very broad area.”

A 2019 study in the journal Jama Dermatology showed that black patients had greater satisfaction when they were examined by black dermatologists, particularly with regard to hair and skin care guidelines.

The participants, 18 women and one man, also pointed out that at the specialized clinics they felt better served because the professionals listened to them and educated them about their skin condition.

Empathizing with black patients and understanding the peculiarities of pigmented skin are fundamental, highlights dermatologist Carolina Alice Silva do Nascimento, 36, from Salvador.

“Looking at black skin was something very natural for me, because I was a patient before becoming a dermatologist. I went through very good professionals, but, as technically excellent as they were, looking at the pathologies and nuances that a pigmented skin needs to sometimes it was missing”, he says.

According to Nascimento, empathy comes, for example, from the professional understanding that curly and curly hair needs an extra degree of hydration and that, when the patient reports that she is using cream [para o cabelo] and he’s getting pimples on his back, the doctor can’t just tell him to stop using the product.

“She can’t stop using it because the cream is what’s hydrating her hair, so you have to adapt. I think the fact that I’m black and have the personal experience makes my look different from the beginning. “

Another issue that involves health and identity is alopecia, or severe hair loss. Depending on the dermatologist, the indication is that the patient removes the braids, while, combining treatment and thinner braids, it is possible to reverse the problem.

Carolina also remembers that there is a common sense that pigmented skin, as it has more melanin, does not need sunscreen. Is not true. Protection is necessary and prevents melanoma, a type of cancer that, the doctor emphasizes, is the most serious of all.

“In patients who have more pigmented skin, [o melanoma] has different characteristics. He appears more upright and hand, and if the doctor doesn’t examine these parts, he can let it go.”

This failure in the assessment is one of the reasons that black people, although less likely to have skin cancer —the largest organ in the human body—, are more likely to die from the disease, according to a 2016 study. published in the NCBI (National Center for Biotechnology Information).

In the researchers’ assessment, this is due to the lack of awareness, the diagnosis at a more advanced stage, and the socioeconomic barriers that hinder black people’s access to care.

Dermatologist Eliana Lopes Chagas, 50, who works in Rio, points out other diseases that are more common in blacks. “Melasma is the great champion, and the second one is nigra papular dermatosis, which are those dark little balls [no rosto]”he says.

According to her, any dyschromia (change in color) draws more attention in black than in white. Keloid (protruding scar mark), acne and the ability to blemish are also common.

“Most diseases express themselves differently in black skin: what is red in fair skin on black skin may just be shiny, so the doctor needs to have more experience to make a complete and accurate diagnosis.”

Chagas worked in many needy communities —where the majority of the patients were black— and, in the consultations, he noticed that the problems were always the same: dyschromia and complaints of spots.

She remembers that 28 years ago, when she was in college, books always dealt with the topic in an exclusive way. “They talked about what was more common in black skin in some diseases. Then you can fight to get that reference”, says the doctor, who has been specializing in trial and error and in reading material from outside Brazil.

Currently, however, she celebrates, with social networks and greater access to the internet, it is possible to find more data and professionals focused on black skin. Chagas even noticed an increase in black patients in his office after creating an Instagram profile.

“People go after me because I’m black, believing that I know how to deal with the problems that pertain to them and, by chance, I actually do,” she says.