Training the Eye to See Disease On Dark Skin

By Maria C. Hunt | | June 22, 2022

Dermatologist Jenna Lester stands in the garden outside the medical building on the Parnassus Campus of UCSF.

Jenna Lester founded the UCSF Skin of Color Program to improve dermatological care for people with dark skin, whose images are often excluded from training literature. Photo: Sarahbeth Maney

Jonas wears the close-shaved natural hairstyle that’s on-trend for many Black men. He’s been styling his hair this way for years, but during the pandemic he noticed, a few days after each shave, some spots on his scalp that hurt or even bled a little. When the pain and bleeding started to spread, he searched for Black dermatologists and found Jenna Lester, MD. “I wanted someone that had familiarity with my skin,” he says.

Lester directs the Skin of Color Program at UC San Francisco, which includes a training clinic that specializes in treating dark skin. There are just a handful of such clinics across the country, and Lester’s is the only one in Northern California.

Dermatologist Jenna Lester looks over a male patient

Jenna Lester, MD, an assistant professor of dermatology at UCSF, treats her patient, Geoffry Blair Hutto. Photo: Barbara Ries

Sporting pink glasses, black Nikes, and a white lab coat, Lester greets Jonas with the warmth of an old friend. She listens to his concerns and then asks a series of detailed questions: What kind of razor do you use? Any creams or lotions? How about aftershave? When you shower, what kind of soap do you use? Do you have a rash anywhere else? What have you tried to resolve this?

Soon enough, she determines the cause of his ailment: Pseudofolliculitis barbae. Also known as ingrown hairs or razor bumps, the condition is especially prevalent in Black people. “We have curly hair,” Lester explains to Jonas, “and so our hair can lose its way as it’s about to erupt out of the skin,” leading to inflammation. She swabs his scalp for a lab test and recommends a treatment plan that includes washing his head and then applying benzoyl peroxide, an antiseptic. If that doesn’t help, she tells him, he might have to consider giving himself a less close shave in the future.

People of color often seek out specialists like Lester because they’ve been misdiagnosed in the past or suspect their doctors are missing something. They’re right to be skeptical. In a survey of U.S. dermatologists, nearly half said their training left them feeling unqualified to diagnose disease in Black or brown skin.

Some skin conditions show up on different parts of the body or look different on light and dark skin. White people, for instance, tend to develop melanoma on their chest, face, or back. For Black people, melanoma often first appears on their palms or the soles of their feet or as a dark stripe down a fingernail. Other examples include psoriasis, dermatitis, and COVID-19 rashes, which look pink or red on light skin but can be purple or brownish on dark skin.